Prevalence and Determinants of Malaria Among Children Under Five Years in Malaria‐Endemic Areas of Mpumalanga Province, South Africa

BACKGROUND: Malaria remains a major public health concern among children under five in sub-Saharan Africa, with sociodemographic and environmental factors influencing transmission. This study assessed malaria prevalence and examined sociodemographic, socioeconomic, household and malaria prevention determinants associated with malaria risk among children under five in malaria-endemic areas of Mpumalanga Province. METHODS: A cross-sectional analytical study was conducted using secondary data obtained from the Demographic and Health Surveys (DHS) Programme collected from malaria-endemic areas of Mpumalanga Province, South Africa. The study included 108,898 children aged 0-59 months with complete information on malaria status and relevant explanatory variables. Data were collected using standardised household questionnaires and sampling procedures employed by the DHS Programme. Descriptive statistics and logistic regression analyses were performed to identify sociodemographic, socioeconomic, household and malaria prevention factors associated with malaria infection. Crude odds ratios (CORs) and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) and p values of ≤ 0.05 indicate a significant statistical difference, while a > 0.05 p value reporting no statistical significance. RESULTS: The overall malaria prevalence was 4.91% (95% CI: 4.78-5.04). Higher prevalence was observed in rural areas (6.40%) compared to urban areas (1.44%). Children from the poorest households (8.00%) and those with mothers with no formal education (9.40%) had higher malaria prevalence. Nkomazi had the highest burden (12.25%). In multivariable analysis, rural residence (AOR = 2.35; 95% CI: 2.10-2.63; p < 0.001), no maternal education (AOR = 2.05; 95% CI: 1.75-2.40; p < 0.001), poorest wealth status (AOR = 2.48; 95% CI: 2.10-2.93; p < 0.001), nonuse of insecticide-treated nets (AOR = 1.72; 95% CI: 1.55-1.92; p < 0.001) and absence of indoor residual spraying exposure (AOR = 1.31; 95% CI: 1.17-1.47; p < 0.001) were significant predictors of malaria infection. CONCLUSION: Malaria risk is strongly influenced by socioeconomic disadvantage, rural residence and inadequate prevention measures. Targeted interventions addressing inequality and improving coverage and utilisation of malaria control strategies are essential.