Geographic Variation of Malaria Transmission and Burden Among Children Under Five Across Coastal and Inland Counties of Liberia: Analysis of the 2022 Malaria Indicator Survey

Background Like other countries in the WHO African Region, malaria remains a critical public health threat in Liberia, contributing to a significant proportion of outpatient visits, hospital admissions, and deaths, particularly among vulnerable populations such as children under five and pregnant women. Despite extensive control efforts, malaria continues to cause significant illness and death among young children and pregnant women in sub-Saharan Africa, including Liberia. This study aimed to investigate the socioeconomic, demographic and behavioral factors that drive geographic disparities in malaria burden among children under five between coastal and inland counties of Liberia. Method This study analyzed secondary data from the 2022 Liberia Malaria Indicator Survey (LMIS) that is nationally representative and included a total weighted sample size of 2,189 children under five (5) years (aged 6–59 months) and their caregivers. Descriptive statistics was done using the guide to DHS Statistics (DHS-8) to calculate the malaria prevalence as a parameter using other factors by counties and regions. A two-proportion Z-test was also done to determine statistically significant difference in malaria prevalence between coastal and inland regions of Liberia. Logistic regression was used to identify the determinants impacting malaria in children under five. Result The study revealed malaria prevalence among under-five children was 8.3% in coastal and 12.7% in inland regions. It (Z = 3.33, p = 0.001) showed a significant difference between the two regions. Logistic regression identified key predictors: children not sleeping under ITNs had 1.6 times higher odds of malaria; all anemia levels increased risk, with severe anemia showing the highest odds (AOR = 2.4; 95% CI: 2.25–54.17); children from the poorest households had the greatest risk (AOR = 11.1; 95% CI: 2.69–45.72); infants (0–11 months) had lower odds (AOR = 0.04; 95% CI: 0.01–0.16); and urban children were less likely to have malaria than rural ones (AOR = 0.6; 95% CI: 0.40–0.88). Conclusion This study revealed marked spatial heterogeneity in under-five malaria across Liberia, with inland and some coastal counties showing higher prevalence. Malaria risk was linked to anemia, child age, ITN use, household wealth, and rural residence. Targeted interventions should prioritize inland and coastal hotspots, focusing on vulnerable groups and strengthening rural health and vector control efforts.