The burden of malaria and associated factors among children aged 6–59 months in Mozambique: a nationwide cross‑sectional survey

Abstract

Malaria remains a major cause of morbidity and mortality among children under five years of age in Mozambique despite ongoing prevention and control interventions. Understanding the sociodemographic and household factors associated with malaria is essential for designing targeted public health strategies. This study aimed to determine the burden of malaria and identify its associated factors among children aged 6–59 months in Mozambique. This study used secondary data from the nationally representative 2022–23 Mozambique Demographic and Health Survey. A weighted sample of 4,016 children aged 6–59 months who underwent malaria rapid diagnostic testing (mRDT) was included in the analysis. Descriptive statistics were used to summarize participants’ characteristics and estimate malaria prevalence. Associations between malaria and independent variables were assessed using modified Poisson regression with robust variance estimation. Adjusted prevalence ratios (APRs) with 95% confidence intervals (CIs) were reported. The overall prevalence of malaria among children aged 6–59 months was 32.3% (95% CI 29.1–35.7), with marked regional variation ranging from 0% in Cidade de Maputo to 54.7% in Nampula Province. In the multivariable analysis, malaria was independently associated with older child age (24–59 months) (APR = 1.58; 95% CI 1.42–1.76), rural residence (APR = 1.36; 95% CI 1.10–1.68), maternal primary education (APR = 2.06; 95% CI 1.52–2.81), informal maternal education (APR = 2.04; 95% CI 1.49–2.78), unimproved roof materials (APR = 1.29; 95% CI 1.07–1.56), middle wealth status (APR = 1.97; 95% CI 1.43–2.70), poor wealth status (APR = 2.41; 95% CI 1.73–3.37), anemia (APR = 2.89; 95% CI 2.42–3.45), malnutrition (APR = 1.10; 95% CI 1.02–1.21), residence in the central zone (APR = 1.92; 95% CI 1.41–2.64), and residence in the northern zone (APR = 3.06; 95% CI 2.24–4.19). Malaria remains highly prevalent among Mozambican children and is strongly associated with socioeconomic and household conditions. Bold, integrated, and equity-driven action that strengthens health systems, addresses social determinants, and protects the most vulnerable children are urgently required.