Work

Women’s empowerment and childhood malaria in sub-Saharan Africa: evidence from DHS, 2013–2022

Year: 2026

Type: article

Abstract: Background: Women's empowerment is known to be associated with better access to child healthcare and household prevention practices. Children under five years of age depend on caregivers for access to malaria prevention, diagnosis, and treatment, making maternal agency potentially relevant to childhood malaria. However, evidence linking its multidimensional components to childhood malaria remains limited. We examined the association between women's empowerment and childhood malaria among children in sub-Saharan Africa and explored whether these associations varied across countries and according to the children's bed net utilisation. Methods: We conducted a cross-sectional secondary analysis of Demographic and Health Survey (DHS) data from 19 sub-Saharan African countries surveyed between 2013 and 2022. Weighted generalised linear mixed models with a primary sampling unit random intercept and country fixed effects examined associations between three Survey-based Women's Empowerment Global index domains (attitude to violence, social independence and decision-making) and malaria test positivity among children under five years of age. Then, we ran country-specific analyses to assess between-country heterogeneity and exploratory adjustment, interaction, and stratified analyses to examine whether associations varied by the children's bed net utilisation on the previous night. Results: Our sample comprised 79,739 children. Compared with low empowerment, medium (adjusted odds ratio (aOR) = 0.85; 95% confidence interval (CI) = 0.78-0.92), and high (aOR = 0.85; 95% CI = 0.80-0.90) empowerment within the attitude to violence domain were associated with lower odds of malaria positivity. Inverse associations were also observed for high social independence (aOR = 0.79; 95% CI = 0.74-0.84) and high decision-making empowerment (aOR = 0.89; 95% CI = 0.80-0.99), yet the medium levels of these domains were not clearly associated with malaria positivity. Between-country heterogeneity was identified for social independence and decision-making. Exploratory analyses suggested variation by bed net utilisation for attitude to violence and decision-making, but not social independence. Conclusions: Selected dimensions of women's empowerment were associated with lower odds of childhood malaria, with the clearest association observed for high social independence. Variation across domains, countries, and household prevention contexts supports gender-sensitive malaria research and programme planning. Longitudinal and mixed-methods studies are needed to clarify the temporality of these associations and the underlying mechanisms.

Source: Journal of Global Health

DOI: 10.7189/jogh.16.04369