Prevalence and factors associated with malaria in households following scale up of integrated community case management of malaria in Kiruhura District, Western Uganda

Abstract

Background: Malaria remains a major public health challenge in sub-Saharan Africa, with a disproportionate burden in rural Uganda. Despite national adoption of integrated community case management implemented through Village Health Teams to improve early diagnosis and treatment, several districts continue to report high malaria burden. This study assessed malaria prevalence and examined household-level factors associated with malaria risk following scale-up of integrated community case management in Kiruhura District, western Uganda. Methods: mixed-methods cross-sectional study was conducted among 327 households registered under integrated community case management between September 2022 and August 2023. Quantitative data were collected using structured questionnaires and analyzed to estimate malaria prevalence and associated factors. Bivariate and multivariable logistic regression analyses identified factors independently associated with malaria, with results reported as odds ratios and 95 percent confidence intervals. Qualitative data were collected through key informant interviews and Focus Group Discussions involving 15 purposively selected stakeholders and analyzed thematically to explore experiences with integrated community case management implementation. Results: A total of 327 households were surveyed across Kiruhura District under the ICCM intervention, achieving a response rate of 98.4%. The majority of households were located in rural areas, with a mean household size of seven individuals. Overall, 410 malaria episodes were reported, corresponding to a prevalence of 26.7% among residents of ICCM-supported households, while 10.1% of households experienced at least one malaria episode during the reference period. Children under five years accounted for 74.8% of reported cases, indicating a disproportionate burden of malaria in this age group. In multivariable analysis, the presence of vegetation near households was associated with increased malaria risk (AOR = 1.17; 95% CI: 1.02–1.34). Conversely, use of long-lasting insecticide-treated nets (AOR = 0.66; 95% CI: 0.48–0.91) and seeking care from public health facilities (AOR = 0.74; 95% CI: 0.66–0.83) were independently protective. Conclusion: Malaria remains highly prevalent in ICCM supported households in Kiruhura District. Efforts to reduce household malaria burden could focus on strengthening the supply chain for ICCM commodities, improving VHT support and motivation and enhancing community education on effective malaria prevention practices, such as the proper use of LLINs.