Abstract
Malaria remains a public health concern in humanitarian settings, where displacement-related living conditions, environmental exposure, limited preventive measures, and disrupted healthcare may increase vulnerability. However, evidence on laboratory-confirmed malaria and associated factors among febrile adults in Somali IDP camps is limited. This study assessed malaria positivity and associated factors among febrile adults attending screening points in selected IDP camps in Mogadishu, Somalia. A camp-based cross-sectional study was conducted from 15 January to 14 February 2026 among febrile adults attending screening points in six selected IDP camps in Mogadishu. Of 1761 participants enrolled, 1688 with complete questionnaire and laboratory data were analyzed. Data were collected using an interviewer-administered questionnaire, and malaria was confirmed by microscopy of stained thick and thin blood smears. Frequencies, percentages, and cross-tabulations summarized participant characteristics and malaria positivity. Associated factors were identified using modified Poisson regression with robust variance, reporting adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). Mixed-effects sensitivity analysis accounted for camp-level clustering. Among 1688 participants, 488 tested positive for malaria (28.91%; 95% CI: 26.76-31.14%). Plasmodium falciparum accounted for 441 (90.37%) infections and P. vivax for 47 (9.63%); no mixed infections were detected. Although 60.66% reported household ITN availability, consistent use was limited. Malaria positivity was higher in Samaraac, Gulow, Gal'ad, Dulqad 2, and Xaqdhowr than in Bilan. No other sociodemographic, household, preventive, or healthcare-seeking factors were independently associated with positivity. Sensitivity analysis produced broadly similar findings. Almost three in every ten febrile adults attending screening points in six selected IDP camps in Mogadishu tested positive for malaria, with P. falciparum predominating and variation observed between camps. Malaria control efforts in these selected IDP camps should prioritize improving consistent ITN use and consider the observed camp-level variation when targeting prevention activities, particularly in camps with higher malaria positivity.