Abstract
BACKGROUND: Schoolchildren face a high risk of malaria, yet remain a neglected demographic in control programmes compared to pregnant women and children under five. In Tanzania, in recent years, mosquito nets have been provided to primary schoolchildren, but usage remains low. Studies on malaria knowledge and mosquito net use among schoolchildren is limited. This study aimed to assess malaria knowledge and identify factors associated with mosquito net use among schoolchildren in Muheza District, Tanzania. METHODS: A school-based cross-sectional study was conducted from December 2022 to February 2023. Schoolchildren and household heads were interviewed using an interviewer-administered questionnaire. Malaria knowledge was assessed, with scores above 50% classified as good knowledge. Modified Poisson regression analysis was used to identify factors associated with mosquito net use, with statistical significance set at p ≤ .05. RESULTS: A total of 530 schoolchildren were enrolled. Of these, 87.2% owned at least one mosquito net, and among them, 69.8% reported using a net the previous night. Overall, 90.6% of children demonstrated good malaria knowledge. Factors significantly associated with mosquito net use included urban residence (aPR 1.40; 95% CI, 1.19 to 1.62), living with parents (aPR 1.35; 95% CI, 1.14-1.58), and ownership of a television or radio (aPR 1.39; 95% CI, 1.05 to 1.83). Household-level determinants included access to electricity (aPR 2.17; 95% CI, 1.12 to 4.20), a household size-to-bed-net ratio of ≤ 2 (aPR 2.30; 95% CI, 1.36 to 3.88), and possession of a mosquito net that had been in use for ≤ 3 years (aPR 1.69; 95% CI, 1.19 to 2.41). CONCLUSION: Although most schoolchildren in Muheza District have good malaria knowledge, 30% did not use a mosquito net the night before the interview, and 3% still believed in local herbal remedies. Higher mosquito net use was associated with living in urban areas, parental care, ownership of mass-media devices, household access to electricity, a favourable household size-to-bed-net ratio, and having a relatively new mosquito net. Strengthened malaria education and targeted interventions, particularly in rural areas are urgently needed to promote consistent net use and correct misconceptions regarding malaria treatment.