Prevalence of Malaria and Associated Factors among Febrile Children Under 15 Years at Bududa General Hospital, Eastern Uganda

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This study aimed to determine the prevalence of malaria and its associated factors among febrile children under 15 years of age at Bududa General Hospital, Eastern Uganda. Methods This cross-sectional study was conducted between April and June 2023. Informed consent was obtained from parents/guardians before 250 febrile children below 15 years were enrolled in this study. A structured questionnaire was administered to parents/guardians to collect sociodemographic characteristics and identify factors associated with malaria. Venous blood samples were collected from the children and screened for the presence of malaria parasitaemia using via blood smear microscopy. The data collected were entered into an Excel spreadsheet and analysed using STATA version 14. Logistic regression models were developed to determine the factors associated with malaria, and we considered ≤ 0.05 as the level of significance. Results Out of the 250 study participants, the overall prevalence of malaria was 111(44.4%). Among the children who tested positive for malaria, 98 (88.3%) had Plasmodium falciparum , 11 (9.9%) had Plasmodium malariae , and (1.8%) had Plasmodium ovale infection. The mean parasite count was 21,951 parasites/µL of blood. The prevalence rates of mild, moderate, and severe malaria parasitaemia were 46.8%, 28.0%, and 25.2%, respectively. In the multivariate analysis, the factors associated with malaria infections were older age; 1 to 5 years (p = 0.013), 6 to 10 years (p = 0.000), 11 to 15 years (p = 0.000), secondary education level of parent/guardian (p = 0.050), and no use of insecticide-treated bed nets (p = 0.002). Conclusion The prevalence of malaria among febrile children in this study was high, with nearly half of the participants showing severe infections. Health education on the correct use of insecticide-treated mosquito nets should be prioritized to help control malaria. Prevalence malaria factors febrile children Uganda Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Malaria remains a public health problem with the highest burden in the African Region of the World Health Organization (WHO). Globally, in 2022, there were 249 million malaria cases, and the WHO African Region accounted for 94% of the cases ( 1 ). This same report also indicated that Nigeria (27%), the Democratic Republic of Congo (12%), Uganda (5%) and Mozambique (4%) accounted for almost half of the total global malaria cases ( 1 ). In Uganda, malaria is the foremost cause of morbidity and mortality, and a recent publication acknowledged that it led to 29.1% outpatient visits, 39.5% inpatient admissions, and 10.9% hospital deaths ( 2 ). According to reports, between December 2018 and February 2019, the nationwide prevalence of malaria in children under five years old was 9%. The majority of cases were caused by Plasmodium falciparum, with the remaining cases being caused by Plasmodium malariae (10%), Plasmodium ovale (2%) and mixed infections (9%) ( 3 ). Limited information is available in Uganda regarding the frequency of malaria in children under the age of 15, but a report published in the malaria consortium 2023 states that children between the ages of 5 and 15 are susceptible to malaria, frequently without any accompanying symptoms, which can impede efforts to eradicate the parasite and spread it further ( 4 ). Several studies have also been conducted by scholars within the country among children under 5 years in recent years; a 76% prevalence of malaria among children under five years of age was reported in two general hospitals in Karamoja ( 2 ), and another study reported a 23.3% prevalence of malaria among children under five years of age in the whole country on the basis of evidence from the previous 2018–2019 Uganda Malaria Indicator Survey ( 5 ). Despite the malaria control measures put by the Ministry of Health, such as the distribution and use of insecticide-treated mosquito nets, intermittent preventive treatment of malaria during pregnancy and indoor residual spraying, malaria remains a public health challenge among children in Uganda ( 3 ). The utilization rate of LLITNs in Africa remains considerably low, although a small segment of the population uses them regularly. The key reasons for not using nets include discomfort from heat and concerns about the chemicals they contain ( 6 , 7 ). In addition, the prevalence of malaria among children under 5 years of age in the Bugisu sub-region was reported to be 5% ( 3 ), and scarce information exists about malaria in Bududa General Hospital; however, the increased cases of malaria from April to June 2023 at this facility called for this cross-sectional study. Continuous studies are necessary if Uganda is to meet the malaria control target; therefore, this study aimed to determine the prevalence of malaria and associated factors among children under 15 years of age at Bududa General Hospital, Eastern Uganda, and address the above gaps. Materials and methods Study site This was a cross-sectional study carried out at Bududa General Hospital, a public healthcare institution in the district of Bududa in the Bugisu sub-region in Eastern Uganda. It is located approximately 38 kilometers southeast of Mbale city. The coordinates of Bududa General Hospital are 01°00'34.0"N latitude and 34°19'58.0"E longitude. The hospital has 100 beds and offers a variety of medical services, including inpatient and outpatient treatment, maternity care, surgical services, laboratory services, and pharmacy services. It also provides HIV/AIDS testing and counselling, immunization, and family planning. Study Design This cross-sectional study was conducted between April 2023 and June 2023. The choice of this study period was primarily the increased number of malaria cases among children at Bududa General Hospital in the abovementioned months, which could be influenced by the climatic conditions of Bududa District and neighboring areas since previous malaria surveys were conducted between December 2018 and February 2019. Study population Febrile children below 15 years at Bududa General Hospital. Inclusion criteria Age below 15 years Fever ≥ 37.5°C in the past 48 hours Parents/guardians provided written informed consent for participation. Exclusion criteria Non-febrile children Children with chronic or congenital Illnesses (e.g., sickle cell disease, HIV/AIDS) Children already receiving anti-malarial treatment Children with recent malaria diagnosis (e.g., within the last two weeks) Severe Acute Illness (e.g., bacterial infections, viral illnesses). Children on long-term Prophylaxis for malaria Sample size calculation The required sample size for enrolment was estimated the Kish and Leslie formula for a single population proportion on the following assumptions: a malaria prevalence of 19.7%, a 95% confidence level, and a 5% marginal error. This estimation was informed by a study conducted in Uganda ( 8 ). The formula for calculating the sample size for proportion was as follows: where n = the desired sample size. Z = critical value of the normal distribution at 95%, which corresponds to 1.96 P = the proportion of the target population estimated to have malaria. d = estimated margin of error 5% n = 243 Hence, this study recruited 243 study participants, but we collected data from 250 study participants. Sampling procedure A simple random sampling method was used to recruit the participants, and those who declined were excluded. Participants were assigned folded papers with numbers written inside ranging from 1–40, and anyone who selected an even number was enrolled in the study until the calculated sample size was achieved. Data collection Informed consent was obtained from the parents/guardians of the children who met the inclusion criteria, and a structured questionnaire was administered to the parents/guardians to collect their sociodemographic characteristics and identify factors associated with malaria. Approximately four millilitres (4 ml) of venous blood samples were collected from the children in an ethylene-diamine-tetraacetic acid (EDTA) vacutainer and screened for the presence of malaria parasitaemia using blood smear microscopy method. Thick and thin blood smears were prepared, stained with Giemsa stain and examined at ×1000 magnification for malaria parasite detection, species identification and parasite counting. Parasite density was determined by counting the number of malaria parasites present and the number of white cells present simultaneously. Counting was stopped when ≥ 100 parasites in 200 white cells were counted or if ≤ 99 parasites in 500 white cells were counted. The parasite density was then calculated by dividing the number of parasites by the number of white cells counted and multiplying by 8000 and reported as parasite/µL of blood according to WHO guidelines ( 9 ). The parasite density was classified as mild (parasite number = 5–10,000/µL of blood), moderate (parasite number = 10,000–100,000/µL of blood) or severe (parasite number > 100,000/µL of blood) ( 10 ). Participants with positive results were referred to physicians for management. Quality control A standard operating procedure (SOP) was employed and followed at each step of the testing process to ensure data quality. Structured questionnaires and a checklist were pretested for appropriateness. The Giemsa stain working solution was freshly prepared daily. Furthermore, the glass slides were labelled with the study participants’ unique code numbers. A sterile, single-use syringe was used for each child during blood sample collection, and the smears were reviewed by a WHO-certified malaria microscopist. Data analysis The data collected were entered into an Excel spreadsheet and analysed using STATA software version 14.0. Categorical data and continuous variables are presented using descriptive statistics in the form of percentages, frequencies and pie-chart. Associations between malaria prevalence and factors were determined using bivariate logistic regression analysis. Factors with p values less than or equal to 0.1 in the bivariate analysis were subjected to multivariate logistic regression analysis. Factors with p values ≤ 0.05 were considered statistically significant. Results Demographic characteristics of the study participants This study enrolled 250 study participants. The mean age was 6.2 years (SD = 4.95 years). The majority of the study participants were aged between 1 and 5 years (37.6%), were females (54%), were living in rural areas (89.6%), had parents/guardians who had attained secondary education (57.2%), and peasant farmers (72%), as shown in (Table 1 ) . Table 1 Socio-Demographic Characteristics of study Participants Variables Frequency (n) Percentage (%) Age (years) < 1 36 14.4 1–5 94 37.6 6–10 53 21.2 11–15 67 26.8 Sex Male 115 46.0 Female 135 54.0 Residence Rural 224 89.6 Urban 26 10.4 Education level of parent/guardian Primary 100 40 Secondary 143 57.2 Tertiary 7 2.8 Occupation of parent/guardian Business 21 8.4 Peasant 180 72 Others 49 19.6 Household income 4 23 9.20 Distance to hospital ≤ 2km 99 39.6 > 2km 151 60.4 Ugandan Shillings (Ugx) Prevalence of malaria The overall prevalence of malaria was 111 (44.4%) among children aged less than 15 years at Bududa General Hospital (Fig. 1 ). Among the children who tested positive for malaria, 98 (88.3%) had Plasmodium falciparum , 11 (9.9%) had Plasmodium malariae and 2 (1.8%) had Plasmodium ovale infection. The mean parasite count was 21,951 parasites/µL of blood, The prevalence rates of mild, moderate, and severe malaria parasitaemia among children with malaria were 52 (46.8%), 31 (28.0%), and 28 (25.2%), respectively. Factors associated with malaria infection The associations between malaria prevalence and various factors (age, sex, education level of parents/guardians, use of insecticide-treated mosquito nets, stagnant water around the home, household income, number of children in the household, type of housing, residence, occupation of parents/guardians, history of malaria infection, and staying outside at night) were assessed using logistic regression analysis. In the bivariate analysis, older age (1–5 years (p = 0.008), 6–10 years (p = 0.000), and 11–15 years (p = 0.000)) and not using insecticide-treated mosquito nets (p = 0.001) were significantly associated with malaria (Table 2 ). Table 2 Bivariate analysis of factors associated with malaria Variables Odds ratio 95% Confidence interval P value Age (years) < 1 Ref 1–5 4.01 1.43–11.27 0.008 * 6–10 10.79 3.63–32.06 0.000 * 11–15 6.93 2.38–20.23 0.000 * Sex Male Ref Female 1.15 0.64–2.06 0.640 Occupation Business Ref Peasant 0.88 0.28–2.76 0.830 Others 0.94 0.28–3.15 0.920 Traveling history No Ref Yes 0.69 0.27–1.74 0.427 Residence Rural Ref Urban 1.66 0.57–4.84 0.351 Number of household children 2km 0.79 0.42–1.48 0.462 Housing Permanent with screen Ref Permanent without screen 0.30 0.06–1.49 0.140 Semi-permanent with screen 0.84 0.31–2.28 0.736 Semi-permanent without screen 0.33 0.11–1.04 0.056 Education level Primary Ref Secondary 1.73 0.89–3.37 0.107 Tertiary 0.71 0.09–5.70 0.747 Household income (Ugandan shillings) < 100,000/= Ref ≥ 100,000/= 0.63 0.33–1.20 0.161 Stay outside at night No Ref Yes 1.36 0.64–2.86 0.424 Stagnant water No Ref Yes 1.48 0.41–5.33 0.549 Use of Insecticide treated mosquito net Yes Ref No 3.78 1.75–8.12 0.001 * Significant * According to multivariate analysis, individuals aged 1–5 years (p = 0.013), 6–10 years (p = 0.000), and 11–15 years (p = 0.000) had a greater risk of malaria infection than younger individuals did (< 1 year). Additionally, children of parents/guardians who had attained secondary education (p = 0.050) were at greater risk of malaria infection than were children of parents who had attained primary education. Finally, children who were not using insecticide-treated mosquito nets (p = 0.002) were at greater risk of suffering from malaria than were children who were sleeping under insecticide-treated mosquito nets (Table 3 ). Table 3 Multivariate analysis of factors associated with malaria Variables Adjusted Odds ratio 95% Confidence interval P value Age (years) < 1 Ref 1–5 3.47 1.30–9.27 0.013 * 6–10 9.60 3.35–27.60 0.000 * 11–15 6.34 2.30–17.49 0.000 * Education level Primary Ref Secondary 1.84 1.00–3.37 0.050 * Tertiary 1.10 1.18–6.63 0.919 Insecticide treated mosquito net usage Yes Ref No 2.93 1.48–5.84 0.002 * Household income (Ugandan shillings) < 100,000/= Ref ≥ 100,000/= 0.62 0.34–1.12 0.110 Note : * Significant factor Discussion The prevalence of malaria among febrile children under 15 years of age in the present study was 44.4%, with prevalences of mild, moderate, and severe malaria of 46.8%, 28.0%, and 25.2%, respectively. The overall prevalence of malaria revealed in this study differs from the findings of the Uganda Malaria indicator health survey, which reported that the prevalence of malaria among children under 5 years of age was 9% and 5% in the Bugisu region ( 11 ). Several other studies conducted within Ugandan reported 19.04% ( 12 ), 19.7% ( 13 ), 23.3% ( 5 ) and 76% ( 2 ) prevalence of malaria among children under 5 years of age. The possible explanations for this observation could be differences in age specifics. The Uganda Malaria Indicator Health Survey focused on children under 5 years, while our study examined children under 15 years. Other reasons of the differences in findings could be the access to and use of insecticide-treated mosquito nets, differences in the malaria peak for different regions in Uganda, differences in vector density due to rainfall patterns and temperatures, changes in biting patterns, which are now both indoors and outdoors, parasite variations ( Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale ), drug resistance, the type of housing and vegetation density and all these factors influence mosquito breeding, infective mosquito bites, and malaria infection recurrence or recrudescence. This study's findings were also incompatible with previous findings, which reported prevalences of 12.2% ( 14 ) and 14% ( 15 ), respectively, in Rwanda. Several studies reported rates of 24.6% ( 16 ), 22.1% ( 17 ), 14.7% in Ethiopia ( 18 ), and 33% in Malawi ( 19 ). The variation in prevalence could be due to diagnostic criteria, sample size differences, geographical disease distribution, study design, health-seeking habits, and the socioeconomic status of these children's parents. Our findings, however, were closely comparable to the reported prevalence rates of malaria of 36.6% in Uganda ( 20 ), 44% in Guinea ( 21 ), and 37% in Malawi ( 22 ). Plasmodium falciparum infection was the most common malaria infection among the children in the current study. Other species reported in the present study also include Plasmodium malariae and Plasmodium ovale infections. This finding is in line with reports from the Uganda Malaria Indicator Health survey, which also reported Plasmodium falciparum infection to be the most common malaria infection, followed by Plasmodium malariae and Plasmodium ovale infections, among children ( 3 ). The emergence of plasmodium malariae and ovale in Uganda poses a challenge for the region, as the detection of these species, in addition to Plasmodium falciparum , requires specialized training for laboratory microscopists. Our study revealed that older age was associated with malaria infection and that children who were older were more likely to suffer from malaria. Although we recruited participants with fever, the above finding is comparable with two studies conducted in Uganda, which reported a similar finding that older age is a predictor of malaria among children under 15 years of age ( 5 , 12 ), and in Kenya ( 23 ). This observation has been attributed to the age related immunity that develops in these children because of continuous exposure to infective mosquito bites, and this immunity develops first against complicated malaria, then to uncomplicated malaria and to malaria parasitemia, explaining the high prevalence of malaria parasitemia among older children but without them developing clinical disease ( 24 ). The malaria consortium 2023 highlighted that one of the new challenges posed by global malaria trends is the shifting epidemiological patterns in at-risk populations, which include children aged 5 to 15 who are more likely to have malaria without symptoms and who are also less likely to use mosquito nets and receive treatment ( 4 ). This study also reported that parents’/guardians’ secondary level of education was associated with high malaria parasitemia. This finding is not in agreement with a finding of a study in Uganda that revealed an association between the primary and tertiary education levels of the child’s parents or guardians and a lower risk of malaria infection ( 12 ). Other studies were also not in agreement with our findings about parents’/guardians’ education ( 22 , 25 ). However, parent/guardian education attainment is associated with higher socioeconomic status, a wealthier household, and a better life, which leads to a reduced risk of developing malaria infection ( 12 ). Parents and guardians who had not received health education in the past 6 months were more likely to have children suffering from malaria due to the knowledge gap in disease control and prevention ( 16 ), which still elaborates on the significance of parent/guardian education in influencing their children’s health. Children who were not sleeping under insecticide-treated mosquito nets were 2.93-fold more likely to develop malaria parasitemia than were those who were sleeping under insecticide-treated mosquito nets. This finding was in line with a study that reported a 15-fold increase in the risk of developing malaria among children who were not sleeping under insecticide-treated mosquito nets ( 14 ). This study was also in agreement with studies that linked malaria infection with irregular utilization of insecticide-treated bed nets, and the probable explanation was continuous exposure to infective mosquito bites that can lead to malaria infection ( 16 , 25 ). In Africa, mosquito-treated bed nets have shown to be a crucial intervention in the fight against malaria, especially for susceptible groups like expectant mothers and children. Misuse (Figs. 2, 3, 4 and 5), however, has the potential to cause loss of efficacy and environmental deterioration. Community leaders, health groups, and governments must prioritize correct utilization and establish alternative resources for activities like fishing or crop protection to guarantee bed nets remain dedicated to their primary role in malaria prevention ( 26 ). Conclusion On the basis of the study results, malaria remains a significant public health issue, with an overall prevalence of 44.4%, with almost half of the study participants having a severe form of malaria. Age, the mother's secondary education level, and failure to use insecticide-treated bed nets were identified as significant factors associated with malaria infection. These findings underscore the need for targeted interventions, such as promoting the use of bed nets and increasing awareness of malaria prevention, particularly in vulnerable age groups and less educated populations. Limitation of the study This study utilized a cross sectional study design and it was a hospital based study and it limits its generalizability to other regions. Declarations Ethics approval and consent to participate This study was approved by the Faculty Research Committee (FRC), Faculty of Medicine, Mbarara University of Science and Technology, and the office of the Hospital Director, Bududa General Hospital (Approval number MUST/MLS/030). Consent for publication Informed consent was obtained from the parents/guardians of the children, and they were assured of confidentiality. The purpose of the study was explained to them that their participation was free and voluntary and that they were free to withdraw from the study at any time and would not affect their access to medical attention. Funding No financial support received for this study. Acknowledgements The study acknowledges the invaluable support and cooperation of participants, hospital administration and medical staff of Bududa General Hospital in making this research possible, your unwavering support throughout the data collection process greatly facilitated the research. The successful completion of this study would not have been possible without the collaboration and generosity of everyone involved. Author contributions BO: Conceived the study, conducted data collection, performed data analysis, drafted the manuscript, and provided final approval for the submitted version. DA: Conceived the study, conducted data collection, CO: Performed data analysis and manuscript drafting. RW and EM: Conceived the study, conducted data collection, and manuscript drafting. Data availability The data are available upon request from the corresponding author. Competing interests “The author(s) declare(s) that they have no competing interests”. References WHO. 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Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 07 Feb, 2025 Read the published version in Malaria Journal → Version 1 posted Editorial decision: Revision requested 23 Nov, 2024 Reviews received at journal 19 Nov, 2024 Reviewers agreed at journal 18 Nov, 2024 Reviewers invited by journal 16 Nov, 2024 Editor assigned by journal 25 Oct, 2024 Submission checks completed at journal 25 Oct, 2024 First submitted to journal 24 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5328245","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":370725155,"identity":"2dacffd6-d353-469f-93a5-9d505435df11","order_by":0,"name":"Benson Okongo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYBACAwY2MC1HuhZjIGZsIElLYgPRWszZ2xIfF/yySV87I/35A4YaOwaD8wvwa7HsOXbYeGZfWu62GzmGDQzHkhkMbjwg4LAb6W3SvD2HQVqADmM7ABQ5QJyWdLMb6Q8bGP4RpSXtmDTPj8MJZjcSDBsY24BazjcQ9EuyMW9DmuG2M28MZyT2JfNI3sCvAxRiho95/tjImx1Pf/Dhwzc7Ob7zBBwGBoxtUEYCAwMPg0QCEVoY/iBz+ImxZRSMglEwCkYSAABpVUmqw/X+YwAAAABJRU5ErkJggg==","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Benson","middleName":"","lastName":"Okongo","suffix":""},{"id":370725157,"identity":"bb186fbf-6a16-4fd5-a720-0d74390ab1bb","order_by":1,"name":"Daisy Asiimwe","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Daisy","middleName":"","lastName":"Asiimwe","suffix":""},{"id":370725159,"identity":"c53e372b-12a8-4007-9867-cb8c72fe76ee","order_by":2,"name":"Clinton Olong","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Clinton","middleName":"","lastName":"Olong","suffix":""},{"id":370725160,"identity":"85e4dcc6-6088-4ecb-b8dd-edd063820de6","order_by":3,"name":"Enoch Muwanguzi","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Enoch","middleName":"","lastName":"Muwanguzi","suffix":""},{"id":370725161,"identity":"d8ba0678-dc2b-420f-9efc-30153abfb152","order_by":4,"name":"Robert Wagubi","email":"","orcid":"","institution":"Mbarara Regional Referral Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Robert","middleName":"","lastName":"Wagubi","suffix":""}],"badges":[],"createdAt":"2024-10-24 20:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5328245/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5328245/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12936-024-05218-0","type":"published","date":"2025-02-07T15:57:29+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":67765412,"identity":"7136a851-837d-4fc1-89cb-d4debbcf6c5f","added_by":"auto","created_at":"2024-10-29 13:06:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19505,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePie chart showing the prevalence of malaria among children below 15 years at Bududa General Hospital\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5328245/v1/060c28c07220425e58160b8b.png"},{"id":67766323,"identity":"49a6b384-6bbf-41b9-9d6b-9114283920f8","added_by":"auto","created_at":"2024-10-29 13:14:23","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":2771744,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure21.png","url":"https://assets-eu.researchsquare.com/files/rs-5328245/v1/7db38af83f8e04f9287061f9.png"},{"id":67766324,"identity":"4d570834-f7a0-4f63-a253-ba899c78ec79","added_by":"auto","created_at":"2024-10-29 13:14:23","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2702670,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure31.png","url":"https://assets-eu.researchsquare.com/files/rs-5328245/v1/f158307ec36921d04651adc6.png"},{"id":67765413,"identity":"bec2c1f3-dcc2-4a42-92c1-2cc4afc3de5c","added_by":"auto","created_at":"2024-10-29 13:06:23","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":2811632,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure41.png","url":"https://assets-eu.researchsquare.com/files/rs-5328245/v1/944e22c51d8c96ae2d86ff93.png"},{"id":67765416,"identity":"f528cb8a-674f-49f9-9d82-be87dfc76382","added_by":"auto","created_at":"2024-10-29 13:06:23","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":2768388,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version\u003c/p\u003e","description":"","filename":"Figure51.png","url":"https://assets-eu.researchsquare.com/files/rs-5328245/v1/508a30badb7e5399d117fc20.png"},{"id":75930410,"identity":"142e82d8-15a6-44bd-9ab9-43fa8f676b11","added_by":"auto","created_at":"2025-02-10 16:11:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":11930290,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5328245/v1/7d99e243-d3f7-42a5-813f-affed52e2243.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence of Malaria and Associated Factors among Febrile Children Under 15 Years at Bududa General Hospital, Eastern Uganda","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMalaria remains a public health problem with the highest burden in the African Region of the World Health Organization (WHO). Globally, in 2022, there were 249\u0026nbsp;million malaria cases, and the WHO African Region accounted for 94% of the cases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This same report also indicated that Nigeria (27%), the Democratic Republic of Congo (12%), Uganda (5%) and Mozambique (4%) accounted for almost half of the total global malaria cases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Uganda, malaria is the foremost cause of morbidity and mortality, and a recent publication acknowledged that it led to 29.1% outpatient visits, 39.5% inpatient admissions, and 10.9% hospital deaths (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). According to reports, between December 2018 and February 2019, the nationwide prevalence of malaria in children under five years old was 9%. The majority of cases were caused by Plasmodium falciparum, with the remaining cases being caused by Plasmodium malariae (10%), Plasmodium ovale (2%) and mixed infections (9%) (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Limited information is available in Uganda regarding the frequency of malaria in children under the age of 15, but a report published in the malaria consortium 2023 states that children between the ages of 5 and 15 are susceptible to malaria, frequently without any accompanying symptoms, which can impede efforts to eradicate the parasite and spread it further (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral studies have also been conducted by scholars within the country among children under 5 years in recent years; a 76% prevalence of malaria among children under five years of age was reported in two general hospitals in Karamoja (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e), and another study reported a 23.3% prevalence of malaria among children under five years of age in the whole country on the basis of evidence from the previous 2018\u0026ndash;2019 Uganda Malaria Indicator Survey (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Despite the malaria control measures put by the Ministry of Health, such as the distribution and use of insecticide-treated mosquito nets, intermittent preventive treatment of malaria during pregnancy and indoor residual spraying, malaria remains a public health challenge among children in Uganda (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The utilization rate of LLITNs in Africa remains considerably low, although a small segment of the population uses them regularly. The key reasons for not using nets include discomfort from heat and concerns about the chemicals they contain (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn addition, the prevalence of malaria among children under 5 years of age in the Bugisu sub-region was reported to be 5% (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), and scarce information exists about malaria in Bududa General Hospital; however, the increased cases of malaria from April to June 2023 at this facility called for this cross-sectional study. Continuous studies are necessary if Uganda is to meet the malaria control target; therefore, this study aimed to determine the prevalence of malaria and associated factors among children under 15 years of age at Bududa General Hospital, Eastern Uganda, and address the above gaps.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy site\u003c/h2\u003e\n \u003cp\u003eThis was a cross-sectional study carried out at Bududa General Hospital, a public healthcare institution in the district of Bududa in the Bugisu sub-region in Eastern Uganda. It is located approximately 38 kilometers southeast of Mbale city. The coordinates of Bududa General Hospital are 01\u0026deg;00\u0026apos;34.0\u0026quot;N latitude and 34\u0026deg;19\u0026apos;58.0\u0026quot;E longitude. The hospital has 100 beds and offers a variety of medical services, including inpatient and outpatient treatment, maternity care, surgical services, laboratory services, and pharmacy services. It also provides HIV/AIDS testing and counselling, immunization, and family planning.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eThis cross-sectional study was conducted between April 2023 and June 2023. The choice of this study period was primarily the increased number of malaria cases among children at Bududa General Hospital in the abovementioned months, which could be influenced by the climatic conditions of Bududa District and neighboring areas since previous malaria surveys were conducted between December 2018 and February 2019.\u003c/p\u003e\n\u003cp\u003eStudy population\u003c/p\u003e\n\u003cp\u003eFebrile children below 15 years at Bududa General Hospital.\u003c/p\u003e\n\u003cp\u003eInclusion criteria\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eAge below 15 years\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eFever\u0026thinsp;\u0026ge;\u0026thinsp;37.5\u0026deg;C in the past 48 hours\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eParents/guardians provided written informed consent for participation.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eExclusion criteria\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eNon-febrile children\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eChildren with chronic or congenital Illnesses (e.g., sickle cell disease, HIV/AIDS)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eChildren already receiving anti-malarial treatment\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eChildren with recent malaria diagnosis (e.g., within the last two weeks)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eSevere Acute Illness (e.g., bacterial infections, viral illnesses).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eChildren on long-term Prophylaxis for malaria\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ch3\u003eSample size calculation\u003c/h3\u003e\n\u003cp\u003eThe required sample size for enrolment was estimated the Kish and Leslie formula for a single population proportion on the following assumptions: a malaria prevalence of 19.7%, a 95% confidence level, and a 5% marginal error. This estimation was informed by a study conducted in Uganda (\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e). The formula for calculating the sample size for proportion was as follows:\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"https://myfiles.space/user_files/122228_c8a1650c59388082/122228_custom_files/img1730204113.png\"\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003ewhere n\u0026thinsp;=\u0026thinsp;the desired sample size.\u003c/p\u003e\n\u003cp\u003eZ\u0026thinsp;=\u0026thinsp;critical value of the normal distribution at 95%, which corresponds to 1.96\u003c/p\u003e\n\u003cp\u003eP\u0026thinsp;=\u0026thinsp;the proportion of the target population estimated to have malaria.\u003c/p\u003e\n\u003cp\u003ed\u0026thinsp;=\u0026thinsp;estimated margin of error 5%\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;243\u003c/p\u003e\n\u003cp\u003eHence, this study recruited 243 study participants, but we collected data from 250 study participants.\u003c/p\u003e\n\u003ch3\u003eSampling procedure\u003c/h3\u003e\n\u003cp\u003eA simple random sampling method was used to recruit the participants, and those who declined were excluded. Participants were assigned folded papers with numbers written inside ranging from 1\u0026ndash;40, and anyone who selected an even number was enrolled in the study until the calculated sample size was achieved.\u003c/p\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ewas obtained from the parents/guardians of the children who met the inclusion criteria, and a structured questionnaire was administered to the parents/guardians to collect their sociodemographic characteristics and identify factors associated with malaria. Approximately four millilitres (4 ml) of venous blood samples were collected from the children in an ethylene-diamine-tetraacetic acid (EDTA) vacutainer and screened for the presence of malaria parasitaemia using blood smear microscopy method. Thick and thin blood smears were prepared, stained with Giemsa stain and examined at \u0026times;1000 magnification for malaria parasite detection, species identification and parasite counting. Parasite density was determined by counting the number of malaria parasites present and the number of white cells present simultaneously. Counting was stopped when \u0026ge;\u0026thinsp;100 parasites in 200 white cells were counted or if\u0026thinsp;\u0026le;\u0026thinsp;99 parasites in 500 white cells were counted. The parasite density was then calculated by dividing the number of parasites by the number of white cells counted and multiplying by 8000 and reported as parasite/\u0026micro;L of blood according to WHO guidelines (\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe parasite density was classified as mild (parasite number\u0026thinsp;=\u0026thinsp;5\u0026ndash;10,000/\u0026micro;L of blood), moderate (parasite number\u0026thinsp;=\u0026thinsp;10,000\u0026ndash;100,000/\u0026micro;L of blood) or severe (parasite number\u0026thinsp;\u0026gt;\u0026thinsp;100,000/\u0026micro;L of blood) (\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e). Participants with positive results were referred to physicians for management.\u003c/p\u003e\n\u003cp\u003eQuality control\u003c/p\u003e\n\u003cp\u003eA standard operating procedure (SOP) was employed and followed at each step of the testing process to ensure data quality. Structured questionnaires and a checklist were pretested for appropriateness. The Giemsa stain working solution was freshly prepared daily. Furthermore, the glass slides were labelled with the study participants\u0026rsquo; unique code numbers. A sterile, single-use syringe was used for each child during blood sample collection, and the smears were reviewed by a WHO-certified malaria microscopist.\u003c/p\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eData analysis\u003c/h2\u003e\n \u003cp\u003eThe data collected were entered into an Excel spreadsheet and analysed using STATA software version 14.0. Categorical data and continuous variables are presented using descriptive statistics in the form of percentages, frequencies and pie-chart. Associations between malaria prevalence and factors were determined using bivariate logistic regression analysis. Factors with p values less than or equal to 0.1 in the bivariate analysis were subjected to multivariate logistic regression analysis. Factors with p values\u0026thinsp;\u0026le;\u0026thinsp;0.05 were considered statistically significant.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eDemographic characteristics of the study participants\u003c/h2\u003e \u003cp\u003eThis study enrolled 250 study participants. The mean age was 6.2 years (SD\u0026thinsp;=\u0026thinsp;4.95 years). The majority of the study participants were aged between 1 and 5 years (37.6%), were females (54%), were living in rural areas (89.6%), had parents/guardians who had attained secondary education (57.2%), and peasant farmers (72%), as shown in (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-Demographic Characteristics of study Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e26.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e46.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e54.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level of parent/guardian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation of parent/guardian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e8.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeasant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;Ugx. 100,000/=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e42.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;Ugx. 100,000/=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e57.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of children in household\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistance to hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e39.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e60.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eUgandan Shillings (Ugx)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of malaria\u003c/h2\u003e \u003cp\u003eThe overall prevalence of malaria was 111 (44.4%) among children aged less than 15 years at Bududa General Hospital (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Among the children who tested positive for malaria, 98 (88.3%) had \u003cem\u003ePlasmodium falciparum\u003c/em\u003e, 11 (9.9%) had \u003cem\u003ePlasmodium malariae\u003c/em\u003e and 2 (1.8%) had \u003cem\u003ePlasmodium ovale\u003c/em\u003e infection. The mean parasite count was 21,951 parasites/\u0026micro;L of blood, The prevalence rates of mild, moderate, and severe malaria parasitaemia among children with malaria were 52 (46.8%), 31 (28.0%), and 28 (25.2%), respectively.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with malaria infection\u003c/h2\u003e \u003cp\u003eThe associations between malaria prevalence and various factors (age, sex, education level of parents/guardians, use of insecticide-treated mosquito nets, stagnant water around the home, household income, number of children in the household, type of housing, residence, occupation of parents/guardians, history of malaria infection, and staying outside at night) were assessed using logistic regression analysis. In the bivariate analysis, older age (1\u0026ndash;5 years (p\u0026thinsp;=\u0026thinsp;0.008), 6\u0026ndash;10 years (p\u0026thinsp;=\u0026thinsp;0.000), and 11\u0026ndash;15 years (p\u0026thinsp;=\u0026thinsp;0.000)) and not using insecticide-treated mosquito nets (p\u0026thinsp;=\u0026thinsp;0.001) were significantly associated with malaria (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e\u003cb\u003e).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate analysis of factors associated with malaria\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOdds ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% Confidence interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.43\u0026ndash;11.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.008\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.63\u0026ndash;32.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.38\u0026ndash;20.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.64\u0026ndash;2.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.640\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePeasant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.28\u0026ndash;2.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.830\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.28\u0026ndash;3.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.920\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraveling history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.27\u0026ndash;1.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.427\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.57\u0026ndash;4.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of household children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.29\u0026ndash;2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.642\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDistance to hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;2km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;2km\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.42\u0026ndash;1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.462\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePermanent with screen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePermanent without screen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.06\u0026ndash;1.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.140\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSemi-permanent with screen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.31\u0026ndash;2.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.736\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSemi-permanent without screen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.11\u0026ndash;1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.89\u0026ndash;3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.09\u0026ndash;5.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.747\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold income (Ugandan shillings)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100,000/=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;100,000/=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.33\u0026ndash;1.20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.161\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStay outside at night\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.64\u0026ndash;2.86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.424\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStagnant water\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.41\u0026ndash;5.33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.549\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUse of Insecticide treated mosquito net\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.75\u0026ndash;8.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eSignificant \u003csup\u003e*\u003c/sup\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAccording to multivariate analysis, individuals aged 1\u0026ndash;5 years (p\u0026thinsp;=\u0026thinsp;0.013), 6\u0026ndash;10 years (p\u0026thinsp;=\u0026thinsp;0.000), and 11\u0026ndash;15 years (p\u0026thinsp;=\u0026thinsp;0.000) had a greater risk of malaria infection than younger individuals did (\u0026lt;\u0026thinsp;1 year). Additionally, children of parents/guardians who had attained secondary education (p\u0026thinsp;=\u0026thinsp;0.050) were at greater risk of malaria infection than were children of parents who had attained primary education. Finally, children who were not using insecticide-treated mosquito nets (p\u0026thinsp;=\u0026thinsp;0.002) were at greater risk of suffering from malaria than were children who were sleeping under insecticide-treated mosquito nets (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis of factors associated with malaria\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAdjusted Odds ratio\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% Confidence interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u0026ndash;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.30\u0026ndash;9.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.013\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.35\u0026ndash;27.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.30\u0026ndash;17.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u0026ndash;3.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.050\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.18\u0026ndash;6.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.919\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInsecticide treated mosquito net usage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.48\u0026ndash;5.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.002\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousehold income (Ugandan shillings)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;100,000/=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;100,000/=\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.34\u0026ndash;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.110\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e\u003cb\u003eNote\u003c/b\u003e: \u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e \u003cb\u003eSignificant factor\u003c/b\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe prevalence of malaria among febrile children under 15 years of age in the present study was 44.4%, with prevalences of mild, moderate, and severe malaria of 46.8%, 28.0%, and 25.2%, respectively. The overall prevalence of malaria revealed in this study differs from the findings of the Uganda Malaria indicator health survey, which reported that the prevalence of malaria among children under 5 years of age was 9% and 5% in the Bugisu region (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Several other studies conducted within Ugandan reported 19.04% (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), 19.7% (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), 23.3% (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) and 76% (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) prevalence of malaria among children under 5 years of age. The possible explanations for this observation could be differences in age specifics. The Uganda Malaria Indicator Health Survey focused on children under 5 years, while our study examined children under 15 years. Other reasons of the differences in findings could be the access to and use of insecticide-treated mosquito nets, differences in the malaria peak for different regions in Uganda, differences in vector density due to rainfall patterns and temperatures, changes in biting patterns, which are now both indoors and outdoors, parasite variations (\u003cem\u003ePlasmodium falciparum, Plasmodium malariae and Plasmodium ovale\u003c/em\u003e), drug resistance, the type of housing and vegetation density and all these factors influence mosquito breeding, infective mosquito bites, and malaria infection recurrence or recrudescence.\u003c/p\u003e \u003cp\u003eThis study's findings were also incompatible with previous findings, which reported prevalences of 12.2% (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) and 14% (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), respectively, in Rwanda. Several studies reported rates of 24.6% (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), 22.1% (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), 14.7% in Ethiopia (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), and 33% in Malawi (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The variation in prevalence could be due to diagnostic criteria, sample size differences, geographical disease distribution, study design, health-seeking habits, and the socioeconomic status of these children's parents. Our findings, however, were closely comparable to the reported prevalence rates of malaria of 36.6% in Uganda (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), 44% in Guinea (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), and 37% in Malawi (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cem\u003ePlasmodium falciparum\u003c/em\u003e infection was the most common malaria infection among the children in the current study. Other species reported in the present study also include \u003cem\u003ePlasmodium malariae\u003c/em\u003e and \u003cem\u003ePlasmodium ovale\u003c/em\u003e infections. This finding is in line with reports from the Uganda Malaria Indicator Health survey, which also reported \u003cem\u003ePlasmodium falciparum\u003c/em\u003e infection to be the most common malaria infection, followed by \u003cem\u003ePlasmodium malariae\u003c/em\u003e and \u003cem\u003ePlasmodium ovale\u003c/em\u003e infections, among children (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The emergence of \u003cem\u003eplasmodium malariae\u003c/em\u003e and \u003cem\u003eovale\u003c/em\u003e in Uganda poses a challenge for the region, as the detection of these species, in addition to \u003cem\u003ePlasmodium falciparum\u003c/em\u003e, requires specialized training for laboratory microscopists.\u003c/p\u003e \u003cp\u003eOur study revealed that older age was associated with malaria infection and that children who were older were more likely to suffer from malaria. Although we recruited participants with fever, the above finding is comparable with two studies conducted in Uganda, which reported a similar finding that older age is a predictor of malaria among children under 15 years of age (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), and in Kenya (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This observation has been attributed to the age related immunity that develops in these children because of continuous exposure to infective mosquito bites, and this immunity develops first against complicated malaria, then to uncomplicated malaria and to malaria parasitemia, explaining the high prevalence of malaria parasitemia among older children but without them developing clinical disease (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The malaria consortium 2023 highlighted that one of the new challenges posed by global malaria trends is the shifting epidemiological patterns in at-risk populations, which include children aged 5 to 15 who are more likely to have malaria without symptoms and who are also less likely to use mosquito nets and receive treatment (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis study also reported that parents\u0026rsquo;/guardians\u0026rsquo; secondary level of education was associated with high malaria parasitemia. This finding is not in agreement with a finding of a study in Uganda that revealed an association between the primary and tertiary education levels of the child\u0026rsquo;s parents or guardians and a lower risk of malaria infection (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Other studies were also not in agreement with our findings about parents\u0026rsquo;/guardians\u0026rsquo; education (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). However, parent/guardian education attainment is associated with higher socioeconomic status, a wealthier household, and a better life, which leads to a reduced risk of developing malaria infection (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Parents and guardians who had not received health education in the past 6 months were more likely to have children suffering from malaria due to the knowledge gap in disease control and prevention (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), which still elaborates on the significance of parent/guardian education in influencing their children\u0026rsquo;s health.\u003c/p\u003e \u003cp\u003eChildren who were not sleeping under insecticide-treated mosquito nets were 2.93-fold more likely to develop malaria parasitemia than were those who were sleeping under insecticide-treated mosquito nets. This finding was in line with a study that reported a 15-fold increase in the risk of developing malaria among children who were not sleeping under insecticide-treated mosquito nets (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This study was also in agreement with studies that linked malaria infection with irregular utilization of insecticide-treated bed nets, and the probable explanation was continuous exposure to infective mosquito bites that can lead to malaria infection (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Africa, mosquito-treated bed nets have shown to be a crucial intervention in the fight against malaria, especially for susceptible groups like expectant mothers and children. Misuse (Figs.\u0026nbsp;2, 3, 4 and 5), however, has the potential to cause loss of efficacy and environmental deterioration. Community leaders, health groups, and governments must prioritize correct utilization and establish alternative resources for activities like fishing or crop protection to guarantee bed nets remain dedicated to their primary role in malaria prevention (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOn the basis of the study results, malaria remains a significant public health issue, with an overall prevalence of 44.4%, with almost half of the study participants having a severe form of malaria. Age, the mother's secondary education level, and failure to use insecticide-treated bed nets were identified as significant factors associated with malaria infection. These findings underscore the need for targeted interventions, such as promoting the use of bed nets and increasing awareness of malaria prevention, particularly in vulnerable age groups and less educated populations.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitation of the study\u003c/h2\u003e \u003cp\u003eThis study utilized a cross sectional study design and it was a hospital based study and it limits its generalizability to other regions.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Faculty Research Committee (FRC), Faculty of Medicine, Mbarara University of Science and Technology, and the office of the Hospital Director, Bududa General Hospital (Approval number MUST/MLS/030). \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from the parents/guardians of the children, and they were assured of confidentiality. The purpose of the study was explained to them that their participation was free and voluntary and that they were free to withdraw from the study at any time and would not affect their access to medical attention.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eNo financial support received for this study.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eThe study acknowledges the invaluable support and cooperation of participants, hospital administration and medical staff of Bududa General Hospital in making this research possible, your unwavering support throughout the data collection process greatly facilitated the research. The successful completion of this study would not have been possible without the collaboration and generosity of everyone involved.\u003c/p\u003e\n\u003cp\u003eAuthor contributions\u003c/p\u003e\n\u003cp\u003eBO: Conceived the study, conducted data collection, performed data analysis, drafted the manuscript, and provided final approval for the submitted version. DA: Conceived the study, conducted data collection, CO: Performed data analysis and manuscript drafting. RW and EM: Conceived the study, conducted data collection, and manuscript drafting.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cem\u003eData availability\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data are available upon request from the corresponding author.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u0026ldquo;The author(s) declare(s) that they have no competing interests\u0026rdquo;. \u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWHO. World malaria report 2023. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO. 2023.\u003c/li\u003e\n\u003cli\u003eZalwango JF, Nankabirwa JI, Kitutu FE, Akunzirwe R, Buhuguru R, Rokani JB, et al. Malaria diagnostic and treatment practices for febrile children under 5 years at two general hospitals in Karamoja, a high transmission setting in Uganda. Malaria journal. 2022;21(1):312.\u003c/li\u003e\n\u003cli\u003eNMCD. Uganda National Malaria Control Division (NMCD), Uganda Bureau of Statistics (UBOS), and ICF. 2020. Uganda Malaria Indicator Survey 2018-19. Kampala, Uganda, and Rockville, Maryland, USA: NMCD, UBOS, and ICF. 2020.\u003c/li\u003e\n\u003cli\u003eAchan J. Malaria in older children and adolescents and the intermittent preventive treatment of malaria in school-aged children. Malaria Consortium US, https://wwwmalariaconsortiumorg/resources/publications/1731/malaria-in-older-children-and-adolescents-and-the-intermittent-preventive-treatment-of-malaria-in-school-aged-children2023.\u003c/li\u003e\n\u003cli\u003eKooko R, Wafula ST, Orishaba P. Socioeconomic determinants of malaria prevalence among under five children in Uganda: Evidence from 2018-19 Uganda Malaria Indicator Survey. Journal of Vector Borne Diseases. 2023;60(1):38-48.\u003c/li\u003e\n\u003cli\u003eAnikwe CC, Irechukwu JC, Okorochukwu BC, Ikeoha CC, Obuna JA, Ejikeme BN, et al. Long‐Lasting Insecticide‐Treated Nets: Assessment of the Awareness and Utilization of Them among Antenatal Clinic Attendees in Abakaliki, Southeast Nigeria. Journal of Tropical Medicine. 2020;2020(1):2984867.\u003c/li\u003e\n\u003cli\u003eAntony I, Andinda M, Robert K, Tony M, John R, Semana AR. Factors associated with utilization of insecticide treated nets among residents of Kamwenge Town Council-Kamwenge District-Uganda. International Journal of Infectious Diseases and Therapy. 2019;4(1):1.\u003c/li\u003e\n\u003cli\u003eRoberts D, Matthews G. Risk factors of malaria in children under the age of five years old in Uganda. Malaria journal. 2016;15(1):1-11.\u003c/li\u003e\n\u003cli\u003eWHO. WHO. Basic malaria microscopy. Part I. Learner\u0026rsquo;s guide. Second edition. Geneva: 2010. 2010.\u003c/li\u003e\n\u003cli\u003eAntwi-Baffour S, Mensah BT, Johnson G, Armah DNO, Ali-Mustapha S, Annison L. Haematological parameters and their correlation with the degree of malaria parasitaemia among outpatients attending a polyclinic. Malaria journal. 2023;22(1):281.\u003c/li\u003e\n\u003cli\u003eUMIHS. Uganda National Malaria Control Division (NMCD), Uganda Bureau of Statistics (UBOS), and ICF. 2020. Uganda Malaria Indicator Survey 2018-19. Kampala, Uganda, and Rockville, Maryland, USA: NMCD, UBOS, and ICF. 2018-19.\u003c/li\u003e\n\u003cli\u003eWanzira H, Katamba H, Okullo AE, Agaba B, Kasule M, Rubahika D. Factors associated with malaria parasitaemia among children under 5 years in Uganda: a secondary data analysis of the 2014 Malaria Indicator Survey dataset. Malaria journal. 2017;16(1):1-9.\u003c/li\u003e\n\u003cli\u003eRoberts D, Matthews GJMj. Risk factors of malaria in children under the age of five years old in Uganda. 2016;15(1):1-11.\u003c/li\u003e\n\u003cli\u003eNyirakanani C, Chibvongodze R, Habtu M, Masika M, Mukoko D, Njunwa KJ. Prevalence and risk factors of asymptomatic malaria among underfive children in Huye District, Southern Rwanda. Tanzania Journal of Health Research. 2018;20(1).\u003c/li\u003e\n\u003cli\u003eHabyarimana F, Ramroop S. Prevalence and risk factors associated with malaria among children aged six months to 14 years old in Rwanda: evidence from 2017 Rwanda malaria indicator survey. 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Global Pediatric Health. 2021;8:2333794X211059107.\u003c/li\u003e\n\u003cli\u003eZgambo M, Mbakaya BC, Kalembo FW. Prevalence and factors associated with malaria parasitaemia in children under the age of five years in Malawi: A comparison study of the 2012 and 2014 Malaria Indicator Surveys (MISs). PloS one. 2017;12(4):e0175537.\u003c/li\u003e\n\u003cli\u003eSemakula HM, Liang S, Mukwaya PI, Mugagga F, Swahn M, Nseka D, et al. Determinants of malaria infections among children in refugee settlements in Uganda during 2018\u0026ndash;2019. Infectious Diseases of Poverty. 2023;12(1):1-12.\u003c/li\u003e\n\u003cli\u003eBeavogui AH, Delamou A, Camara BS, Camara D, Kourouma K, Camara R, et al. Prevalence of malaria and factors associated with infection in children aged 6 months to 9 years in Guinea: results from a national cross-sectional study. Parasite Epidemiology and Control. 2020;11:e00162.\u003c/li\u003e\n\u003cli\u003eGaston RT, Ramroop S. Prevalence of and factors associated with malaria in children under five years of age in Malawi, using malaria indicator survey data. Heliyon. 2020;6(5).\u003c/li\u003e\n\u003cli\u003eKamau A, Mtanje G, Mataza C, Mwambingu G, Mturi N, Mohammed S, et al. Malaria infection, disease and mortality among children and adults on the coast of Kenya. 2020;19(1):1-12.\u003c/li\u003e\n\u003cli\u003eYeka A, Nankabirwa J, Mpimbaza A, Kigozi R, Arinaitwe E, Drakeley C, et al. Factors associated with malaria parasitemia, anemia and serological responses in a spectrum of epidemiological settings in Uganda. PloS one. 2015;10(3):e0118901.\u003c/li\u003e\n\u003cli\u003eWoday A, Mohammed A, Gebre A, Urmale K. Prevalence and associated factors of malaria among febrile children in Afar region, Ethiopia: a health facility based study. Ethiopian journal of health sciences. 2019;29(5).\u003c/li\u003e\n\u003cli\u003eWHO. World Malaria Report 2021. Geneva: World Health Organization. Available at: https://www.who.int/publications/i/item/9789240040496.; 2021.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Prevalence, malaria, factors, febrile, children, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-5328245/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5328245/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eA considerable number of malaria-related deaths occur in Africa, with Uganda being one of the endemic nations where malaria continues to pose a public health challenge. This study aimed to determine the prevalence of malaria and its associated factors among febrile children under 15 years of age at Bududa General Hospital, Eastern Uganda.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis cross-sectional study was conducted between April and June 2023. Informed consent was obtained from parents/guardians before 250 febrile children below 15 years were enrolled in this study. A structured questionnaire was administered to parents/guardians to collect sociodemographic characteristics and identify factors associated with malaria. Venous blood samples were collected from the children and screened for the presence of malaria parasitaemia using via blood smear microscopy. The data collected were entered into an Excel spreadsheet and analysed using STATA version 14. Logistic regression models were developed to determine the factors associated with malaria, and we considered\u0026thinsp;\u0026le;\u0026thinsp;0.05 as the level of significance.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOut of the 250 study participants, the overall prevalence of malaria was 111(44.4%). Among the children who tested positive for malaria, 98 (88.3%) had \u003cem\u003ePlasmodium falciparum\u003c/em\u003e, 11 (9.9%) had \u003cem\u003ePlasmodium malariae\u003c/em\u003e, and (1.8%) had \u003cem\u003ePlasmodium ovale\u003c/em\u003e infection. The mean parasite count was 21,951 parasites/\u0026micro;L of blood. The prevalence rates of mild, moderate, and severe malaria parasitaemia were 46.8%, 28.0%, and 25.2%, respectively. In the multivariate analysis, the factors associated with malaria infections were older age; 1 to 5 years (p\u0026thinsp;=\u0026thinsp;0.013), 6 to 10 years (p\u0026thinsp;=\u0026thinsp;0.000), 11 to 15 years (p\u0026thinsp;=\u0026thinsp;0.000), secondary education level of parent/guardian (p\u0026thinsp;=\u0026thinsp;0.050), and no use of insecticide-treated bed nets (p\u0026thinsp;=\u0026thinsp;0.002).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe prevalence of malaria among febrile children in this study was high, with nearly half of the participants showing severe infections. Health education on the correct use of insecticide-treated mosquito nets should be prioritized to help control malaria.\u003c/p\u003e","manuscriptTitle":"Prevalence of Malaria and Associated Factors among Febrile Children Under 15 Years at Bududa General Hospital, Eastern Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-10-29 13:06:18","doi":"10.21203/rs.3.rs-5328245/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-23T09:55:12+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-19T10:27:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151600002538068867335596736613888629214","date":"2024-11-18T09:31:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-11-16T12:00:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-25T15:58:35+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-25T15:57:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2024-10-24T20:24:21+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"malaria-journal","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"malj","sideBox":"Learn more about [Malaria Journal](http://malariajournal.biomedcentral.com/)","snPcode":"12936","submissionUrl":"https://submission.nature.com/new-submission/12936/3","title":"Malaria Journal","twitterHandle":"@malariajournal","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ceada5c2-6fee-45eb-a62a-07ea7f02fe56","owner":[],"postedDate":"October 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-10T16:01:52+00:00","versionOfRecord":{"articleIdentity":"rs-5328245","link":"https://doi.org/10.1186/s12936-024-05218-0","journal":{"identity":"malaria-journal","isVorOnly":false,"title":"Malaria Journal"},"publishedOn":"2025-02-07 15:57:29","publishedOnDateReadable":"February 7th, 2025"},"versionCreatedAt":"2024-10-29 13:06:18","video":"","vorDoi":"10.1186/s12936-024-05218-0","vorDoiUrl":"https://doi.org/10.1186/s12936-024-05218-0","workflowStages":[]},"version":"v1","identity":"rs-5328245","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5328245","identity":"rs-5328245","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}