Abstract
Malaria remains a major public health concern in Uganda, with prevalence in Lira City rising sharply in recent years despite ongoing interventions. Women of reproductive age are particularly vulnerable, yet little is known about their use of available preventive measures. This study assessed knowledge, attitudes, perceptions, and utilization of malaria control interventions, and examined factors influencing their uptake. A cross-sectional study was conducted with 629 randomly selected women of reproductive age in Lira City. Quantitative data were collected using semi structured questionnaires, while qualitative insights were obtained through focus group discussions. Descriptive statistics were used to summarize knowledge, attitudes, perceptions, and use of insecticide-treated nets (ITNs), intermittent preventive treatment (IPT), and indoor residual spraying (IRS). Chi-square tests were used to examine associations, and multivariate logistic regression was applied to identify predictors of utilization. Qualitative data were analyzed thematically to explore barriers to uptake, and findings were triangulated with quantitative results for validation and deeper interpretation. ITN utilization was high (84.1%), IPT uptake moderate (68%), and IRS coverage low (32.8%). Almost all participants (96.8%) were knowledgeable about ITNs, mainly gained through health workers, and expressed positive attitudes toward malaria prevention (mean score: 4.34, SD = 0.67). While most (91.9%) perceived IRS as effective, concerns included bad odor and discomfort (51.7%), doubt about safety (21.9%), and effectiveness (17.3%). Age, type of house, challenges faced with nets, marital status, and exposure to health education were significant predictors of utilization. Despite widespread ITN use, IRS uptake remains limited due to persistent concerns and misconceptions. Strengthening targeted health education, addressing community fears, and improving access to interventions are critical for enhancing malaria control in high-transmission settings like Lira City.