Prevalence And Factors Associated With Malaria Amongst Under-Five Children In Senga Hill District, Northern Province Zambia. A Community Based cross-sectional study

Prevalence And Factors Associated With Malaria Amongst Under-Five Children In Senga Hill District, Northern Province Zambia. 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A Community Based cross-sectional study Shaba Santu Arthur, Lavel Moonga, Shoheil Ogata, Kyoko Hayashida, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7402852/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Mar, 2026 Read the published version in Malaria Journal → Version 1 posted 15 You are reading this latest preprint version Abstract Introduction . Malaria is one of the major public health problems in developing countries like Zambia. Under-five year children are the most vulnerable group affected by malaria, accounting for 61% of all malaria deaths worldwide. Despite efforts to reduce the mortality and morbidity, the disease is still a prominent health problem in Senga Hill District. Knowledge of malaria prevalence and associated risk factors among under-five children in the district is insufficient. The main objective of this study was to assess the prevalence of malaria and associated risk factors amongst Under-Five Children in the District. Methods . Community-based cross-sectional study was conducted among under-five children in Senga Hill District from November 2022 to August, 2023. A total of 216 under-five children were subjected to a Care Start TM Malaria Rapid diagnostic test which can detect histidine-rich protein 2 of Plasmodium falciparum and Plasmodium lactate dehydrogenase of P. vivax was used to diagnose malaria. At the same time, a structured questionnaire was administered to the parents or guardians to collect data on hypothesised risk factors for the disease. Bivariate analysis and binary logistic regression analysis was used to identify risk factors associated with malaria. Results and Conclusion. The overall prevalence of malaria among the under-five children in the study district was 31.9%. Further analysis of the data indicated that correct use of Insecticide Treated Nets, those households that reported indoor residual spaying had been done within the past six-months and those that reported having a single mosquito net had significantly reduced odds of positive malaria cases in under-five children, than those than had not. Furthermore, male children had significantly higher odds of being malaria positive than females. These results show that the prevalence of malaria among the under-five children in Senga Hill was high. Thus, all concerned bodies, including the community should strengthen ownership and encourage correct use of ITNs and acceptance of IRS service acceptance to stop the transmission of the malaria. Prevalence Malaria Risk factors Under-five children Mosquitoes Zambia Introduction Children under-five are the most susceptible to the malaria and make up 61% of all deaths to the disease globally [ 1 ]. According to data from the World Malaria Report, 2020 [ 1 ] nearly every minute, a child under 5 dies of malaria. Many of these deaths are preventable and treatable. In 2020, there were 249 million malaria cases globally that led to 608,000 deaths in total. Of these deaths, 76 per cent were children under 5 years of age. This translates into a daily toll of over 1,000 children under age 5 [ 1 ]. Children who survive malaria may experience long-term effects from the illness [ 2 ]. Frequent bouts of fever and sickness limit play, social engagement, and educational opportunities, suppress appetite, and ultimately hinder growth [ 3 ]. Poorer households are known to have higher rates of child mortality, with malaria accounting for a significant share of these deaths [ 3 ]. In resource-limited environments, like those found in most of Africa and Zambia in particular, malaria is a significant contributor to poverty[ 2 ]. Some population groups are at considerably higher risk of contracting malaria and developing severe disease including infants, mobile populations and travellers [ 3 ]. Furthermore, new-borns, children under five, pregnant women, and HIV/AIDS patients, are significantly more likely to get malaria and develop severe illness [ 3 ]. Malaria has an impact not only on health status but also on homes and daily life. Severe episodes of the disease can cause modest developmental and cognitive abnormalities in children as well as long-term neurological sequelae[ 5 ] Families may also suffer significant financial implications [ 6 ]. Malaria prevention and control in Zambia commenced in 1952. Since then great progress has been achieved, however, malaria still kills more children under the age of five than any other diseases. It affects more than 4 million Zambians annually [ 1 ], causing 30% of outpatient visits resulting into about 8000 deaths each year [ 1 ]. Risk is highest in the wetter, rural, impoverished areas of Luapula, Northern, Muchinga, North Western, Western, Copperbelt, and Eastern provinces [ 8 ]. According to District health office (ZDHS) data, malaria is one of the leading causes of morbidity and mortality in the District affecting both adults and children under five [ 7 ]. Hence, knowing the current prevalence of malaria and its associated risk factors in the district is of paramount importance in designing and scaling up appropriate intervention programs. Currently, there is scarcity of information as no such studies have been previous done in the study area (Senga Hill District) [ 8 ]. Materials and Methods Study Area The study was conducted in Senga Hill District, one of the twelve administrative districts of Northern Province, of Zambia. The district is approximately 175 kilometres from Kasama, the provincial headquarters. It has a population of about 126,308 people, with a population growth of 2.8 per annum and an estimated 27, 470 under-five children [ 9 ]. The district is divided into 31 Catchment areas with Mambwe Mission being the central catchment area. It has an estimated number of 27,470 under five children, [ 9 ]. The study was conducted in four catchment areas (community level) of the district, namely Senga and Nondo (peri-urban catchment areas), Mambwe and Mpande (rural catchment areas). The four targeted catchment areas were selected using simple random sampling. Research Design and sampling The cross-sectional sampling was conducted between November 2022 and August 2023. Under five children who had resided in the area for more than 6 months and their parents / guardians consented were included in the study. The sample size estimated at 216 participants using single population proportion formula of Dobson formula [ 10 ]. The assumptions were a malaria prevalence for Senga Hill of the 85% [ 11 ], a 95% confidence level, a 5% margin of error and 10% non-response rate. The number of under-five children in each catchment area was proportionally allocated to each catchment area. (Table 1 ). Table 1 Proportional allocation of sample size according to catchment area, under five children population size Catchment Area U5 Catchment Population Sample size Proportion by catchment Sample size Allocation Senga 3022 (7432 ÷ 3022) 2.46 87 Mambwe 1511 (7432 ÷ 1511) 4.91 44 Nondo 1496 (7432 ÷ 1496) 4.96 44 Mpande 1401 (7432 ÷ 1401) 5.31 41 Total 7432 216 Data was gathered at community level in the four respective catchment areas of Senga Hill District using simple random sample techique to select the study participants. Data on under five population was obtained from health care clinic in the respective catchment areas. A structured questionnaire was used to obtain data from guardians or parents following consent. Information on socio-demographic characteristics, insecticide treated nets (ITN) condition, availability and utilization, indoor residual spraying (IRS), presence of stagnant water within 500m of household, child outdoor stay beyond 19 hours, housing condition, and travel outside district and health information about malaria risk factors was collected. The questionnaire was pre-tested to determine the quality of data to be collected. The pre-test was done at Chikunta Catchment area (not part of the study sites) that has similar population characteristics to the target catchment areas in this study. A blood sample was aseptically collected into a capillary tube from each child regardless malaria signs and symptoms. The blood sample test was done by medical laboratory professional (laboratory technologists). The blood sample were tested immediately using Care Start ™ Malaria RDT which detect histidine-rich protein 2 (HRP2) of Plasmodium falciparum and plasmodium lactate dehydrogenase (pLDH) of Plasmodium vivax according to the manufacturer’s instructions [ 12 ]. Data Analysis Data was entered into MS Excel [ 13 ] then transferred to SPSS-V20 software for analysis [ 14 ]. Frequencies, proportions and summary statistics were then generated for each variable. Chi-Square (χ2) test was used to determine association between categorical variables. All variables that had p-values less than or equal to 0.250 in the bivariate analysis were included in the binary logistic regression model using a backward Stepwise (Likelihood Ratio) method. The omnibus test for model coefficients and the Hosmer and Lemeshow test was used to assess that the model-fitted the data. All statistics were considered significant at p ≤ 0.050. Results Socio-Demographic Characteristics of the study population A total of 216 study participants were included in the study and their socio-demographic characteristics were collected (Table 2 ). One hundred nineteen 55% of the study participants were female with a mean age of 2.38 months. Fifty-nine 27% were less than one year old. Majority of them (40%) were from Senga catchment (Community). Eighty-eight 41% of the households reported having only one (1) under five child. Regarding mother or caregiver related socio-demographic characteristics, majority of them (85%) were married, (40%) had no formal education and (45%) reported having no monthly income Insecticide-treated bed net was the most commonly mentioned malaria prevention measures reported by 85% of the respondents. One hundred fifteen (53%) of the households reported using an ITN the day preceding the study with an average of 1.87 mosquito nets ownership per household. Of the households who reported having ITN, 59%, 17% and 0.1% of them possessed one, two and three ITNs respectively. One Hundred fifty seven (73%) of them reported that their ITN was torn / or damaged, Table 2 . In this study, 18.5% of the parents/caregivers had not attained any formal education, whereas a total of 81.0% parents/caregivers had knowledge that mosquitoes were the vector for malaria transmission, the remaining (19.0%) had misconceptions about the mode of transmission. Furthermore, the majority (73.0%) of the guardians reported seeking treatment at least within 24 hours after the onset of fever (Table 3 ). Table 2 ; Socio-Demographic Characteristics of Under-Five Children in Senga Hill District; Northern-Province, Zambia (n = 216). Variables Categories n % (95% CI) Childs Location Senga 87 40.0(0.34, 0.47) Mambwe 44 20.0(0.15, 0.26) Nondo 44 20.0(0.15, 0.26) Mpande 41 19.0(0.14, 0.25) Gender of the Child Male 98 45.0 (0.39, 0.52) Female 119 55.0 (0.48, 0.61) Age of Child (months) < 12 59 27.0 (0.22, 0.33) 12–23 59 27.0 (0.22, 0.33) 24–35 55 26.0 (0.20, 0.32) 36–47 43 20.0 (0.15, 0.25) U5-Population/HH one 88 41.0 (0.34, 0.47) Two 77 35.0 (0.29, 0.42) Three & above 51 24.0 (0.19, 0.30) Number of Sleeping Spaces per Household One 14 6.4 (0.04, 0.11) Two 104 48.0 (0.42, 0.55) Three & above 98 45.0 (0.39, 0.52) Travel History Two weeks ago 7 3.2 (0.02, 0.07) Three weeks ago 14 6.5 (0.04, 0.11) A month ago or more 103 48.0 (0.41, 0.54) Not travelled 92 43.0 (0.39, 0.49) Educational Status of caregiver College & above 9 4.2 (0.02, 0.08) Secondary 39 18.0 (0.14, 0.24) Primary 128 59.0 (0.52, 0.65) No formal education 40 19.0 (0.14, 0.24) Marital status of caregiver Married 183 84.7 (0.79, 0.89) Not married 30 13.9 (0.10, 0.19) Widowed 2 0.9 (0.00, 0.02) Divorced 1 0.6 (0.00, 0.03) Income Status of caregiver-Monthly (ZWK) No Formal income 45 21.0 (0.16, 0.27) <K200 103 48.0 (0.41, 0.54) Between K200-K500 36 17.0 (0.13, 0.23) K500 & above 32 15.0 (0.11, 0.20) Number of ITN per Household One 137 63.0 (0.57, 0.69) Two 36 17.0 (0.13, 0.23) Three & Above 10 4.6 (0.03, 0.08) No ITN 33 15.0 (0.11, 0.21) Sources of ITNs Self-Procured 14 6.5 (0.03, 0.10) GRZ Mass Distribution 142 65.0 (0.59, 0.71) NGO Supplied 27 13.0 (0.09, 0.18) No ITN 33 15.0 (0.11, 0.21) Caregiver Knowledgeable on malaria transmission & Prevention Yes 175 81.0 (0.75, 0.86) No 41 19.0 (0.14, 0.25) Caregiver Health Seeking Behaviour Yes 158 73.0 (0.67, 0.79) No 58 27.0 (0.21, 0.33) Malaria Prevalence The prevalence of malaria according to the hypothesized risk factors among under five years children in Senga district are shown in Table 3 . The overall prevalence of malaria among the under-five children in Senga Hill District was 31.9% (95% CI = 0.26, 0.38). Children in the age group 12–23 months had the highest prevalence of malaria followed by the age groups < 12 months while those aged between 24–35 were third highest (25.3%) (Table 3 ). In terms of gender, the prevalence was higher among the males than the female children (Table 3 ). Table 3 Risk factors associated with malaria amongst Under-Five Children in Senga Hill District, Northern Province Zambia, from November 2022 and August 2023 (n = 216). Variable Category n Prevalence(95%CI) P-Value* Gender of the child Male 98 20.8 (15.62, 26.87) < 0.001 Female 118 11.1 (7.26, 16.08) Number of ITNs per HH One 137 16.7 (11.29, 22.32) 0.030 Two 36 8.3 (5.01, 12.85) Three & above 10 0.9 (0.11, 3.30) No ITN 33 6.0 (3.24, 10.07) Daily use of ITN Yes 146 17.6 (12.76, 23.34) 0.007 No 70 14.4 (9.96, 19.75) Correct ITN use Yes 148 14.8 (10.36, 20.27) < 0.001 No 68 17.1 (12.36, 22.82) Tear on ITN Yes 157 25.9 (20.22, 32.27) 0.055 No 59 6.0 (3.24, 10.07) IRS done last spray-season Yes 81 8.3 (5.01, 12.85) 0.018 No 135 23.6 (18.11, 29.85) Materials of structure for HH Cement Blocks 9 3.7 (1.61, 7.17) < 0.001 Burnt Bricks 182 24.5 (18.95, 30.88) Mud & Sticks 25 3.7 (1.61, 7.17) Caregiver Knowledgeable on malaria prevention & treatment Yes 175 24.1 (18.53, 30.34) 0.146 No 41 7.9 (4.65, 12.30) Community Factors attributed to poor health seeking behaviour Yes 133 21.8 (16.45, 27.86) 0.176 No 83 10.2 (6.49, 15.01) Caregiver health seeking behaviour Yes 158 25.0 (19.37, 31.33) 0.245 No 58 6.9 (3.94, 11.20) *Chi Square Test of Association 4.4. Factors associated with Risk of Malaria Infection The results in Table 3 shows that the gender was significantly associated with positive malaria RDT test result (χ 2 p = < 0.001). Further, correct use of ITN and households that reported IRS services the previous season had significantly low malaria prevalence on RDT test than those that did not (χ 2 p = < 0.001) and (χ 2 p = 0.018) respectively. The age of the child, number of sleeping spaces per household and educational status of the caregiver were not significantly associated with positive malaria prevalence. Similarly, Child outdoor stay after 19 hours and tear on ITN showed no association with malaria prevalence. Overgrown grass within 500m of the household also showed no association with malaria prevalence (Table 3 ). Caregiver/guardian knowledge status on malaria transmission & prevention, Cultural/beliefs attributed to poor Health seeking behaviour and Community factors attributed to poor health seeking behaviour were not significantly associated with associated with malaria prevalence in the under-five children in Senga Hill District (Table 3 ). Risk factors of under-five children being positive for malaria. The Omnibus test of model coefficient was significant (P < 0.001) and the Hosmer and Lemeshow test was not significant (p = 0.853), indicating that the model fitted the data. Four variables were found to be significant predicators of malaria in under-five children in Senga Hill District. Correct use of ITNs and having IRS services for mosquitoes in the previous season were found to reduce the odds of malaria, than those that did not (Table 4 ). Being a boy increased the odds of being positive for malaria when compared to that of a girl in under-five children. Households with a single (1) ITNs were associated with reduced odds of malaria, while households with three or more ITNs were found to be associated with increased odds of malaria, when compared to those that had no ITN (Table 4 ). The other variables were not significant predictors of under-five children being positive to malaria in under-five children in Senga Hill district. Table 4 ; Maximum-likelihood estimates of factors associated with malaria amongst Under-Five Children in Senga Hill District, Northern Province Zambia. Variables Categories n odds Ratios 95% CI for OR p-value Gender of Child Male 98 3.035 1.518, 6.068 0.002 Female 118 Correct ITN use Yes 148 0.089 0.034, 0.232 < 0.001 No 68 IRS done last Spray-season Yes 81 0.375 0.178, 0.789 0.01 No 135 Number of ITNs / HH One 137 0.354 0.141, 0.891 0.028 Two 36 0.797 0.147, 4.325 0.792 Three & above 10 7.366 2.299, 23.598 0.001 No ITN 33 Discussion Malaria is a serious public health issue that affects the health status of many people in tropical and subtropical regions of the world, including Zambia. It is important that the drivers of the burden of the disease at local level are understood so that preventive and control measures are planned and implemented. This study therefore aimed at estimating the prevalence and determination of risk factors that are associated with the prevalence of malaria amongst under five children in Senga Hill District of Northern Province of Zambia. The study found that malaria was prevalence was lower compared to the previous study findings of 48.1% and 61.3% in the surrounding districts of Chiengi and Puta, respectively, of Luapula Province, Zambia [ 15 ]. One possible explanation for the low prevalence in this study could be the different study period. Data for this study was gathered during the season of high malaria transmission [ 18 ]. Different local malaria parasite epidemiology and variations in the way malaria intervention efforts are implemented could also be a reason [ 18 ]. The current prevalence, however, was higher than that reported from Choma District, Southern Province, Zambia, ranged from 2.1 percent to 3.9 percent [ 19 ]. The risk of contracting malaria infection was higher among children recorded from household without ITNs. This result is consistent with earlier research conducted in Zimbabwe [ 20 ] and Ethiopia [ 21 ] that showed children from households without ITNs having higher risk of contracting malaria infection. ITN usage is largely dependent on access [ 22 ]. This demonstrated increased odds of ITN usage among children from households with good ITN supply compared to those with ITNs. It is normal for a mother to sleep with their young children and are therefore protected by her bed net if she has one. If a household has one bed net, the male head of the household may be given the preference to use the bed net because males are frequently the principal breadwinners in their families [ 23 ]. In this study, households that reported having a single ITNs had reduced odds of malaria in under-five children compared to those whose households reported not having ITN. Results are consistent with studies including a cohort study from Kenya in which ITN use was associated with a 44% relative reduction among under-five children [ 24 ] and a study from Tanzania in which the estimated protective efficacy of ITN use was 27% among children under five years old [ 25 ]. Nevertheless, the percentage of children using ITNs is still below the World Health Assembly [ 26 ] and Ministry of Health target of 80% for an acceptable level of protection. Low rates of bed net usage reported by communities in the tropics are attributed primarily to lack of sufficient nets to cover all household members [ 27 ] but also to heat discomfort associated with poor airflow caused by bed nets [ 28 ]. Households that reported incorrect use and/or use of worn out ITNs had an increased odds of having a child being positive for malaria compared to households reported correct use or not worn out ITN. These results are consistent to recent findings from other studies (western Kenya) that have reported lack of protective effect for ITN use and coverage that could be attributed to the state and conditions of the ITNs [ 29 ]. This result contrasts with a research conducted in Uganda, which found that children who used an ITN had chances that were 1.33 times higher of being positive for malaria than those of children who did not use one [ 30 ]. However, this findings is in line with earlier research conducted in the East Shewa zone of the Oromiya regional state and Southern Ethiopia [ 31 , 32 ] which showed households that reported incorrect use and/or use of worn out ITNs having an increased odds of being positive for malaria amongst under-five children. Additionally, this is consistent with existing literature on ITNs reducing malaria transmission, a recent systematic review and meta-analysis of 11 studies in Ethiopia found that the use of ITNs was associated with lower odds of malaria [ 33 ]. ITN use is protective against malaria for individuals using them properly and consistently, especially in Africa where the primary vectors are endophagic and anthropophilic mosquitoes [ 34 ]. Households that reported not having been sprayed in the last 12 months had increased odds of having a malaria positive in under-five children compared to those whose households reported receiving the service within the same period. This finding is in line with the previous studies done in Nchelenge district Northern Zambia [ 36 ] and a secondary analysis of Zambia Malaria Indicator Survey 2018 (MIS) [ 36 ]. Children who sleep in rooms that have been sprayed in the last six months were about 68% less likely to be infected with malaria than children who did not [ 37 ], all else being equal. This finding supports similar evidence presented by Loha et al, [ 37 ] that IRS significantly reduces the incidence of falciparum malaria. Chemicals used in indoor residual sprays kill and repel mosquitoes. As a result, the residents of the home are shielded from mosquito bites and the risk of contracting malaria. This is in line with a Ugandan. study that found indoor residual spray to be protective and that children who lived in untreated homes were more likely to have malaria [ 38 ]. Gender was significantly associated with increased malaria prevalence. Male children had a high odds of being positive for malaria compared to female children. The annual incidence of malaria for males was 447 cases per 1000 population, while for females this was 413 cases per 1000 population in the year 2020 [ 39 ]. The malaria inpatient case fatality rate (CFR) reported among children were at 7.2/1000 population and 6.0 / 1000 population for male and female children respectively [ 40 ].This result is consistent with earlier research conducted in Nsanje District in Malawi, which also showed that there were more malaria cases in males (51.4%) than in females (48.6%) [ 40 ]. However, another study in Zambia specifically on health-seeking behaviour did not find any significant differences between boys and girls for common childhood illnesses [ 41 ]. Potential explanation could be the differences in population proportions with the female gender having a higher proportion compare to males [ 42 ]. Conclusion This study revealed a high prevalence of malaria among under-five children of 31.9%. The risk factors associated with malaria cases amongst under-five children in Senga Hill District were non availability of ITNs at household level and incorrect use of ITN. Other risk factors were low coverage of IRS services and (Gender) male under-five children. The results of this study demonstrate that interventions, such as the correct (proper and consistent) usage of ITN and IRS, may help prevent malaria. All relevant parties, including the local authorities and communities, should endeavor to promote correct ITN usage and 100% IRS coverage. Abbreviations AIDS: Acquired Immunodeficiency Syndrome, CHA: Community Health Asistants, CSO: Central Statistic Office, DDT: Dichlorodiphenyltrichloroethane, DHO: District Health Office, GRZ:Government of the Republic of Zambia, HH: HouseHold, HIV:Human Immunodeficiency Virus, HRP2:Histidine-rich protein 2, IRS: Indoor Residual Spraying, ITN:Inserticide Treated Bed Net, MoH; Ministry of Health, NGO:Non-Governmental Organisation, pLDH: Plasmodium lactate Dehydrogenase, RDT: Rapid Diagnostic Test, U5: Under-Five Children, ZWK: Zambian Kwacha and χ2:Chi-Square Declarations Conflicts of Interest The authors declares no conflict of interest regarding the publication of this article. Ethics Consideration The protocol was ethically approved by ERES Converge Ethics Committee (Ref. No. 2023 -Oct-006, National Health Research Authority (Ref. No. NHRAR-R-2002/30/09/2023) and Operational ethical approval was sought from the Senga Hill DHO. Acknowledgements The Authors wish to thank Ministry of Health - Provincial Health Office: Northern Province and Senga Hill District health office for the assistance rendered in data collection, Laboratory Technologist and research assistants for their hard work in making the study a success. Funding This work was not supported by any organisation. Availability of data and materials The data sets and materials used in the analysis of this current study are readily available from the corresponding author and can be accessed upon reasonable request. Authors’ contributions A. Shabasantu, conducted the research work and wrote the report, drafted and edited the manuscript, M. Simuunza & A. Shabasantu, analysed the data, reviewed and edited the manuscript, M. Simuunza & A. Shabasantu, conceptualized the study, drafted the manuscript and supervised research work. All authors read and approved the final version of the manuscript. 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(2015) ‘Factors associated with malaria infection in Honde valley, Mutasa district, Zimbabwe, 2014: a case control study’, BMC research notes , 8, p. 829. Available at: https://doi.org/10.1186/s13104-015-1831-3. Agegnehu, F. et al. (2018) ‘Determinants of malaria infection in Dembia district, Northwest Ethiopia: a case-control study’, BMC public health , 18(1), p. 480. Available at: https://doi.org/10.1186/s12889-018-5370-4. Koenker, H. et al. (2018) ‘Assessing whether universal coverage with insecticide-treated nets has been achieved: is the right indicator being used?’, Malaria Journal , 17(1), p. 355. Available at: https://doi.org/10.1186/s12936-018-2505-0. Carlson, K.J. and Schiff, I. (1996) ‘Alternatives to hysterectomy for menorrhagia’, The New England Journal of Medicine , 335(3), pp. 198–199. Available at: https://doi.org/10.1056/NEJM199607183350309. Fegan, G.W. et al. (2007) ‘Effect of expanded insecticide-treated bednet coverage on child survival in rural Kenya: a longitudinal study’, The Lancet , 370(9592), pp. 1035–1039. Available at: https://doi.org/10.1016/S0140-6736(07)61477-9. Schellenberg, J.R.A. et al. (2001) ‘Effect of large-scale social marketing of insecticide-treated nets on child survival in rural Tanzania’, The Lancet , 357(9264), pp. 1241–1247. Available at: https://doi.org/10.1016/S0140-6736(00)04404-4. Korenromp, E.L. et al. (2003) ‘Monitoring mosquito net coverage for malaria control in Africa: possession vs. use by children under 5 years’, Tropical Medicine & International Health , 8(8), pp. 693–703. Available at: https://doi.org/10.1046/j.1365-3156.2003.01084.x. Tchinda, V.H.M. et al. (2012) ‘Factors associated to bed net use in Cameroon: a retrospective study in Mfou health district in the Centre Region’, The Pan African Medical Journal , 12, p. 112. Von Seidlein, L. et al. (2012) ‘Airflow attenuation and bed net utilization: observations from Africa and Asia’, Malaria Journal , 11(1), p. 200. Available at: https://doi.org/10.1186/1475-2875-11-200. Githinji, S. et al. (2010) ‘Mosquito nets in a rural area of Western Kenya: ownership, use and quality’, Malaria Journal , 9, p. 250. Available at: https://doi.org/10.1186/1475-2875-9-250. Wanzira, H. et al. (2017) ‘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 , 16(1), p. 191. Available at: https://doi.org/10.1186/s12936-017-1847-3. Haji, Y., Fogarty, A.W. and Deressa, W. (2016) ‘Prevalence and associated factors of malaria among febrile children in Ethiopia: A cross-sectional health facility-based study’, Acta Tropica , 155, pp. 63–70. Available at: https://doi.org/10.1016/j.actatropica.2015.12.009. Belete, E.M. and Roro, A.B. (2016) ‘Malaria Prevalence and Its Associated Risk Factors among Patients Attending Chichu and Wonago Health Centres, South Ethiopia’, Journal of Research in Health Sciences , 16(4), pp. 185–189. Biset, G. et al. (2022) ‘Malaria among under-five children in Ethiopia: a systematic review and meta-analysis’, Malaria Journal , 21(1), p. 338. Available at: https://doi.org/10.1186/s12936-022-04370-9. Takken, W., Charlwood, D. and Lindsay, S.W. (2024) ‘The behaviour of adult Anopheles gambiae, sub-Saharan Africa’s principal malaria vector, and its relevance to malaria control: a review’, Malaria Journal , 23(1), p. 161. Available at: https://doi.org/10.1186/s12936-024-04982-3. Hamlet, A. et al. (2022) ‘The potential impact of Anopheles stephensi establishment on the transmission of Plasmodium falciparum in Ethiopia and prospective control measures’, BMC Medicine , 20(1), p. 135. Available at: https://doi.org/10.1186/s12916-022-02324-1. Nambozi, M. et al. (2014) ‘Defining the malaria burden in Nchelenge District, northern Zambia using the World Health Organization malaria indicators survey’, Malaria Journal , 13(1), p. 220. Available at: https://doi.org/10.1186/1475-2875-13-220. Mabaso, M.L.H., Sharp, B. and Lengeler, C. (2004) ‘Historical review of malarial control in southern African with emphasis on the use of indoor residual house‐spraying’, Tropical Medicine & International Health , 9(8), pp. 846–856. Available at: https://doi.org/10.1111/j.1365-3156.2004.01263.x. Ssempiira, J. et al. (2017) ‘Geostatistical modelling of malaria indicator survey data to assess the effects of interventions on the geographical distribution of malaria prevalence in children less than 5 years in Uganda’, PLOS ONE . Edited by É.M. Braga, 12(4), p. e0174948. Available at: https://doi.org/10.1371/journal.pone.0174948. MoH, 2021. Health Management Information System. Gondwe, T., Yang, Y., Yosefe, S., Kasanga, M., Mulula, G., Luwemba, M.P., Jere, A., Daka, V., Mudenda, T., 2021. Epidemiological Trends of Malaria in Five Years and under Children of Nsanje District in Malawi, 2015–2019. Int. J. Environ. Res. Public. Health 18, 12784. https://doi.org/10.3390/ijerph182312784 Apuleni, G., Jacobs, C. and Musonda, P. (2021) ‘Predictors of Health Seeking Behaviours for Common Childhood Illnesses in Poor Resource Settings in Zambia, A Community Cross Sectional Study’, Frontiers in Public Health , 9, p. 569569. Available at: https://doi.org/10.3389/fpubh.2021.569569. Abeku, T.A. et al. (2003) ‘Spatial and temporal variations of malaria epidemic risk in Ethiopia: factors involved and implications’, Acta Tropica , 87(3), pp. 331–340. Available at: https://doi.org/10.1016/S0001-706X(03)00123-2. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 31 Mar, 2026 Read the published version in Malaria Journal → Version 1 posted Editorial decision: Revision requested 23 Oct, 2025 Reviews received at journal 13 Oct, 2025 Reviews received at journal 10 Oct, 2025 Reviewers agreed at journal 07 Oct, 2025 Reviews received at journal 07 Oct, 2025 Reviews received at journal 06 Oct, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers agreed at journal 30 Sep, 2025 Reviewers invited by journal 28 Aug, 2025 Editor assigned by journal 21 Aug, 2025 Submission checks completed at journal 21 Aug, 2025 First submitted to journal 18 Aug, 2025 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. 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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-7402852","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":509296275,"identity":"4d53d8a8-9ec1-4eea-ad3f-a883d99fa7ad","order_by":0,"name":"Shaba Santu Arthur","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4UlEQVRIiWNgGAWjYDADPiA+8IGBIYEYxYwNDAwGDGxA1sEZJGth5iFGi3z72eOPeRj+JLaxnz142LbNLo+fvYHxw8cc3FoMzuQlNvMwGCS28eQlHM5tSy6W7DnALDlzGx4tDDmGEC0MOQZALcyJG24ksDHz4tEi3/8GqoX/jcFhy7Z6wloYbsBskQDawth2mLAWgxtvDGfOMTA2bpN4Y3Cw59zxxJk9B5vx+kW+P8fgw5sKOdl+/hzjDz/KqhP72ZsPfviIz2HQQIAARjYw2UBIPTL4Q4riUTAKRsEoGCkAAJwgUMYnIfziAAAAAElFTkSuQmCC","orcid":"","institution":"University of Zambia","correspondingAuthor":true,"prefix":"","firstName":"Shaba","middleName":"Santu","lastName":"Arthur","suffix":""},{"id":509296276,"identity":"88c81e0d-8976-422e-a467-5093b2590432","order_by":1,"name":"Lavel Moonga","email":"","orcid":"","institution":"university of Zambia","correspondingAuthor":false,"prefix":"","firstName":"Lavel","middleName":"","lastName":"Moonga","suffix":""},{"id":509296277,"identity":"bc760532-7fbd-4f34-8e64-36f8fcc89624","order_by":2,"name":"Shoheil Ogata","email":"","orcid":"","institution":"Hokkaido University","correspondingAuthor":false,"prefix":"","firstName":"Shoheil","middleName":"","lastName":"Ogata","suffix":""},{"id":509296278,"identity":"25d17c2e-f621-47d7-ab35-75fe1775b2c8","order_by":3,"name":"Kyoko Hayashida","email":"","orcid":"","institution":"Hokkaido University","correspondingAuthor":false,"prefix":"","firstName":"Kyoko","middleName":"","lastName":"Hayashida","suffix":""},{"id":509296279,"identity":"1b1182bc-93c0-4a5f-a066-03367ff4b23e","order_by":4,"name":"Martin Chitolongo Simuunza","email":"","orcid":"","institution":"University of Lusaka","correspondingAuthor":false,"prefix":"","firstName":"Martin","middleName":"Chitolongo","lastName":"Simuunza","suffix":""}],"badges":[],"createdAt":"2025-08-18 21:23:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7402852/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7402852/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12936-026-05853-9","type":"published","date":"2026-03-31T15:59:17+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":106343972,"identity":"ba4efd98-0259-492b-954b-c5f7bd404d9c","added_by":"auto","created_at":"2026-04-07 16:11:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":980994,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7402852/v1/f4104f64-7f68-4ae4-9b63-adab2e773b29.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence And Factors Associated With Malaria Amongst Under-Five Children In Senga Hill District, Northern Province Zambia. A Community Based cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eChildren under-five are the most susceptible to the malaria and make up 61% of all deaths to the disease globally [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. According to data from the World Malaria Report, 2020 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] nearly every minute, a child under 5 dies of malaria. Many of these deaths are preventable and treatable. In 2020, there were 249\u0026nbsp;million malaria cases globally that led to 608,000 deaths in total. Of these deaths, 76 per cent were children under 5 years of age. This translates into a daily toll of over 1,000 children under age 5 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Children who survive malaria may experience long-term effects from the illness [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Frequent bouts of fever and sickness limit play, social engagement, and educational opportunities, suppress appetite, and ultimately hinder growth [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Poorer households are known to have higher rates of child mortality, with malaria accounting for a significant share of these deaths [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn resource-limited environments, like those found in most of Africa and Zambia in particular, malaria is a significant contributor to poverty[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Some population groups are at considerably higher risk of contracting malaria and developing severe disease including infants, mobile populations and travellers [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Furthermore, new-borns, children under five, pregnant women, and HIV/AIDS patients, are significantly more likely to get malaria and develop severe illness [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Malaria has an impact not only on health status but also on homes and daily life. Severe episodes of the disease can cause modest developmental and cognitive abnormalities in children as well as long-term neurological sequelae[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] Families may also suffer significant financial implications [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eMalaria prevention and control in Zambia commenced in 1952. Since then great progress has been achieved, however, malaria still kills more children under the age of five than any other diseases. It affects more than 4\u0026nbsp;million Zambians annually [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], causing 30% of outpatient visits resulting into about 8000 deaths each year [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eRisk is highest in the wetter, rural, impoverished areas of Luapula, Northern, Muchinga, North Western, Western, Copperbelt, and Eastern provinces [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. According to District health office (ZDHS) data, malaria is one of the leading causes of morbidity and mortality in the District affecting both adults and children under five [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Hence, knowing the current prevalence of malaria and its associated risk factors in the district is of paramount importance in designing and scaling up appropriate intervention programs. Currently, there is scarcity of information as no such studies have been previous done in the study area (Senga Hill District) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy Area\u003c/h2\u003e\u003cp\u003eThe study was conducted in Senga Hill District, one of the twelve administrative districts of Northern Province, of Zambia. The district is approximately 175 kilometres from Kasama, the provincial headquarters. It has a population of about 126,308 people, with a population growth of 2.8 per annum and an estimated 27, 470 under-five children [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The district is divided into 31 Catchment areas with Mambwe Mission being the central catchment area. It has an estimated number of 27,470 under five children, [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The study was conducted in four catchment areas (community level) of the district, namely Senga and Nondo (peri-urban catchment areas), Mambwe and Mpande (rural catchment areas). The four targeted catchment areas were selected using simple random sampling.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eResearch Design and sampling\u003c/h3\u003e\n\u003cp\u003eThe cross-sectional sampling was conducted between November 2022 and August 2023. Under five children who had resided in the area for more than 6 months and their parents / guardians consented were included in the study.\u003c/p\u003e\u003cp\u003eThe sample size estimated at 216 participants using single population proportion formula of Dobson formula [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The assumptions were a malaria prevalence for Senga Hill of the 85% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], a 95% confidence level, a 5% margin of error and 10% non-response rate. The number of under-five children in each catchment area was proportionally allocated to each catchment area. (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\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\u003eProportional allocation of sample size according to catchment area, under five children population size\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCatchment Area\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eU5 Catchment Population\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSample size Proportion by catchment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSample size Allocation\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSenga\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e3022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(7432\u0026thinsp;\u0026divide;\u0026thinsp;3022) 2.46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMambwe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1511\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(7432\u0026thinsp;\u0026divide;\u0026thinsp;1511) 4.91\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNondo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1496\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(7432\u0026thinsp;\u0026divide;\u0026thinsp;1496) 4.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMpande\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1401\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e(7432\u0026thinsp;\u0026divide;\u0026thinsp;1401) 5.31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e\u003cb\u003e7432\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e\u003cb\u003e216\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eData was gathered at community level in the four respective catchment areas of Senga Hill District using simple random sample techique to select the study participants. Data on under five population was obtained from health care clinic in the respective catchment areas.\u003c/p\u003e\u003cp\u003e A structured questionnaire was used to obtain data from guardians or parents following consent. Information on socio-demographic characteristics, insecticide treated nets (ITN) condition, availability and utilization, indoor residual spraying (IRS), presence of stagnant water within 500m of household, child outdoor stay beyond 19 hours, housing condition, and travel outside district and health information about malaria risk factors was collected. The questionnaire was pre-tested to determine the quality of data to be collected. The pre-test was done at Chikunta Catchment area (not part of the study sites) that has similar population characteristics to the target catchment areas in this study.\u003c/p\u003e\u003cp\u003eA blood sample was aseptically collected into a capillary tube from each child regardless malaria signs and symptoms. The blood sample test was done by medical laboratory professional (laboratory technologists).\u003c/p\u003e\u003cp\u003eThe blood sample were tested immediately using Care Start\u003csup\u003e\u0026trade;\u003c/sup\u003e Malaria RDT which detect histidine-rich protein 2 (HRP2) of \u003cem\u003ePlasmodium falciparum\u003c/em\u003e and \u003cem\u003eplasmodium\u003c/em\u003e lactate dehydrogenase (pLDH) of \u003cem\u003ePlasmodium vivax\u003c/em\u003e according to the manufacturer\u0026rsquo;s instructions [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eData Analysis\u003c/h2\u003e\u003cp\u003eData was entered into MS Excel [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] then transferred to SPSS-V20 software for analysis [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Frequencies, proportions and summary statistics were then generated for each variable. Chi-Square (χ2) test was used to determine association between categorical variables. All variables that had p-values less than or equal to 0.250 in the bivariate analysis were included in the binary logistic regression model using a backward Stepwise (Likelihood Ratio) method. The omnibus test for model coefficients and the Hosmer and Lemeshow test was used to assess that the model-fitted the data. All statistics were considered significant at p\u0026thinsp;\u0026le;\u0026thinsp;0.050.\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003eSocio-Demographic Characteristics of the study population\u003c/h2\u003e\u003cp\u003eA total of 216 study participants were included in the study and their socio-demographic characteristics were collected (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). One hundred nineteen 55% of the study participants were female with a mean age of 2.38 months. Fifty-nine 27% were less than one year old. Majority of them (40%) were from Senga catchment (Community). Eighty-eight 41% of the households reported having only one (1) under five child. Regarding mother or caregiver related socio-demographic characteristics, majority of them (85%) were married, (40%) had no formal education and (45%) reported having no monthly income\u003c/p\u003e\u003cp\u003eInsecticide-treated bed net was the most commonly mentioned malaria prevention measures reported by 85% of the respondents. One hundred fifteen (53%) of the households reported using an ITN the day preceding the study with an average of 1.87 mosquito nets ownership per household. Of the households who reported having ITN, 59%, 17% and 0.1% of them possessed one, two and three ITNs respectively. One Hundred fifty seven (73%) of them reported that their ITN was torn / or damaged, Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003eIn this study, 18.5% of the parents/caregivers had not attained any formal education, whereas a total of 81.0% parents/caregivers had knowledge that mosquitoes were the vector for malaria transmission, the remaining (19.0%) had misconceptions about the mode of transmission. Furthermore, the majority (73.0%) of the guardians reported seeking treatment at least within 24 hours after the onset of fever (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\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\u003e; Socio-Demographic Characteristics of Under-Five Children in Senga Hill District; Northern-Province, Zambia (n\u0026thinsp;=\u0026thinsp;216).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\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=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\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\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e% (95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eChilds Location\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSenga\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40.0(0.34, 0.47)\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\u003eMambwe\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.0(0.15, 0.26)\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\u003eNondo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.0(0.15, 0.26)\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\u003eMpande\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.0(0.14, 0.25)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender of the Child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.0 (0.39, 0.52)\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=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e55.0 (0.48, 0.61)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge of Child (months)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.0 (0.22, 0.33)\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\u003e12\u0026ndash;23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.0 (0.22, 0.33)\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\u003e24\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e26.0 (0.20, 0.32)\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\u003e36\u0026ndash;47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.0 (0.15, 0.25)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eU5-Population/HH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e41.0 (0.34, 0.47)\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\u003eTwo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e35.0 (0.29, 0.42)\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\u003eThree \u0026amp; above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.0 (0.19, 0.30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eNumber of Sleeping Spaces per Household\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.4 (0.04, 0.11)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e104\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.0 (0.42, 0.55)\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\u003eThree \u0026amp; above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e45.0 (0.39, 0.52)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTravel History\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTwo weeks ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.2 (0.02, 0.07)\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\u003eThree weeks ago\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.5 (0.04, 0.11)\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\u003eA month ago or more\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.0 (0.41, 0.54)\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\u003eNot travelled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e43.0 (0.39, 0.49)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eEducational Status of caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCollege \u0026amp; above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.2 (0.02, 0.08)\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=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18.0 (0.14, 0.24)\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\u003ePrimary\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e59.0 (0.52, 0.65)\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\u003eNo formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.0 (0.14, 0.24)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarital status of caregiver\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e183\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e84.7 (0.79, 0.89)\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\u003eNot married\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.9 (0.10, 0.19)\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\u003eWidowed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.9 (0.00, 0.02)\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\u003eDivorced\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.6 (0.00, 0.03)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIncome Status of caregiver-Monthly (ZWK)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo Formal income\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21.0 (0.16, 0.27)\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\u0026lt;K200\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e103\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e48.0 (0.41, 0.54)\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\u003eBetween K200-K500\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.0 (0.13, 0.23)\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\u003eK500 \u0026amp; above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.0 (0.11, 0.20)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of ITN per Household\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e63.0 (0.57, 0.69)\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\u003eTwo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.0 (0.13, 0.23)\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\u003eThree \u0026amp; Above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e4.6 (0.03, 0.08)\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\u003eNo ITN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.0 (0.11, 0.21)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSources of ITNs\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-Procured\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.5 (0.03, 0.10)\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\u003eGRZ Mass Distribution\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e142\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e65.0 (0.59, 0.71)\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\u003eNGO Supplied\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.0 (0.09, 0.18)\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\u003eNo ITN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15.0 (0.11, 0.21)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver Knowledgeable on malaria transmission \u0026amp; Prevention\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e81.0 (0.75, 0.86)\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\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.0 (0.14, 0.25)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver Health Seeking Behaviour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e73.0 (0.67, 0.79)\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\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27.0 (0.21, 0.33)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eMalaria Prevalence\u003c/h2\u003e\u003cp\u003eThe prevalence of malaria according to the hypothesized risk factors among under five years children in Senga district are shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The overall prevalence of malaria among the under-five children in Senga Hill District was 31.9% (95% CI\u0026thinsp;=\u0026thinsp;0.26, 0.38). Children in the age group 12\u0026ndash;23 months had the highest prevalence of malaria followed by the age groups\u0026thinsp;\u0026lt;\u0026thinsp;12 months while those aged between 24\u0026ndash;35 were third highest (25.3%) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In terms of gender, the prevalence was higher among the males than the female children (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\u003eRisk factors associated with malaria amongst Under-Five Children in Senga Hill District, Northern Province Zambia, from November 2022 and August 2023 (n\u0026thinsp;=\u0026thinsp;216).\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=\"char\" char=\".\" 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\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCategory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePrevalence(95%CI)\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\u003eGender of the child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.8 (15.62, 26.87)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\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=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.1 (7.26, 16.08)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of ITNs per HH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16.7 (11.29, 22.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.030\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\u003eTwo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.3 (5.01, 12.85)\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\u003eThree \u0026amp; above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.9 (0.11, 3.30)\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\u003eNo ITN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.0 (3.24, 10.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDaily use of ITN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e146\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.6 (12.76, 23.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.007\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\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e70\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.4 (9.96, 19.75)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCorrect ITN use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14.8 (10.36, 20.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\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\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e17.1 (12.36, 22.82)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTear on ITN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.9 (20.22, 32.27)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.055\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\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e59\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.0 (3.24, 10.07)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIRS done last spray-season\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8.3 (5.01, 12.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.018\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\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e135\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.6 (18.11, 29.85)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMaterials of structure for HH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCement Blocks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.7 (1.61, 7.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\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\u003eBurnt Bricks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e182\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.5 (18.95, 30.88)\u003c/p\u003e\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\u003eMud \u0026amp; Sticks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.7 (1.61, 7.17)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver Knowledgeable on malaria prevention \u0026amp; treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e175\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e24.1 (18.53, 30.34)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.146\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\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.9 (4.65, 12.30)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCommunity Factors attributed to poor health seeking behaviour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e133\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e21.8 (16.45, 27.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.176\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\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e83\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10.2 (6.49, 15.01)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCaregiver health seeking behaviour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e25.0 (19.37, 31.33)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e0.245\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\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.9 (3.94, 11.20)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003e*Chi Square Test of Association\u003c/h3\u003e\n\u003cp\u003e4.4. \u003cb\u003eFactors associated with Risk of Malaria Infection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe results in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows that the gender was significantly associated with positive malaria RDT test result (χ\u003csup\u003e2\u003c/sup\u003e p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Further, correct use of ITN and households that reported IRS services the previous season had significantly low malaria prevalence on RDT test than those that did not (χ\u003csup\u003e2\u003c/sup\u003e p\u0026thinsp;=\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and (χ\u003csup\u003e2\u003c/sup\u003e p\u0026thinsp;=\u0026thinsp;0.018) respectively. The age of the child, number of sleeping spaces per household and educational status of the caregiver were not significantly associated with positive malaria prevalence. Similarly, Child outdoor stay after 19 hours and tear on ITN showed no association with malaria prevalence. Overgrown grass within 500m of the household also showed no association with malaria prevalence (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCaregiver/guardian knowledge status on malaria transmission \u0026amp; prevention, Cultural/beliefs attributed to poor Health seeking behaviour and Community factors attributed to poor health seeking behaviour were not significantly associated with associated with malaria prevalence in the under-five children in Senga Hill District (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cb\u003eRisk factors of under-five children being positive for malaria.\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe Omnibus test of model coefficient was significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and the Hosmer and Lemeshow test was not significant (p\u0026thinsp;=\u0026thinsp;0.853), indicating that the model fitted the data.\u003c/p\u003e\u003cp\u003eFour variables were found to be significant predicators of malaria in under-five children in Senga Hill District. Correct use of ITNs and having IRS services for mosquitoes in the previous season were found to reduce the odds of malaria, than those that did not (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Being a boy increased the odds of being positive for malaria when compared to that of a girl in under-five children. Households with a single (1) ITNs were associated with reduced odds of malaria, while households with three or more ITNs were found to be associated with increased odds of malaria, when compared to those that had no ITN (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The other variables were not significant predictors of under-five children being positive to malaria in under-five children in Senga Hill district.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e; Maximum-likelihood estimates of factors associated with malaria amongst Under-Five Children in Senga Hill District, Northern Province Zambia.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\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=\"char\" char=\".\" 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\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\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\u003cp\u003eCategories\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003en\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eodds Ratios\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e95% CI for OR\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\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\u003eGender of Child\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e98\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e3.035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.518, 6.068\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.002\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=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e118\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCorrect ITN use\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e148\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.034, 0.232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\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\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e68\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIRS done last Spray-season\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e81\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.375\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.178, 0.789\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.01\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\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e135\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNumber of ITNs / HH\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOne\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.354\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.141, 0.891\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.028\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\u003eTwo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.797\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.147, 4.325\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.792\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\u003eThree \u0026amp; above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.366\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.299, 23.598\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.001\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\u003eNo ITN\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e33\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\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMalaria is a serious public health issue that affects the health status of many people in tropical and subtropical regions of the world, including Zambia. It is important that the drivers of the burden of the disease at local level are understood so that preventive and control measures are planned and implemented. This study therefore aimed at estimating the prevalence and determination of risk factors that are associated with the prevalence of malaria amongst under five children in Senga Hill District of Northern Province of Zambia. The study found that malaria was prevalence was lower compared to the previous study findings of 48.1% and 61.3% in the surrounding districts of Chiengi and Puta, respectively, of Luapula Province, Zambia [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. One possible explanation for the low prevalence in this study could be the different study period. Data for this study was gathered during the season of high malaria transmission [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Different local malaria parasite epidemiology and variations in the way malaria intervention efforts are implemented could also be a reason [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The current prevalence, however, was higher than that reported from Choma District, Southern Province, Zambia, ranged from 2.1 percent to 3.9 percent [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe risk of contracting malaria infection was higher among children recorded from household without ITNs. This result is consistent with earlier research conducted in Zimbabwe [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] and Ethiopia [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] that showed children from households without ITNs having higher risk of contracting malaria infection. ITN usage is largely dependent on access [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. This demonstrated increased odds of ITN usage among children from households with good ITN supply compared to those with ITNs. It is normal for a mother to sleep with their young children and are therefore protected by her bed net if she has one. If a household has one bed net, the male head of the household may be given the preference to use the bed net because males are frequently the principal breadwinners in their families [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, households that reported having a single ITNs had reduced odds of malaria in under-five children compared to those whose households reported not having ITN. Results are consistent with studies including a cohort study from Kenya in which ITN use was associated with a 44% relative reduction among under-five children [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and a study from Tanzania in which the estimated protective efficacy of ITN use was 27% among children under five years old [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Nevertheless, the percentage of children using ITNs is still below the World Health Assembly [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and Ministry of Health target of 80% for an acceptable level of protection. Low rates of bed net usage reported by communities in the tropics are attributed primarily to lack of sufficient nets to cover all household members [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] but also to heat discomfort associated with poor airflow caused by bed nets [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHouseholds that reported incorrect use and/or use of worn out ITNs had an increased odds of having a child being positive for malaria compared to households reported correct use or not worn out ITN. These results are consistent to recent findings from other studies (western Kenya) that have reported lack of protective effect for ITN use and coverage that could be attributed to the state and conditions of the ITNs [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This result contrasts with a research conducted in Uganda, which found that children who used an ITN had chances that were 1.33 times higher of being positive for malaria than those of children who did not use one [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. However, this findings is in line with earlier research conducted in the East Shewa zone of the Oromiya regional state and Southern Ethiopia [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] which showed households that reported incorrect use and/or use of worn out ITNs having an increased odds of being positive for malaria amongst under-five children. Additionally, this is consistent with existing literature on ITNs reducing malaria transmission, a recent systematic review and meta-analysis of 11 studies in Ethiopia found that the use of ITNs was associated with lower odds of malaria [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. ITN use is protective against malaria for individuals using them properly and consistently, especially in Africa where the primary vectors are endophagic and anthropophilic mosquitoes [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHouseholds that reported not having been sprayed in the last 12 months had increased odds of having a malaria positive in under-five children compared to those whose households reported receiving the service within the same period. This finding is in line with the previous studies done in Nchelenge district Northern Zambia [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] and a secondary analysis of Zambia Malaria Indicator Survey 2018 (MIS) [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Children who sleep in rooms that have been sprayed in the last six months were about 68% less likely to be infected with malaria than children who did not [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], all else being equal. This finding supports similar evidence presented by Loha et al, [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] that IRS significantly reduces the incidence of falciparum malaria.\u003c/p\u003e\u003cp\u003eChemicals used in indoor residual sprays kill and repel mosquitoes. As a result, the residents of the home are shielded from mosquito bites and the risk of contracting malaria. This is in line with a Ugandan. study that found indoor residual spray to be protective and that children who lived in untreated homes were more likely to have malaria [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eGender was significantly associated with increased malaria prevalence. Male children had a high odds of being positive for malaria compared to female children. The annual incidence of malaria for males was 447 cases per 1000 population, while for females this was 413 cases per 1000 population in the year 2020 [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. The malaria inpatient case fatality rate (CFR) reported among children were at 7.2/1000 population and 6.0 / 1000 population for male and female children respectively [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].This result is consistent with earlier research conducted in Nsanje District in Malawi, which also showed that there were more malaria cases in males (51.4%) than in females (48.6%) [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. However, another study in Zambia specifically on health-seeking behaviour did not find any significant differences between boys and girls for common childhood illnesses [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Potential explanation could be the differences in population proportions with the female gender having a higher proportion compare to males [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study revealed a high prevalence of malaria among under-five children of 31.9%. The risk factors associated with malaria cases amongst under-five children in Senga Hill District were non availability of ITNs at household level and incorrect use of ITN. Other risk factors were low coverage of IRS services and (Gender) male under-five children. The results of this study demonstrate that interventions, such as the correct (proper and consistent) usage of ITN and IRS, may help prevent malaria. All relevant parties, including the local authorities and communities, should endeavor to promote correct ITN usage and 100% IRS coverage.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIDS: Acquired Immunodeficiency Syndrome, CHA: Community Health Asistants, CSO: Central Statistic Office, DDT: Dichlorodiphenyltrichloroethane, DHO: District Health Office, GRZ:Government of the Republic of Zambia, HH: HouseHold, HIV:Human Immunodeficiency Virus, HRP2:Histidine-rich protein 2, IRS: Indoor Residual Spraying, ITN:Inserticide Treated Bed Net, MoH; Ministry of Health, NGO:Non-Governmental Organisation, pLDH: Plasmodium lactate Dehydrogenase, RDT: Rapid Diagnostic Test, U5: Under-Five Children, ZWK: Zambian Kwacha and \u0026chi;2:Chi-Square\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declares no conflict of interest regarding the publication of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe protocol was ethically approved by ERES Converge Ethics Committee (Ref. No. \u0026nbsp;2023 -Oct-006, National Health Research Authority (Ref. No. NHRAR-R-2002/30/09/2023) and Operational ethical approval was sought from the Senga Hill DHO.\u003c/p\u003e\n\u003cp id=\"_Toc187388911\"\u003e\u003cstrong\u003eAcknowledgements \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Authors wish to thank Ministry of Health - Provincial Health Office: Northern Province and Senga Hill District health office for the assistance rendered in data collection, Laboratory Technologist and research assistants for their hard work in making the study a success.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;This work was not supported by any organisation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets and materials used in the analysis of this current study are readily available from the corresponding author and can be accessed upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA. Shabasantu, conducted the research work and wrote the report, drafted and edited the manuscript, M. Simuunza \u0026amp; A. Shabasantu, analysed the data, reviewed and edited the manuscript, M. Simuunza \u0026amp; A. Shabasantu, conceptualized the study, drafted the manuscript and supervised research work. All authors read and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDepartment of Public Health, Senga Hill District Health office, 420075, Senga Hill, Northern Province Zambia 2.Department of Diseases Control, 32379, School of Veterinary Medicine, University of Zambia.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Malaria Report (2020). Available online at: https://www.who.int/teams/ global-malaria-programme/reports/world-malaria-report-2020 \u003c/li\u003e\n\u003cli\u003eMasaninga, F. \u003cem\u003eet al.\u003c/em\u003e (2013) \u0026lsquo;Review of the malaria epidemiology and trends in Zambia\u0026rsquo;, \u003cem\u003eAsian Pacific Journal of Tropical Biomedicine\u003c/em\u003e, 3(2), pp. 89\u0026ndash;94. Available at: https://doi.org/10.1016/S2221-1691(13)60030-1.\u003c/li\u003e\n\u003cli\u003eNawa, M. \u003cem\u003eet al.\u003c/em\u003e (2019) \u0026lsquo;investigating the upsurge of malaria prevalence in Zambia between 2010 and 2015: a decomposition of determinants\u0026rsquo;, \u003cem\u003eMalaria Journal\u003c/em\u003e, 18(1), p. 61. Available at: https://doi.org/10.1186/s12936-019-2698-x.\u003c/li\u003e\n\u003cli\u003eAyele, D.G., Zewotir, T.T. and Mwambi, H.G. (2012) \u0026lsquo;Prevalence and risk factors of malaria in Ethiopia\u0026rsquo;, \u003cem\u003eMalaria Journal\u003c/em\u003e, 11(1), p. 195. 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(2016) \u0026lsquo;Malaria Prevalence and Its Associated Risk Factors among Patients Attending Chichu and Wonago Health Centres, South Ethiopia\u0026rsquo;, \u003cem\u003eJournal of Research in Health Sciences\u003c/em\u003e, 16(4), pp. 185\u0026ndash;189.\u003c/li\u003e\n\u003cli\u003eBiset, G. \u003cem\u003eet al.\u003c/em\u003e (2022) \u0026lsquo;Malaria among under-five children in Ethiopia: a systematic review and meta-analysis\u0026rsquo;, \u003cem\u003eMalaria Journal\u003c/em\u003e, 21(1), p. 338. Available at: https://doi.org/10.1186/s12936-022-04370-9.\u003c/li\u003e\n\u003cli\u003eTakken, W., Charlwood, D. and Lindsay, S.W. (2024) \u0026lsquo;The behaviour of adult Anopheles gambiae, sub-Saharan Africa\u0026rsquo;s principal malaria vector, and its relevance to malaria control: a review\u0026rsquo;, \u003cem\u003eMalaria Journal\u003c/em\u003e, 23(1), p. 161. 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(2004) \u0026lsquo;Historical review of malarial control in southern African with emphasis on the use of indoor residual house‐spraying\u0026rsquo;, \u003cem\u003eTropical Medicine \u0026amp; International Health\u003c/em\u003e, 9(8), pp. 846\u0026ndash;856. Available at: https://doi.org/10.1111/j.1365-3156.2004.01263.x.\u003c/li\u003e\n\u003cli\u003eSsempiira, J. \u003cem\u003eet al.\u003c/em\u003e (2017) \u0026lsquo;Geostatistical modelling of malaria indicator survey data to assess the effects of interventions on the geographical distribution of malaria prevalence in children less than 5 years in Uganda\u0026rsquo;, \u003cem\u003ePLOS ONE\u003c/em\u003e. Edited by \u0026Eacute;.M. Braga, 12(4), p. e0174948. Available at: https://doi.org/10.1371/journal.pone.0174948.\u003c/li\u003e\n\u003cli\u003eMoH, 2021. Health Management Information System.\u003c/li\u003e\n\u003cli\u003eGondwe, T., Yang, Y., Yosefe, S., Kasanga, M., Mulula, G., Luwemba, M.P., Jere, A., Daka, V., Mudenda, T., 2021. Epidemiological Trends of Malaria in Five Years and under Children of Nsanje District in Malawi, 2015\u0026ndash;2019. Int. J. Environ. Res. Public. Health 18, 12784. https://doi.org/10.3390/ijerph182312784\u003c/li\u003e\n\u003cli\u003eApuleni, G., Jacobs, C. and Musonda, P. (2021) \u0026lsquo;Predictors of Health Seeking Behaviours for Common Childhood Illnesses in Poor Resource Settings in Zambia, A Community Cross Sectional Study\u0026rsquo;, \u003cem\u003eFrontiers in Public Health\u003c/em\u003e, 9, p. 569569. Available at: https://doi.org/10.3389/fpubh.2021.569569.\u003c/li\u003e\n\u003cli\u003eAbeku, T.A. \u003cem\u003eet al.\u003c/em\u003e (2003) \u0026lsquo;Spatial and temporal variations of malaria epidemic risk in Ethiopia: factors involved and implications\u0026rsquo;, \u003cem\u003eActa Tropica\u003c/em\u003e, 87(3), pp. 331\u0026ndash;340. Available at: https://doi.org/10.1016/S0001-706X(03)00123-2.\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, Risk factors, Under-five children, Mosquitoes, Zambia","lastPublishedDoi":"10.21203/rs.3.rs-7402852/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7402852/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e. Malaria is one of the major public health problems in developing countries like Zambia. Under-five year children are the most vulnerable group affected by malaria, accounting for 61% of all malaria deaths worldwide. Despite efforts to reduce the mortality and morbidity, the disease is still a prominent health problem in Senga Hill District. Knowledge of malaria prevalence and associated risk factors among under-five children in the district is insufficient. The main objective of this study was to assess the prevalence of malaria and associated risk factors amongst Under-Five Children in the District.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e. Community-based cross-sectional study was conducted among under-five children in Senga Hill District from November 2022 to August, 2023. A total of 216 under-five children were subjected to a\u0026nbsp; Care Start\u003csup\u003eTM\u003c/sup\u003e Malaria Rapid diagnostic test which can detect histidine-rich protein 2 of \u003cem\u003ePlasmodium falciparum\u003c/em\u003e and \u003cem\u003ePlasmodium\u003c/em\u003e lactate dehydrogenase of\u003cem\u003e P. vivax \u003c/em\u003ewas used to diagnose malaria. At the same time, a structured questionnaire was administered to the parents or guardians to collect data on hypothesised risk factors for the disease.\u0026nbsp; Bivariate analysis and binary logistic regression analysis was used to identify risk factors associated with malaria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults and Conclusion.\u003c/strong\u003e The overall prevalence of malaria among the under-five children in the study district was 31.9%. Further analysis of the data indicated that correct use of Insecticide Treated Nets, those households that reported indoor residual spaying had been done within the past six-months and those that reported having a single mosquito net had significantly reduced odds of positive malaria cases in under-five children, than those than had not. Furthermore, male children had significantly higher odds of being malaria positive than females. These results show that the prevalence of malaria among the under-five children in Senga Hill was high. Thus, all concerned bodies, including the community should strengthen ownership and encourage correct use of ITNs and acceptance of IRS service acceptance to stop the transmission of the malaria.\u003c/p\u003e","manuscriptTitle":"Prevalence And Factors Associated With Malaria Amongst Under-Five Children In Senga Hill District, Northern Province Zambia. A Community Based cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-04 17:41:42","doi":"10.21203/rs.3.rs-7402852/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-23T18:24:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-14T03:59:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-10T13:28:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"101262771193484381828585329590110123475","date":"2025-10-07T16:04:06+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-07T15:18:55+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T14:42:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"185011622200987692380453877385895653348","date":"2025-10-01T01:10:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"164424275036405080567654930433376910231","date":"2025-09-30T20:26:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"21401526374181497340793112792964966665","date":"2025-09-30T18:35:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"82029784259915550138085574178061705081","date":"2025-09-30T18:33:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"283911516923979439742038641673493830090","date":"2025-09-30T18:13:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-28T18:01:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-21T14:48:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-21T14:47:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"Malaria Journal","date":"2025-08-18T21:12:46+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":"03211bb4-499b-414a-8b48-e8cc60dd15c0","owner":[],"postedDate":"September 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2026-04-07T16:06:27+00:00","versionOfRecord":{"articleIdentity":"rs-7402852","link":"https://doi.org/10.1186/s12936-026-05853-9","journal":{"identity":"malaria-journal","isVorOnly":false,"title":"Malaria Journal"},"publishedOn":"2026-03-31 15:59:17","publishedOnDateReadable":"March 31st, 2026"},"versionCreatedAt":"2025-09-04 17:41:42","video":"","vorDoi":"10.1186/s12936-026-05853-9","vorDoiUrl":"https://doi.org/10.1186/s12936-026-05853-9","workflowStages":[]},"version":"v1","identity":"rs-7402852","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7402852","identity":"rs-7402852","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}