Prevalence, determinants, and wealth-related inequalities in malaria among under five children in Uganda: evidence from the malaria indicator survey

Background Malaria remains a leading cause of morbidity and mortality among children under five in Uganda. Despite national control efforts, significant disparities and inequalities in prevalence persist across regions, residences, and mean socio-economic status. This study examines the socio-demographic factors and wealth-related inequalities associated with malaria among children under five in Uganda. Methodology A secondary analysis of data from the Uganda Malaria Indicator Survey (UMIS) 2018–2019 was conducted. A sample of 4,600 children with malaria test results was included in the study. The distribution of malaria prevalence across socio-demographic factors was analysed using cross-tabulations and a chi-squared test. Malaria-related inequalities were measured using equity plots and the concentration index (CIX). A multilevel logistic regression model was used to examine the relationship between malaria prevalence and associated factors. The results are presented as adjusted odds ratios (a OR s) with 95% confidence intervals ( CI ). Results Almost twenty-three in every 100 children under five had malaria infection (95% C I: 19.2–27.0). Regional variations in malaria prevalence and wealth-related inequalities were observed. The multilevel model identified several significant independent factors: older child age (a OR = 2.12, 95% CI: 1.51–2.96, P < 0.001), child’s anemia (a OR = 3.16, 95% CI: 2.33–4.29, P < 0.001), and larger household size (a OR = 1.98, 95% CI : 1.13–3.45, P < 0.05) were positively associated with malaria in children under five years in Uganda. A negative concentration index (CIX = − 0.334, P < 0.001) was also observed, indicating that higher malaria prevalence is concentrated among children in the poorest wealth quintile. Conclusion Malaria prevalence in Uganda is associated with a complex interplay of socioeconomic and geographic factors. The substantial disparities observed highlight the need for tailored public health strategies designed for high-burden regions and vulnerable communities to reduce disease burden effectively.