In Malawi, children under the age of five living in different geographical areas may experience
different malaria risk factors. We compare the risk factors of malaria experienced by
children under the age of five from Zomba district, who reside in lakeshore and highland
We conducted a case control study of 765 caregivers, cases being children under-five who
were diagnosed with malaria, and obtained matched controls from local health facilities and
communities. We used a multivariate logistic regression to identify individual and household
In lakeshore areas, risk factors were households located one kilometer or less away from
stagnant water (AOR: 2.246 95% CI: 1.269 to 3.975 P-value: 0.005); or if the household had
obtained a mosquito bed net more than one year ago (AOR: 1.946 95% CI: 1.073 to 3.529
P-value: 0.028). In highland areas, risk factors were households which used a borehole/
unprotected well (AOR: 1.962 95% CI: 1.001 to 3.844 P-value 0.050), communal standpipe
(AOR: 3.293 95% CI: 1.301 to 8.332 P-value 0.012), and un-protected dug well in their
yards (AOR: 16.195 95% CI: 2.585 to 101.464 P-value 0.003) as their drinking water
sources. In highland areas, caregivers not attending health talks on malaria prevention messages was a risk factor (AOR: 2.518 95% CI: 1.439 to 4.406 P-value: 0.001).
Children under the age of five living in highland areas experience different malaria risk factors
compared to children living in lakeshore areas. Settling away from stagnant/open water source in lakeshore and encouraging caregivers to attend health talks on malaria prevention
in highlands can help reduce malaria transmission. Nevertheless, using a mosquito bed net
that is more than one year old is a common risk factor in both locations. Using new mosquito
bed nets can significantly reduce the risk of contracting malaria in children under the age of
S1 Questionnaire. The Zomba malaria case control questionnaire-English & Chichewa.
S1 Dataset. The Zomba malaria case control dataset.