Malaria among children living in flood-prone villages in the Kasese District of Western Uganda: prevalence and risk factors from a cross-sectional study

Abstract Background Plasmodium falciparum infections pose significant health and economic challenges in Uganda. This study evaluated the prevalence of P. falciparum malaria among children in flood-prone villages in Kasese District, Western Uganda, and examined associated factors. Methods A total of 7,987 children 2–12 years of age from 3,702 unique households consented to participate. Demographic data and malaria prevention and treatment behaviours were documented. Capillary blood samples were aseptically collected and tested for P. falciparum circulating HRP1&2 using mRDT. Chi-square or Fisher’s exact tests were used to compare malaria prevalence, while logistic regression identified factors associated with malaria positivity. Generalized estimating equations were used to estimate associations between malaria positivity and factors including age, sex, terrain, LLIN usage. Results The P. falciparum positivity rate was 3.3% (267 of 7.987; 95% CI: 3.0–3.8) by RDT.. Among those who had fever (temp ≥ 37.5°C) at the time of the visit, the PfPR was 10.1% (40/396), compared to 3.0% (227/7,591) among those without a fever. Of the 3,702 households, 213 (5.75%, 95% CI 5.05–6.55) had at least one positive malaria case. The positivity rates varied with sub-county of residence (Kyarumba 8.0% and Karusandara 10.0%); sex (female 2.7% vs. 4.1% males); LLIN use (4.2% No vs. 2.0% yes); and altitude (low 3.8% vs. high 0.5%). Individual positivity clustered at the sub-villages was independently associated with 5–12 years (aOR 2.15, 95% CI 1.37, 3.39; p  6 occupants in the household (aOR 2.7, 95% CI 1.62, 4.63; p < 0.001). Conclusion The findings illustrate ongoing malaria transmission. Household clustering with malaria highlights the presence of hotspots in Kyarumba and Karusandara sub-counties. Targeted campaigns to enhance household ownership and usage of LLINs could further protect against malaria following severe flooding events.