Determinants of malaria infections among children in refugee settlements in Uganda. Analysis of data from Uganda malaria indicator survey, 2018-19

Abstract

Background Globally, 5% of 247 million global malaria cases are reported Uganda which is also one of the top refugee hosting countries in Africa, with 1.36 million refugees currently. Although malaria is an emerging challenge for humanitarian response in refugee settlements, little is known about its risk factors. The study analysed data from the 2018-19 Uganda Malaria Indicator Survey (UMIS) to determine the factors associated with malaria infections among refugee children under five years of age. Methods The analysis was run using the ‘Individual dataset’ of UMIS. The independent variables related to the demographic, social-economic and environmental information on 3,481 refugees spreading across the country. The rapid diagnostics test results was the outcome variable. Multivariate logistic regression was performed to identify predictors of the malaria infections. Results Overall, the prevalence of malaria infections in all refugee settlements across the nine hosting districts was 36.6%. Malaria infections were higher in refugee settlements located in Isingiro (98.7%), Kyegegwa (58.6%) and Arua (57.4%) districts. The odds of contracting malaria were higher in refugee households whose children were aged 31–45 months (AOR = 2.14, 95% CI = 1.32–3.47) and above 45 months (AOR = 2.01, 95% CI = 1.22–3.32). Households whose main sources of domestic water were open water sources, boreholes and water tanks, were 1.22 (AOR = 1.22, 95% CI = 0.08–0.59), 2.11(AOR = 2.11, 95% CI = 0.91–4.89) and 4.47(AOR = 4.47, 95% CI = 1.67–11.9) times more likely to have their children contracting malaria. Households which used pit latrines and those without any toilet facility or used open defecation methods were 1.48 (AOR = 1.48, 95% CI = 1.03–2.13) and 3.29 (AOR = 3.29, 95% CI = 1.54–7.05) times more likely to have their children contracting malaria. Households which did not have insecticide treated bed nets or sprayed their households were 1.15 (AOD = 1.15, 95% CI = 0.43–3.13) and 8.04 (AOD = 8.04, 95% CI = 2.47–26.2) times more likely to have their children contracting malaria. Households which did not know that mosquito bites caused malaria, were 1.09 (AOD = 1.09, 95%=0.79–1.51) times more likely to have their children getting malaria. Conclusions These findings suggest that humanitarian responses and investments that reduce survival, biting, feeding, parasite development and breeding of mosquitoes will provide malaria health benefits in refugee settlements in Uganda.