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Modeling the complex relationship and contribution of these factors to malaria infection is essential for ultimate malaria elimination. Hence, the aim of this study is to model the direct and indirect effect of factors affecting the risk of urban malaria infection in eastern Ethiopia where an invasive malaria vector has been recently detected.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A facility based cross-sectional study was conducted among 329 febrile urban resident patients visiting public health facilities of Dire Dawa city using an interviewer administered questionnaire. Structural Equation Modeling (SEM) was done to identify the direct and indirect effects of factors for malaria infection. Lavaan (Latent variable analysis) package was used in R and diagonally weighted least square (DWLS) estimation method was employed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The confirmatory factor analysis indicated that all selected factors were significantly loaded on their respective latent variables. The direct effect of the final model indicated that wealth index had a negative statistically significant effect on insecticide treated nets (ITN) utilization (-0.66;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001) and knowledge on malaria and its prevention (-0.63;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Attitude had positive effect on ITN utilization (0.16;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.049) and having history of travel outside the city had significant positive effect on malaria infection (0.969;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). The indirect effect analysis revealed two pathways in which attitude and utilization as the mediating factor significantly influenced the risk of malaria infection (indirect path coefficient=-0.091;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.038) and (indirect path coefficient\u2009=\u20090.029;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.048) respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SEM is an effective technique that identified the direct and indirect effects of wealth index, ITN utilization, knowledge, attitude and history of travel on risk of urban malaria infection. Hence, strengthening holistic approach and urban-targeted malaria interventions should be enhanced to prevent and control malaria infection in urban settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-025-11841-2","type":"journal-article","created":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T10:30:58Z","timestamp":1762338658000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Modeling urban malaria infection in Anopheles stephensi hotspot area in Eastern Ethiopia: application of Structural Equation Modeling"],"prefix":"10.1186","volume":"25","author":[{"given":"Hailu","family":"Merga","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teshome","family":"Degefa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zewdie","family":"Birhanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ephrem","family":"Abiy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-Chieh","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guiyun","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delenasaw","family":"Yewhalaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,5]]},"reference":[{"key":"11841_CR1","volume-title":"World malaria report 2023","author":"WHO","year":"2023","unstructured":"WHO. 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No: JUIH\/IRB\/6022). Further, permission was obtained from Dire Dawa administration Health Bureau and head of each health facility. Then, before the onset of the study, permission was sought from each study participant and written informed consent\/assent was obtained from study participants\/parents\/guardians\/in case of participants aged below 18 years. The respondents were informed that participating in the study was voluntary and those who were no longer interested were free to opt-out at any time. To ensure confidentiality, anonymity was ensured. Those patients who were found positive for malaria were treated at the health facility. 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