Role of improved housing and high altitude significantly reduce malaria prevalence among school-age children in mainland Tanzania.

Background : Malaria remains a major public health concern in Tanzania, with school-aged children carrying a significant burden. This study assessed the impact of housing structure on malaria prevalence among school-aged children Methods : A cross-sectional survey was conducted among 6,554 school-age children from 184 districts across all 26 regions, covering 650 public primary schools in mainland Tanzania in 2021. A multi-stage cluster sampling methodology was used to ensure both geographical and demographic representation. Results : Residing in improved houses significantly reduced malaria infection prevalence among SAC (aOR: 0.48, CI: 0.33–0.70, p < 0.001). Male experienced higher malaria infection than female (aOR: 1.40, CI: 1.14–1.72, p = 0.001). Compared to school-aged children living below 750 meters above sea level, those residing at elevations of 1,250–1,750 meters had 53% lower odds of malaria infection (aOR: 0.47; CI: 0.29–0.78; p = 0.003), with an even more noticeable 93% reduction observed among those living above 1,750 meters (aOR: 0.07; CI: 0.01–0.36; p = 0.002). Sleeping under an ITN was associated with a 51% lower malaria infection (aOR: 0.49, CI: 0.34–0.71, p < 0.001). SAC in urban areas were 63% less likely to have malaria compared to those in rural settings (aOR: 0.37, CI: 0.21–0.68, p = 0.001). Conclusion. Housing improvements should be prioritized to ensure access to malaria interventions, especially in marginalized rural communities. Male children and those with severe anemia were most at risk, while higher-altitude residence, urban living, and consistent use of insecticide-treated nets were protective. Integrated, context-specific strategies combining housing, nutrition, and behavior change interventions are essential. Multi-sectoral programs linking health, housing, and social services can sustainably reduce malaria transmission and protect vulnerable children.