Evaluating the effectiveness of seasonal malaria chemoprevention in reducing under-five malaria incidence in Karamoja, Uganda using generalised linear mixed models

Abstract

Background: Malaria remains a major public health challenge in Uganda, particularly among children under five years. Seasonal Malaria Chemoprevention (SMC) is a recommended intervention to reduce malaria incidence in high-transmission areas. This study assessed the effectiveness of SMC in reducing malaria incidence among children under five in the Karamoja region using DHIS2 data. Methods: A retrospective analysis was conducted using malaria case data from the District Health Information Software 2 (DHIS2) for children under five. Temporal and spatial trends were analyzed to identify peak transmission periods and high-burden districts. The effectiveness of SMC was evaluated using Generalized Linear Mixed Models (GLMMs), adjusting for relevant covariates. Results: Malaria incidence exhibited clear seasonal peaks during the rainy months, with considerable variation across districts. Some districts consistently reported higher malaria burden than others. GLMM analysis indicated that SMC significantly reduced malaria incidence among children under five. Additionally, female neonates (0–28 days) were found to have higher malaria incidence compared to older children, highlighting a vulnerable subgroup. Conclusion: SMC is effective in reducing malaria incidence among children under five in the Karamoja region. Malaria transmission varies temporally and spatially, emphasizing the need for targeted, location-specific interventions. Early-life preventive measures should be strengthened for neonates, and SMC delivery should be aligned with seasonal transmission peaks to maximize impact.