Risk factors for malaria among children under five living in net-owning households in Mozambique from the 2022–3 Demographic and Health Survey

Abstract Background Children under 5 (CU5) in Mozambique are highly susceptible to malaria. Few studies focus on household-level mosquito net use using 2022–3 national survey data (n = 1924). This study analyzed household mosquito net use as a predictor of CU5 malaria positivity. Methods We used a cross-sectional multivariable logistic regression including households with ≥1 CU5 (one record per household). The outcome was household-level CU5 malaria positivity, defined as ≥1 rapid diagnostic test-positive CU5. Variables included household mosquito net use, CU5 net use, wealth index, and region. Results Household net use showed no significant association with CU5 malaria after controlling for wealth index. Wealth index indicated a dose-response, where middle-resource households were 43% less likely (adjusted OR aOR = 0.57; 95% CI 0.38 to 0.84; P .0048) and highest-resource households were 84% less likely (aOR = 0.16; 95% CI 0.09 to 0.27; P .0001) compared with lowest-resource households. Seven regions had higher odds of malaria positivity compared with Cidade de Maputo, with significantly higher odds (P .0005) in Nampula (aOR = 18.97) and Cabo Delgado (aOR = 14.70). Conclusions Campaigns should prioritize lower-wealth households and higher-risk regions to reduce CU5 positivity.