Sociodemographic and healthcare determinants of malaria infection among children under five in Burkina Faso: analysis of the 2021 Demographic and Health Survey data

Abstract

BACKGROUND: Malaria remains the leading cause of under-five mortality in Burkina Faso, one of the ten most affected countries globally. Despite substantial control efforts, persistent inequalities continue to limit progress. Addressing the complex and interrelated determinants of malaria is crucial to achieving national elimination targets. This study examined the prevalence of malaria and its associated individual and contextual factors using nationally representative data. METHODS: We analyzed data from 5674 children aged 6-59 months included in the 2021 Burkina Faso Demographic and Health Survey (DHS), which used a two-stage stratified cluster sampling design. Malaria infection was defined by positive microscopy results. Modified Poisson regression models were applied to estimate adjusted prevalence ratios (aPR). RESULTS: The overall malaria prevalence among children under five was 14.1% (95% CI: 13-15). Substantial regional disparities were observed, ranging from 5.1% in the Centre region to 29.3% in the Sahel. Compared with children aged 6-12 months, the risk of malaria increased with age, with aPR of 1.46 (13-23 months), 2.07 (24-35 months), 1.93 (36-47 months), and 1.93 (48-59 months). Higher malaria prevalence was also observed among children living in rural areas (aPR = 2.21), in households without electricity (aPR = 2.01), and in poor households (aPR = 1.60). CONCLUSION: Malaria disparities in Burkina Faso reflect both individual and contextual vulnerabilities. Children aged 24-59 months and those living in rural, poor, or electricity-deprived households were at higher risk. Achieving malaria elimination requires policies that promote equitable access to electricity, poverty reduction, and targeted interventions for vulnerable groups in rural areas.