Abstract
BACKGROUND: Malaria remains a major public health concern in low- and middle-income countries (LMICs), particularly in urban settings experiencing rapid vector adaptation. India, contributing significantly to South-East Asia's malaria burden, faces persistent urban transmission. While previous studies have explored local determinants of vector-borne diseases, large-scale analyses examining the interplay of socioeconomic factors, water availability, storage practices, and disease prevention behaviors remain limited. METHODS: We conducted a socioeconomic and health survey in the cities of Ahmedabad and Surat, India, between September and November 2023. Data were collected from 4,074 households, comprising 15,484 individuals, and we examined associations between socioeconomic indicators, water availability, storage practices, and mosquito-borne disease incidence and prevention behaviors. Logistic regressions were used to identify significant predictors. RESULTS: We find that self-reported disease prevalence was low, with 77 cases of malaria, dengue, and chikungunya, equivalent to 18.90 cases per 1,000 households. Socioeconomic factors such as wealth, caste, and family size were significantly associated with disease reporting and prevention practices. Households in the richest wealth quintile were more likely to adopt prevention measures, but less likely to perceive mosquito-related risks. Water management practices, particularly storage in clean large containers, were associated with increased disease symptoms and prevention measures, highlighting the complexity of vector control. Households with impermeable storage containers reported reduced use of active prevention measures. CONCLUSION: Socioeconomic disparities and water management practices significantly influence malaria incidence and prevention behaviors. Targeted interventions prioritizing disadvantaged households, improved water storage practices, and enhanced investments in preventive care are essential to reduce vector-borne disease vulnerability and accelerate India's malaria elimination goals.