Abstract
Background: Malaria is one of the world's primary public health concerns. In Rwanda, malaria prevention has become a significant problem against the double-barreled burden of an overstretched health system and strained financial resources. Methods: A cross-sectional survey study design was done with a primary outcome variable was an ordinal variable with three categories; no malaria, probable malaria, and confirmed malaria cases. Statistical analysis was done using survey ordinal logistic regression modeling adjusting for random effects for direct effects. Results: The 11,865 participants had a mean age of 22 years, and twothirds of the participants were females (67%). Household related variables (socioeconomic status, health insurance, age in years) showed a significant total effect on malaria infection. Socio-economic status had the most significant total effect, which was a sum of the direct and indirect effects influenced indirectly by education, health insurance and the number of rooms for sleeping in isolation. Conclusion: Poverty is still the core issue to the morbidity patterns driving the malaria. Access to health facility and health insurance has a high positive impact on decreasing disease. A better understanding of the drivers of morbidity directly and/or indirectly can better target interventions to be more efficient in those affected areas.
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