Determinants of malaria prevalence among children under 5 years of age in 17 sub-Saharan African countries: insights from Malaria Indicator Surveys

BACKGROUND: Malaria remains a major public health burden among children under five in several Sub-Saharan African (SSA) countries, largely attributable to their underdeveloped immune systems, constrained access to healthcare services, and environmental conditions conducive to transmission. OBJECTIVE: This study aims to identify the key determinants of malaria infection among children under five by examining both individual-level characteristics and community-level drivers within this vulnerable population. METHODS: < 0.05. Determinants were reported as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). RESULTS: The analysis showed that more than one-third of children under five in several sub-Saharan African (SSA) countries were infected with malaria. At the individual level, significant risk factors included age (1-2 years: AOR = 1.46) and low household wealth index (AOR = 1.94). Protective factors were maternal primary education (AOR = 0.84) and the use of insecticide-treated bed nets (AOR = 0.80). At the community level, increased malaria risk was associated with rural residence (AOR = 2.69) and high community illiteracy rates (AOR = 1.76). CONCLUSIONS: The study findings highlight the sustained health threat that malaria poses to children under 5 years of age in many sub-Saharan African countries. Policymakers should prioritize reducing infections in vulnerable groups, expanding access to insecticide-treated bed nets, and promoting targeted health education to strengthen family and community awareness.