Trends and Socioeconomic Determinants of Malaria Prevalence Among Children Under Five Years in Ghana: Evidence from the 2014–2022 Demographic and Health and Malaria Indicator Surveys
This study analyzes nationally representative data from 2014 to 2022 to show that while Ghana has achieved a significant decline in malaria prevalence among children under five, the disease burden remains disproportionately concentrated among those in poorer households, rural areas, and with lower maternal education, highlighting the need for targeted socioeconomic interventions to achieve elimination.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Malaria is a disease carried by mosquitoes that still sickens millions of children across the world, particularly in places where the weather is warm and wet. For decades, health workers have fought this disease by spreading out mosquito nets, spraying walls with insecticides, and giving medicines to those who get sick. These efforts have worked well enough to lower the number of cases in many countries, but the disease has not disappeared. A stubborn question remains: as the overall number of cases drops, does the risk drop equally for everyone? Or do the poorest and most vulnerable people still carry the heaviest burden? Understanding this is crucial because if the disease hides in specific pockets of poverty, simply handing out more nets to everyone might not be enough to stop it completely.
To answer this question, a team of researchers in Ghana looked at a massive collection of health data gathered over eight years. They examined information from four separate national surveys conducted between 2014 and 2022, focusing on more than 13,000 children under the age of five. In these surveys, health workers tested children for malaria using blood tests that could see the parasites under a microscope, which is considered the most accurate way to confirm an infection. The researchers did not just count how many children were sick; they also looked at the lives of those children. They checked the family's wealth, the mother's level of education, where the family lived, and whether they had electricity or used mosquito nets. By comparing the health results with these life details across different years, the team could see not only if the disease was getting better, but also who was being left behind.
The story the data tells is one of significant progress mixed with stubborn inequality. Over the eight-year period, the number of children with confirmed malaria dropped sharply. In 2014, about one in four children tested positive for the disease. By 2022, that number had fallen to just one in twelve. This decline is a clear sign that the country's health campaigns are working. However, when the researchers broke the numbers down by who the children were and where they lived, a different picture emerged. The improvements were not shared equally. The children who remained most at risk were consistently those from the poorest families, those living in rural villages, and those whose mothers had little or no formal schooling.
The gap between the rich and the poor was stark. In every year the researchers looked at, children from the wealthiest households were far less likely to have malaria than children from the poorest households. In 2014, a child from the richest family was less than one-fifth as likely to be infected as a child from the poorest family. By 2022, that gap had widened even further; the richest children were less than one-tenth as likely to be sick. This pattern held true regardless of the year. Similarly, where a child lived mattered greatly. Children in rural areas faced a much higher risk of infection than those in cities. In 2014, rural children were nearly twice as likely to have malaria as urban children, and this disparity persisted even as overall numbers fell. The researchers also found that older children, specifically those between four and five years old, were more likely to be infected than infants. This is likely because as children grow, they move around more, play outside, and spend less time under the protective cover of their mothers' mosquito nets, making them more exposed to mosquito bites.
Another key factor was the education of the mother. Children whose mothers had completed secondary school or higher education had a much lower chance of getting malaria compared to children whose mothers had no schooling. This link suggests that education helps families make better choices about health, such as understanding how to use mosquito nets correctly or seeking medical help quickly when a child feels sick. While the use of mosquito nets was high across the country, the researchers found that simply having a net was not the only thing that kept children safe. Wealthier families often had better housing with screened windows and finished walls, which kept mosquitoes out in the first place. They also had access to electricity and better healthcare, which helped prevent the disease from taking hold.
The study also highlighted that the disease behaves differently in different parts of the country. In some regions, like the Western and Central areas, malaria remained more common than in others, such as the capital city area. This suggests that the environment, including rainfall and vegetation, plays a big role in how easily the disease spreads in a specific location. The researchers noted that while the country has made great strides, the remaining cases are concentrated in specific groups. The children who are still getting sick are not a random mix of the population; they are overwhelmingly the ones who are poor, live in the countryside, and lack access to the benefits of education and better housing.
These findings suggest that the next phase of fighting malaria in Ghana will need to change its approach. For a long time, the strategy has been to give the same tools, like nets and medicine, to everyone. This has worked to lower the overall numbers, but it has not been enough to protect the most vulnerable. The researchers argue that to truly eliminate the disease, health efforts must go beyond just handing out supplies. They need to address the root causes of why some children are still getting sick. This means improving housing so mosquitoes cannot enter, ensuring that rural areas have good roads and clinics, and continuing to support girls' education so that mothers can protect their families better. The data shows that as long as poverty and inequality exist, malaria will find a way to persist in those communities. The path forward requires targeting the specific groups that are still suffering, rather than assuming that a blanket approach will reach everyone equally.
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