Household environmental management practices, community engagement, and self-reported malaria incidence in urban and rural communities of Malawi

Malaria control in Malawi relies primarily on long-lasting insecticide-treated nets (LLITNs) and indoor residual spraying (IRS), but transmission remains heterogeneous across districts. Previous research indicates that community-based environmental management strategies, such as routine drainage maintenance, vegetation removal, and effective household waste disposal, may reduce environmental conditions conducive to malaria vector proliferation. This study investigated the association between environmental management practices at both household and community levels and self-reported cases of malaria in Malawi. We disseminated an online survey through social media from December 2024 to February 2025, targeting adults in both rural and urban locales, resulting in 282 participants. Negative binomial regression was employed to assess the relationship between preventive measures, household-level environmental management practices, community engagement, and malaria cases during the past year. LLITNs were the most used preventive measure (62.1%). Their use was significantly associated with fewer malaria cases in rural areas (p = 0.035) but more malaria cases in urban areas (p = 0.018). Household-level (94.3%) and community-level (70.9%) environmental management practices were widely reported but showed weak and area-dependent associations with malaria incidence. Regardless of area of residence, respondents faced difficulties maintaining these practices, mostly due to time constraints (49.3%) and financial constraints (61.3%). Strengthening community education, resource support, and integration of environmental management into existing programs is likely to be needed to sustain these practices. The contrasting rural–urban patterns may reflect unmeasured differences in local transmission intensity and warrant investigation in studies with geographically resolved data.