Background: Uganda has more than 2.7 million orphans or children living with non-parent
guardians (NPG) who may have limited access to malaria prevention measures compared to
children living with their biological parents (BP).
Methods: We analyzed weighted data from the 2009 Uganda Malaria Indicator Survey for
malaria and prevention measures including blood smear readings, insecticide-treated net (ITN)
ownership and use, and household characteristics for children under 5 years (under-fives) living
with either NPG or BP. Two-sided Rao Scott Chi-square tests were used to compare categorical
data and Wilcoxon rank sum tests were used for testing distribution differences between
continuous variables.
Results: Of 3933 under-fives, 707 (18%) were categorized as living with NPG during household
surveys. The median age and sex of the head of the household differed for each group; for
children living with NPG the median age was 54 (47-63) years while for children living with BP
it was 34 (28-40) years (p<.01), 46% of heads of households for children living with NPG were
male, while for children living with BP, 82% were male (p<.01). Of children living with NPG,
76% lived in a home with an ITN compared to 80% of children living with BP (p=.33). Of those
households with a bednet for sleeping, 42% (95% CI: 33-50) of children living with NPG versus
25% (95% CI: 21-28) of children living with BP did not have any children sleep under the bednet
the night before the survey (p<.01). Of children living with NPG, 45% (95% CI: 41-49) had a
positive malaria blood smear, compared to 42% (95% CI: 40-44) of children living with BP
(p=0.31). Adjusting for age, age and sex of the head of the household, wealth, and whether
children slept under a bednet the night before the survey, the odds ratio of a positive malaria
blood smear was over four times greater for children living with NPG than those living with BP
(OR: 4.2, 95% CI: 1.8-9.7, p<.01). There were statistically significant interaction terms between
guardianship and whether children slept under a bednet (p<.01) as well as age of the head of the
household (p=.02)