Determinants of malaria infection across different districts of Khyber Pakhtunkhwa, Pakistan: a cross-sectional study

Background Malaria remains a significant public health challenge, particularly in the Khyber Pakhtunkhwa (KP) province, where transmission patterns vary across districts. This study aimed to identify the determinants of malaria transmission using model selection techniques. Methods A cross-sectional study was conducted among general population across various districts in KP, including northern, central, and southern zones. A total of 768 participants across the province were surveyed using a structured questionnaire having socio-demographic variables, housing conditions, access to healthcare, and preventive practices. Malaria infection was diagnosed using the combo rapid diagnostic test. Logistic regression models, including automated model selection techniques, were employed to identify significant predictors of malaria. Results The overall proportion of malaria among respondents was 24.5%. Bivariate analysis showed that male gender, younger age (16–30 years), joint family system, low education, poor housing conditions, low income, long distance to health centers, and non-use of bed nets were significantly associated with malaria (p < 0.05). Final multivariate model results identified gender (AOR 1.8, CI 1.1–2.8, P < 0.05), age group 16–30 years (AOR 4.2, CI 2.1–8.5, P < 0.01), age group 31–50 years (AOR 8.3, CI 4.2–16.3, P < 0.01), age group > 50 years (AOR 3.6, CI 1.9–6.7, P < 0.01), family type (AOR 2.6, CI 1.47–4.61, P = 0.001), education level (AOR 3.9, CI 2.6–5.9, P < 0.01), income level (10,000–50000 rupees) (AOR 17.8, CI 8.1–38.9, P < 0.05), large family size (AOR 11.3, CI 5.9–21.7, P < 0.05), distance of > 3 km to healthcare facilities (AOR 3.1, CI 1.8–5.3, P < 0.01), and lack of modern toilets (AOR 4.8, CI 2.4–9.4, P < 0.01) as independent risk factors of malaria prevalence. Conclusion The study highlights multiple risk factors contributing to malaria prevalence in KP. Tailored interventions, including improved access to education, healthcare, sanitation, and preventive tools like bed nets, are critical. Future studies incorporating geographic mapping and seasonal trends are recommended to strengthen targeted malaria control strategies.