Risk factors for malaria among children under five living in net-owning households in Mozambique from the 2022–3 Demographic and Health Survey

BACKGROUND: Children under 5 (CU5) in Mozambique are highly susceptible to malaria. Few studies focus on household-level mosquito net use using 2022-3 national survey data (n = 1924). This study analyzed household mosquito net use as a predictor of CU5 malaria positivity. METHODS: We used a cross-sectional multivariable logistic regression including households with ≥1 CU5 (one record per household). The outcome was household-level CU5 malaria positivity, defined as ≥1 rapid diagnostic test-positive CU5. Variables included household mosquito net use, CU5 net use, wealth index, and region. RESULTS: Household net use showed no significant association with CU5 malaria after controlling for wealth index. Wealth index indicated a dose-response, where middle-resource households were 43% less likely (adjusted OR [aOR] = 0.57; 95% CI 0.38 to 0.84; P < .0048) and highest-resource households were 84% less likely (aOR = 0.16; 95% CI 0.09 to 0.27; P < .0001) compared with lowest-resource households. Seven regions had higher odds of malaria positivity compared with Cidade de Maputo, with significantly higher odds (P < .0005) in Nampula (aOR = 18.97) and Cabo Delgado (aOR = 14.70). CONCLUSIONS: Campaigns should prioritize lower-wealth households and higher-risk regions to reduce CU5 positivity.