# Determinants of malaria infection across different districts of Khyber Pakhtunkhwa, Pakistan: a cross-sectional study

## TL;DR

This study identifies key risk factors for malaria in Pakistan's Khyber Pakhtunkhwa province, including poor housing, low income, and lack of healthcare access.

## Contribution

The study uses model selection techniques to identify specific socio-demographic and environmental determinants of malaria in a cross-sectional survey.

## Key findings

- Malaria prevalence was 24.5% among 768 participants in Khyber Pakhtunkhwa.
- Key risk factors included low income, poor housing, and distance to healthcare facilities.
- Age and family type were strongly associated with malaria infection.

## Abstract

Malaria remains a significant public health challenge, particularly in the Khyber Pakhtunkhwa (KP) province, where transmission patterns vary across districts. This study aimed to identify the determinants of malaria transmission using model selection techniques.

A cross-sectional study was conducted among general population across various districts in KP, including northern, central, and southern zones. A total of 768 participants across the province were surveyed using a structured questionnaire having socio-demographic variables, housing conditions, access to healthcare, and preventive practices. Malaria infection was diagnosed using the combo rapid diagnostic test. Logistic regression models, including automated model selection techniques, were employed to identify significant predictors of malaria.

The overall proportion of malaria among respondents was 24.5%. Bivariate analysis showed that male gender, younger age (16–30 years), joint family system, low education, poor housing conditions, low income, long distance to health centers, and non-use of bed nets were significantly associated with malaria (p < 0.05). Final multivariate model results identified gender (AOR 1.8, CI 1.1–2.8, P < 0.05), age group 16–30 years (AOR 4.2, CI 2.1–8.5, P < 0.01), age group 31–50 years (AOR 8.3, CI 4.2–16.3, P < 0.01), age group > 50 years (AOR 3.6, CI 1.9–6.7, P < 0.01), family type (AOR 2.6, CI 1.47–4.61, P = 0.001), education level (AOR 3.9, CI 2.6–5.9, P < 0.01), income level (10,000–50000 rupees) (AOR 17.8, CI 8.1–38.9, P < 0.05), large family size (AOR 11.3, CI 5.9–21.7, P < 0.05), distance of > 3 km to healthcare facilities (AOR 3.1, CI 1.8–5.3, P < 0.01), and lack of modern toilets (AOR 4.8, CI 2.4–9.4, P < 0.01) as independent risk factors of malaria prevalence.

The study highlights multiple risk factors contributing to malaria prevalence in KP. Tailored interventions, including improved access to education, healthcare, sanitation, and preventive tools like bed nets, are critical. Future studies incorporating geographic mapping and seasonal trends are recommended to strengthen targeted malaria control strategies.

The online version contains supplementary material available at 10.1186/s12936-025-05731-w.