Household and Maternal Characteristics Associated with Malaria Prevalence Among Children Under Five Years in Ghana: Evidence from the 2019 Malaria Indicator Survey

Background: Malaria remains a major cause of morbidity and mortality among children under five years in Ghana. This study examined household, maternal, and child characteristics associated with malaria prevalence. Methods: Data were drawn from the 2019 Ghana Malaria Indicator Survey. The analytic sample comprised 2,867 children with valid malaria rapid diagnostic test results. Analyses accounted for the survey's multistage cluster design, including primary sampling units, strata, and sampling weights. Survey-weighted descriptive statistics, Rao-Scott corrected chi-square tests, and survey-weighted logistic regression with a quasibinomial link were used. Results: Overall, 22.9% of children tested positive for malaria. At the bivariate level, child age, number of children under five, household wealth, residence, region, household net usage, electricity, television ownership, maternal education, household size, and anaemia level were significantly associated with malaria status (p < 0.05). In the fully adjusted model, children in the poorest and poorer households had higher odds of testing positive than those in the richest households (AOR = 4.13 and 3.13, respectively). Rural children had higher odds than urban children (AOR = 2.36). The highest regional odds were observed in the Eastern Region (AOR = 15.3) compared with Greater Accra. Older children and those with severe anaemia had higher odds of testing positive (AOR = 4.17 and 24.5, respectively). Maternal education significantly interacted with household wealth and household net usage. Conclusion: Household wealth, region, residence, maternal education, child age, and anaemia level were important correlates of malaria prevalence. Findings support interventions addressing socioeconomic and regional inequalities in childhood malaria.