Women's empowerment and childhood malaria in sub-Saharan Africa: evidence from DHS, 2013-2022.
6 affiliations
- 1Department of Global Health, School of Public Health, Peking University, Beijing, China.
- 2Institute for Global Health and Development, Peking University, Beijing, China.
- 3Institute of Food and Nutrition Development, Ministry of Agriculture and Rural Affairs, Beijing, China.
- 4Peking University First Hospital, Xicheng District, Beijing, China.
- 5PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Jln Tungku Link, Bandar Seri Begawan, Brunei Darussalam.
- 6Public Health Department, Faculty of Medicine, Cairo University, Egypt.
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.
Related
- Malaria Control and Endemic Burkitt Lymphoma in Sub-Saharan Africa: Evidence from a 17-Country Meta-Analysis
- Targeting childhood malaria: insights from multi-country DHS data in Sub-Saharan Africa
- Women's empowerment and its association with intimate partner violence in sub-Saharan Africa: a study using recent demographic and health surveys.
- Household and health system cost of malaria in sub Saharan-Africa: a systematic review.
- The past and future impact of climate change on childhood malaria in Africa
BibTeX
@article{pei2026womens,
title = {{Women's empowerment and childhood malaria in sub-Saharan Africa: evidence from DHS, 2013-2022.}},
author = {Zhongfei Pei and Xin Ru and Xiaoyi Yu and Shuduo Zhou and Sok King Ong and Maha El Rabbat and Ming Xu},
journal = {Journal of global health},
year = {2026},
month = oct,
doi = {10.7189/jogh.16.04369},
url = {https://europepmc.org/article/MED/42924630},
note = {CC BY},
}
RIS
TY - JOUR
TI - Women's empowerment and childhood malaria in sub-Saharan Africa: evidence from DHS, 2013-2022.
AU - Zhongfei Pei
AU - Xin Ru
AU - Xiaoyi Yu
AU - Shuduo Zhou
AU - Sok King Ong
AU - Maha El Rabbat
AU - Ming Xu
PY - 2026
DA - 2026/10/23
JO - Journal of global health
DO - 10.7189/jogh.16.04369
UR - https://europepmc.org/article/MED/42924630
AB - 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.
SN - 2047-2978
SN - 2047-2986
ER -