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Background <p>Malaria remains a major public health challenge in Ethiopia, affecting more than two‑thirds of the population living in endemic regions. Although local studies have explored community perceptions, nationally representative evidence on household‑level malaria risk perception is limited.</p> Objectives <p>To examine socioeconomic and geographic correlates of household malaria risk perception in Ethiopia.</p> Methods <p>We analyzed data from 9,157 households in the 2022–2023 Ethiopian National Health Equity Survey (NHES) using multilevel mixed‑effects logistic regression to account for clustering at region, zone, and woreda‑levels. Spatial analysis was conducted using Global Moran's I, and Getis Ord Gi* was used to identify geographic patterns.</p> Results <p>Overall, 76.4% of households reported feeling at risk of malaria (95% CI: 74.9–77.9). Rural households had 54% higher odds of perceiving risk compared to urban households (AOR = 1.54, 95% CI: 1.22–1.95). Households with higher education were nearly twice as likely to perceive risk (AOR = 1.89, 95% CI: 1.36–2.63), while older household heads were about half as likely (AOR = 0.49, 95% CI: 0.35–0.67). Households without a mobile phone (AOR = 0.59, 95% CI: 0.51–0.69) or bank/microfinance account (AOR = 0.59, 95% CI: 0.50–0.70) were less likely to perceive risk. Approximately 38% of the variability in malaria risk perception occurred between woredas, indicating strong local geographic clustering. Approximately 38% of the variability in perception occurred between woredas, with a Median Odds Ratio of 2.62, indicating strong local clustering. Spatial autocorrelation was significant (Global Moran’s I = 0.42, p &lt; 0.001), with 11% of areas identified as High–High clusters.</p> Conclusions <p>Household malaria risk perception in Ethiopia is shaped by socioeconomic disparities and geographic clustering. Integrating perception indicators into malaria surveillance and control strategies will strengthen precision public health and support equitable progress toward malaria elimination.</p>

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Household malaria risk perception in Ethiopia: multilevel and spatial analysis using the 2022–2023 National Health Equity Survey

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月17日

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  • Yitayh Leul,
  • Desalegn Ararso,
  • Aderajew Mekonnen Girmay,
  • Arega Zeru,
  • Girum Taye,
  • Weldemariam Bahre,
  • Kelem Berhanu,
  • Akberet Lemlem,
  • Tsegaye Getachew,
  • Hiwot Achamyeleh,
  • Yirgalem Shibiru,
  • Afewerk Alemu,
  • Ashenif Tadele,
  • Abebaw Wasie,
  • Gebeyaw Molla,
  • Fikreselassie Getachew,
  • Wogayehu Tadele,
  • Senait Alemayehu Beshah,
  • Hanim Tesfaye,
  • Desalew Zelalem,
  • Seboka Abebe Sori,
  • Sinafikish Ayele,
  • Tesfaye Dagne,
  • Teshome Kabeta,
  • Yihalem Abebe Belay,
  • Bililign Terefe,
  • Lelisa Fekadu,
  • Gemu Tiru,
  • Getachew Tollera

摘要

Background

Malaria remains a major public health challenge in Ethiopia, affecting more than two‑thirds of the population living in endemic regions. Although local studies have explored community perceptions, nationally representative evidence on household‑level malaria risk perception is limited.

Objectives

To examine socioeconomic and geographic correlates of household malaria risk perception in Ethiopia.

Methods

We analyzed data from 9,157 households in the 2022–2023 Ethiopian National Health Equity Survey (NHES) using multilevel mixed‑effects logistic regression to account for clustering at region, zone, and woreda‑levels. Spatial analysis was conducted using Global Moran's I, and Getis Ord Gi* was used to identify geographic patterns.

Results

Overall, 76.4% of households reported feeling at risk of malaria (95% CI: 74.9–77.9). Rural households had 54% higher odds of perceiving risk compared to urban households (AOR = 1.54, 95% CI: 1.22–1.95). Households with higher education were nearly twice as likely to perceive risk (AOR = 1.89, 95% CI: 1.36–2.63), while older household heads were about half as likely (AOR = 0.49, 95% CI: 0.35–0.67). Households without a mobile phone (AOR = 0.59, 95% CI: 0.51–0.69) or bank/microfinance account (AOR = 0.59, 95% CI: 0.50–0.70) were less likely to perceive risk. Approximately 38% of the variability in malaria risk perception occurred between woredas, indicating strong local geographic clustering. Approximately 38% of the variability in perception occurred between woredas, with a Median Odds Ratio of 2.62, indicating strong local clustering. Spatial autocorrelation was significant (Global Moran’s I = 0.42, p < 0.001), with 11% of areas identified as High–High clusters.

Conclusions

Household malaria risk perception in Ethiopia is shaped by socioeconomic disparities and geographic clustering. Integrating perception indicators into malaria surveillance and control strategies will strengthen precision public health and support equitable progress toward malaria elimination.