Epidemiological characteristics, prevention and control status, and factors associated with malaria infection among overseas Chinese workforce in Uganda

Malaria remains a major global public health challenge, particularly in sub-Saharan Africa. Overseas Chinese workforce in Uganda face an increasing risk of malaria infection. This study aimed to characterize the epidemiological features and current status of malaria prevention and control among this population, and to identify factors associated with malaria infection. A cross-sectional study was conducted between 2022 and 2023 by members of the 22nd Chinese medical team (China-Uganda Friendship Hospital (Naguru)) to Uganda. An online questionnaire was distributed to overseas Chinese workforce residing in Uganda, with guidance provided to ensure accurate completion. The survey collected data on socio-demographic characteristics, malaria infection and treatment status, malaria prevention knowledge, attitudes, and practices, access to preventive materials and measures, and prevention needs. A total of 798 valid responses were obtained, covering participants from 32 districts across Uganda, including capital city Kampala. Data were analyzed using descriptive statistics, bivariate analyses, and multivariable logistic regression. Multivariable logistic regression was used to estimate adjusted odds ratios, and a two-sided P value < 0.05 was considered statistically significant. Malaria infection was defined as self-reported history of malaria during the stay in Uganda. A total of 798 valid online questionnaires were collected and analyzed, of which 44.5% (n = 355) of respondents reported a history of malaria infection. Multivariable logistic regression analysis revealed that being male (AOR = 1.92, 95% CI: 1.27–2.91), having a higher number of visits to Uganda (AOR = 1.28, 95% CI: 1.06–1.53), longer duration of work and residence in Uganda (AOR = 1.38, 95% CI: 1.19–1.61), negative attitudes on malaria prevention (AOR = 2.49, 95% CI: 1.41–4.40), higher mosquito biting frequency (AOR = 1.31, 95% CI: 1.10–1.56), having a higher presence of malaria cases in the surrounding population (AOR = 1.95, 95% CI: 1.51–2.51), and access to antimalarial drug supplies (AOR = 1.48, 95% CI: 1.04–2.11) were significantly associated with an increased likelihood of malaria infection. In contrast, respondents with a bachelor’s degree or higher education level (AOR = 0.65, 95% CI: 0.44–0.97) and those living with a spouse (AOR = 0.57, 95% CI: 0.36–0.91) had a lower likelihood of malaria infection. This study revealed a substantial burden of self-reported malaria infection among Chinese workforce in Uganda, with recurrent infections underscoring the significant health threats faced by this population. To effectively reduce the malaria burden, an integrated malaria control strategy is required. The strategy should include improving employees’ living conditions and access to healthcare, optimizing work and residential environments to reduce mosquito biting frequency, and implementing systematic and continuous health education programs to strengthen malaria-related knowledge, preventive awareness, and self-efficacy. Establishing a standardized and sustainable supply system for preventive materials and antimalarial drugs is also critical. Comprehensive implementation of these measures will not only protect the health of overseas employees and support stable business operations, but also contribute to sustaining China’s malaria-free status and provide valuable guidance for global malaria control efforts.