Geographic variation in malaria prevalence among children under five in coastal and inland counties of Liberia: analysis of the 2022 Malaria Indicator Survey.

backgroundLike other countries in the WHO African Region, malaria remains a critical public health threat in Liberia, contributing to a significant proportion of outpatient visits, hospital admissions, and deaths, particularly among vulnerable populations such as children under five and pregnant women. Despite extensive control efforts, malaria continues to cause significant illness and death among young children and pregnant women in sub-Saharan Africa, including Liberia. This study aimed to investigate the socioeconomic, demographic, biological, geographic, and behavioural factors associated with malaria infection among children under five between coastal and inland counties of Liberia.

methodsThis study analysed secondary data from the 2022 Liberia Malaria Indicator Survey that is nationally representative and included a total weighted sample size of 2,189 children under 5 years (aged 6-59 months). Descriptive statistics was done using the guide to DHS Statistics (DHS-8). A two-proportion Z-test was also done to determine statistically significant difference in malaria prevalence between coastal and inland regions of Liberia. Logistic regression was used to identify the determinants impacting malaria in children under five.

resultsThe study revealed malaria prevalence among under-five children was 8.3% in coastal and 12.7% in inland regions. It (Z = 3.33, p = 0.001) showed a significant difference between the two regions. Logistic regression identified key predictors: children not sleeping under ITNs had 1.5 times higher odds of malaria; all anaemia levels increased risk, with severe anaemia showing the highest odds (AOR = 6.2; 95% CI 2.34-14.81); children from poor households had the greatest risk (AOR = 6.4; 95% CI 3.06-13.27); infants (0-11 months) had lower odds (AOR = 0.04; 95% CI 0.01-0.17); and urban children were less likely to have malaria than rural ones (AOR = 0.6; 95% CI 0.40-0.86).

conclusionThis study revealed that malaria infection among children under five varies substantially across Liberia, with inland and some coastal counties showing higher prevalence. Malaria risk was linked to anaemia, child age, ITN use, household wealth, and place of residence. Targeted interventions should prioritize inland counties and high-risk groups, particularly children under five from poor households, non-ITN users, anaemic children, and rural residents.