| dc.description.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 | en_US |
