RESUMO
Background:Insecticide Treated Nets are one of the backbones of malaria prevention in Africa where the vector mosquitos bite at night and prefer humans for feeding. Children who sleep under Insecticide Treated Nets though protected still get malaria infections. This study aimed to assess the risk factors of malaria infection among under-five childrenwhosleepunderinsecticide-treatedTreated Nets. Methodology:This was a secondary analysis of a cross-sectional survey the Malaria Indicator survey of 2021 in Zambia. Data was extracted from the database at the Ministry of Health and analysed in STATAversion 14. Data was analysed in counts and frequencies,cross-tabulations andassociationsassessed using logistic regressing using complex data analysis.Results:Atotal of 1695 children aged below five years who had slept under an Insecticide Treated Net the night before the survey were included in the study, 50.9% were female while 49.1 were male. Over a third of them (23.9%) had a fever in the previous two weeks, over half 51.9% of them had anaemia and 28.8% of them had malaria infection tested using Rapid Diagnostic tests. There was a 3.46 (95%CI 2.67 4.49) increase in the odds of having malaria ifthe under-five child was anaemic (haemoglobin less than 11mg/dl). Other factors that are usually associated with malaria infection such as younger age group, low socio-economic status, residing in rural areas and having had a fever in the previous two weeks. Conclusion:In Zambia, about a third of under-five children who slept under insecticide-treated nets still had evidence of malaria infection. Asignificant risk factor for malaria infection among the under-five children who slept under ITNs was anaemia. Other known risk factors for malaria among under-five children such as age, rural residence, wealth status, province of residence and education of guardians were not statistically significant.