Prevalence and determinants of urban malaria among urban residents of Dilla Town, southern Ethiopia: a community-based cross-sectional study

Urban malaria is an emerging public health challenge in sub-Saharan Africa, accounting for an estimated 15–20% of malaria cases. In Ethiopia, persistent urban transmission remains an underrecognized threat to malaria elimination efforts. A community-based cross-sectional study was conducted among 360 residents of Dilla Town, southern Ethiopia, from April to June 2026. Participants were selected using multistage systematic random sampling. Socio-demographic, environmental, and behavioral data were collected using a structured questionnaire. Malaria infection was diagnosed by Giemsa-stained microscopy and multiplex qPCR. Factors associated with malaria infection were identified using multivariable logistic regression, with statistical significance set at p < 0.05. Among 360 participants, malaria prevalence was 15.6% (95% CI: 11.8%–19.3%) by microscopy and 16.9% (95% CI: 13.1%–20.8%) by qPCR. Plasmodium vivax was the predominant species. In multivariable analysis, not sleeping under long-lasting insecticidal nets (LLINs) (AOR = 3.12, 95% CI: 1.55–6.27), absence of insecticide-treated nets (AOR = 2.83, 95% CI: 1.39–5.75), household income < 3,000 ETB (AOR = 2.74, 95% CI: 1.28–5.86), and open drainage near the residence (AOR = 2.97, 95% CI: 1.50–5.86) were independently associated with malaria infection. Urban malaria remains a public health concern in Dilla Town, with Plasmodium vivax predominating. Transmission was associated with inadequate net use and unfavorable environmental conditions. Strengthening net utilization, environmental management, local surveillance, and targeted vector control is essential to reduce transmission.