Background Malaria remains a major cause of morbidity and death among children less than 5 years of age. In Togo, despite intensification of malaria control interventions, malaria remained highly prevalent, with significant heterogeneity from one region to another. The aim of this study is to explore further such regional differences in malaria prevalence and to determine associated risk factors. Methods Data from a 2017 cross-sectional nationally representative malaria indicator survey was used. Children aged 6–59 months in selected households were tested for malaria using a rapid diagnostic test (RDT), confirmed by microscopy. Univariate and multivariate logistic regression analysis were performed using Generalized Linear Models. Results A total of 2131 children aged 6–59 months (1983 in rural areas, 989 in urban areas) were enrolled. Overall 28% of children tested positive for malaria, ranging from 7.0% in the Lomé Commune region to 4% 7.1 in the Plateaux region. In multivariate analysis, statistically significant differences between regions persisted. Independent risk factors identified were higher children aged (aOR = 1.46, 95% CI [1.13–1.88]) for those above 24 months compared to those below; households wealth quintile (aOR = 0.22, 95% CI [0.11–0.41]) for those richest compared to those poorest quintiles; residence in rural areas (aOR = 2.02, 95% CI [1.32–3.13]). Conclusion Interventions that target use of combined prevention measures should prioritise on older children living in poorest households in rural areas, particularly in the regions of high malaria prevalence.

Background: Malaria remains one of the main causes of morbidity and death among children less than 5. In Togo, despite intensification of malaria control interventions, persistence in malaria prevalence was observed and appears to vary from one region to another within the country. The aim of this study is to explore further regional heterogeneities in malaria prevalence and to determine associated risk factors.Methods: Data from the cross-sectional survey of the nationally representative 2017 Togo malaria indicator survey was used. Children aged 6–59 months in the selected households were tested for malaria using the rapid diagnostic test (RDT) and the microscopy. Univariate and multivariate logistic regression analysis were preformed using Generalized Linear Models.Results: A total of 3271 children under five (2441 in rural areas and 830 in urban areas was enrolled. Overall 26% of children tested positive for malaria, as confirmed by microscopy, ranging from 5.3% in the Lomé Commune region to 43.6% in the Plateaux region. In multivariate analysis, factors associated with malaria prevalence were living in the Plateaux region (aOR=4.24, 95%CI [2.38-7.65]), and the Maritime region (aOR=2.02, 95%CI [1.13-3.66], compared to Lomé Commune region); age 24 to 35 months (aOR=1.46, 95%CI [1.13-1.88) and age 36 to 59 months (aOR=2.5, 95%CI [2.04-3.09]) ], Compared to those age 6-23 months; households within the richest wealth quintile (a.OR=0.22, 95%CI [0.11-0.41], compared to poorest) and residence in rural areas (aOR=2.02, 95%CI [1.32-3.13], compared to resident in urban). Conclusion: Interventions that targeted use of combined prevention measures, adapted to older children living in rural areas and particularly in the regions of high malaria prevalence, could result in better malaria control in Togo.