Understanding Socio-Demographic, Environmental, and Behavioral Factors Associated with Malaria Infection Among Children Under Five Years in Tanzania: A Rapid Review

Malaria is a global public health concern and remains one of the major causes of morbidity and mortality among children under five in sub-Saharan Africa, with Tanzania bearing a substantial share of the burden. Although multiple studies have examined risk factors, evidence on socio-demographic, environmental, and behavioral determinants remains fragmented. A comprehensive synthesis of this evidence is critical to guide context-specific interventions. This rapid review synthesised studies published between January 2021 and December 2025 to identify factors associated with malaria infection among children under five. Data on study characteristics and key findings were extracted systematically, verified, and synthesized narratively. The results were organised into socio-demographic, environmental, and behavioural determinant domains. Twenty-one studies met inclusion criteria. Cross-sectional designs predominated (n=8, 38%), followed by randomized trials (n=5, 24%). Most studies were community-based (n=19, 91%) and focused either exclusively on children under 5 (n=8, 38%) or on mixed-age groups (n=6, 29%). Malaria infection among children under five in Tanzania is consistently associated with child age, maternal education, and household socio-economic status. Environmental factors such as housing quality, sanitation, and proximity to mosquito breeding sites, along with behavioral factors including ITN use, care-seeking, and nighttime outdoor exposure, also influence risk. These determinants interact within ecological and socio-economic contexts, underscoring the need for integrated, context-specific interventions. Strengthening vector control, improving housing and environmental conditions, promoting protective behaviors, and addressing socio-economic inequities are key to reducing malaria. This review provides evidence to guide targeted interventions and future research for accelerating malaria control in Tanzania.