SOCIODEMOGRAPHIC AND ECOLOGICAL FACTORS ASSOCIATED WITH MALARIA AND MALARIA RECURRENCE RISK IN CHILDREN IN MSAMBWENI, KWALE COUNTY, KENYA

Abstract

Malaria remains a significant public health issue, particularly in regions where poverty and inadequate healthcare infrastructure intersect. This study aimed to evaluate the sociodemographic and ecological factors affecting malaria risk in Msambweni, Kwale County, Kenya. Additionally, it examined the spatial distribution of malarial fevers in the region. Data was gathered from a cohort of children (aged 1 to 18 years) at Msambweni County Referral Hospital between 2014 and 2018, supplemented by a nested case-control study to analyse malaria fever patterns. The nested case-control data was collected through caregiver or guardian interviews and direct observation. Malaria diagnosis was conducted using microscopy, with recurrent malaria defined as at least two confirmed infections during the study period. Overall, 2610 acute febrile illness visits were made by the 2371 children. Of the 2610 visits, 40.6% (1059/2610) had malaria parasitemia. Most of the participants (83%, 2169/2371) visited the hospital once; 174 children visited the hospital twice, 19 visited the hospital thrice and nine visited the hospital four times. Of the 2371 children, 60 (2.5%, 95%CI 1.9‒3.2) had recurrence of malaria; 51, 8 and 1 children had one, two and three recurrent malaria episodes, respectively. Recurrent malaria was linked to poor-quality housing, especially homes with dirt floors and proximity to mosquito breeding sites like rice fields. Malaria risk increased with the child’s age, lower maternal education, and poor water, sanitation, and hygiene (WASH) conditions. Children from households with poor ventilation and limited windows were also at higher risk. Targeted mosquito control, particularly near rice fields, and the use of insecticidetreated nets should be intensified. Simple house improvements, such as window screens and better roofing, are recommended to complement existing malaria control measures. The shift in malaria risk towards school-aged children suggests the need to expand interventions to target this group. Investments in housing, education, and WASH infrastructure are essential to enhance malaria control efforts in the region and support current malaria interventions