Determinants of malaria among under-five children in Ethiopia: Bayesian multilevel analysis

BACKGROUND: In Ethiopia, malaria is one of the public health problems, and it is still among the ten top leading causes of morbidity and mortality among under-five children. However, the studies conducted in the country have been inconclusive and inconsistent. Thus, this study aimed to assess factors associated with malaria among under-five children in Ethiopia. METHODS: We retrieved secondary data from the malaria indicator survey data collected from September 30 to December 10, 2015, in Ethiopia. A total of 8301 under-five-year-old children who had microscopy test results were included in the study. Bayesian multilevel logistic regression models were fitted and Markov chain Monte Carlo simulation was used to estimate the model parameters using Gibbs sampling. Adjusted Odd Ratio with 95% credible interval in the multivariable model was used to select variables that have a significant association with malaria. RESULTS: In this study, sleeping under the insecticide-treated bed nets during bed time (ITN) [AOR 0.58,95% CI, 0.31–0.97)], having 2 and more ITN for the household [AOR 0.43, (95% CI, 0.17–0.88)], have radio [AOR 0.41, (95% CI, 0.19–0.78)], have television [AOR 0.19, (95% CI, 0.01–0.89)] and altitude [AOR 0.05, (95% CI, 0.01–0.13)] were the predictors of malaria among under-five children. CONCLUSIONS: The study revealed that sleeping under ITN, having two and more ITN for the household, altitude, availability of radio, and television were the predictors of malaria among under-five children in Ethiopia. Thus, the government should strengthen the availability and utilization of ITN to halt under-five mortality due to malaria.