Using the Ghana malaria indicator survey to understand the difference between female and male-headed households and their prevention and testing for malaria among children under 5

Exploring the role of spending on malaria incidence in Uganda using the auto-regressive distributed lag approach

BACKGROUND

Malaria has remained a persistent global health problem. Despite multiple government and donor initiatives to eradicate malaria and its detrimental effects on Uganda's health outcomes, the incidence of malaria is worrying as it appears higher than the average of 219 cases per 1000 for sub-Saharan Africa for the period 2017-2018. This study investigated the effect of public and private healthcare spending on the incidence of malaria in Uganda.

METHODS

Employing time series data spanning over 20 years from the first quarter of 2000 to the last quarter of 2019, the study builds a model based on the Grossman framework for analysing demand for health. The estimation technique used was the ARDL approach that takes into account reverse causality and incidental relationships. Prior to the adoption of the technique, a bounds test was performed to determine whether the variables contained in the model have a long-term relationship. Several diagnostic tests for serial correlation, functional normality, and heteroskedastic specification error were carried out to verify the ARDL model's goodness of fit. Additionally, the cumulative sum of recursive (CUSUM) and cumulative sum of squares of recursive residuals (CUSUMSQ) were used to test model stability.

RESULTS

The results indicate that in the long run, an increase in public spending of one percent significantly reduces malaria incidence by 0.196 at the 10 percent level of significance. On the other hand, there is no significant evidence of private health expenditure's effect on malaria incidence. However, in the short run, public spending reduces malaria incidence by a smaller magnitude of 0.158 percent relative to the long-run. Still, private expenditure is found to exhibit no significant effect. Additional findings point to the importance of GDP per capita and urban population growth in reducing malaria incidence, whereas female unemployment, income inequality, as well as female-headed household. In the short run, however, the female-headed households and urban population growth are found to significantly reduce malaria incidence while an improvement in regulatory quality decreases malaria incidence by 0.129 percent.

CONCLUSIONS

There is need for further government interventions to reduce malaria incidence in the country via budget allocation, as well as the strengthening of programmes to raise household income to support private health spending, in addition to the development of strategies to promote well-planned and organized urban centres.

Identifying childhood malaria hotspots and risk factors in a Nigerian city using geostatistical modelling approach

Malaria ranks high among prevalent and ravaging infectious diseases in sub-Saharan Africa (SSA). The negative impacts, disease burden, and risk are higher among children and pregnant women as part of the most vulnerable groups to malaria in Nigeria. However, the burden of malaria is not even in space and time. This study explores the spatial variability of malaria prevalence among children under five years (U5) in medium-sized rapidly growing city of Akure, Nigeria using model-based geostatistical modeling (MBG) technique to predict U5 malaria burden at a 100 × 100 m grid, while the parameter estimation was done using Monte Carlo maximum likelihood method. The non-spatial logistic regression model shows that U5 malaria prevalence is significantly influenced by the usage of insecticide-treated nets-ITNs, window protection, and water source. Furthermore, the MBG model shows predicted U5 malaria prevalence in Akure is greater than 35% at certain locations while we were able to ascertain places with U5 prevalence > 10% (i.e. hotspots) using exceedance probability modelling which is a vital tool for policy development. The map provides place-based evidence on the spatial variation of U5 malaria in Akure, and direction on where intensified interventions are crucial for the reduction of U5 malaria burden and improvement of urban health in Akure, Nigeria.

Baseline susceptibility of Anopheles gambiae to clothianidin in northern Ghana

BACKGROUND

Clothianidin, an insecticide with a novel mode of action, has been deployed in the annual indoor residual spraying programme in northern Ghana since March 2021. To inform pragmatic management strategies and guide future studies, baseline data on local Anopheles gambiae sensu lato (s.l.) susceptibility to the clothianidin insecticide were collected in Kpalsogu, a village in the Northern region, Ghana.

METHODS

Phenotypic susceptibility of An. gambiae mosquitoes to clothianidin was assessed using the World Health Organization (WHO) insecticide resistance monitoring bioassay. The WHO cone bioassays were conducted on mud and cement walls sprayed with Sumishield 50 wettable granules (WG) (with clothianidin active ingredient). Daily mortalities were recorded for up to 7 days to observe for delayed mortalities. Polymerase chain reaction (PCR) technique was used to differentiate the sibling species of the An. gambiae complex and also for the detection of knock down resistance genes (kdr) and the insensitive acetylcholinesterase mutation (ace-1).

RESULTS

The WHO susceptibility bioassay revealed a delayed killing effect of clothianidin. Mosquitoes exposed to the cone bioassays for 5 min died 120 h after exposure. Slightly higher mortalities were observed in mosquitoes exposed to clothianidin-treated cement wall surfaces than mosquitoes exposed to mud wall surfaces. The kdr target-site mutation L1014F occurred at very high frequencies (0.89-0.94) across all vector species identified whereas the ace-1 mutation occurred at moderate levels (0.32-0.44). Anopheles gambiae sensu stricto was the most abundant species observed at 63%, whereas Anopheles arabiensis was the least observed at 9%.

CONCLUSIONS

Anopheles gambiae s.l. mosquitoes in northern Ghana were susceptible to clothianidin. They harboured kdr mutations at high frequencies. The ace-1 mutation occurred in moderation. The results of this study confirm that clothianidin is an effective active ingredient and should be utilized in malaria vector control interventions.

Prevalence and determinants of malaria infection among pregnant women attending antenatal clinic in Ejisu government hospital in Ghana: A cross-sectional study

INTRODUCTION

Malaria in pregnancy is a global public health problem with the majority of its impact seen in sub-Saharan Africa. Pregnant women with malaria infection are at risk of adverse maternal outcomes. In Ghana, malaria in pregnancy accounts for about 17.6% of outpatient department attendance. Ashanti region is among the three regions with the highest malaria prevalence in pregnancy, particularly in the Ejisu Municipality. The study, therefore, assessed the prevalence and determinants of malaria infection among pregnant women seeking antenatal care at the Ejisu Government Hospital in Ghana.

METHODS

A cross-sectional study design with a convenience sampling technique was used to select 140 respondents for the study. Primary data such as age and residence of respondents were collected using a questionnaire and secondary data such as gestational age and Sulphadoxine Pyrimethamine (SP) administration were collected from clients' maternal health record booklet. Bivariate and multivariate logistic regression analysis were used to assess the association between the malaria infection and the independent variables, and a p-value of < 0.05 was considered statistically significant.

RESULTS

The overall prevalence of malaria in pregnancy was 24 (17.1%). Most of the respondents had received counselling and health education 126 (90%), two or more doses of SP 95 (87.2%), Insecticide Treated Net (ITN) 99 (70.7%) and were sleeping under ITN 104 (74.3%). Multivariate logistic regression analysis showed a statistically significant association between malaria infection and sleeping under ITN (AOR = 0.05; 95% CI = 0.01-0.28, p< .001), the use of insecticide mosquito spray (AOR = 0.27; 95% CI = 0.09-0.84, p = .045) and reason for not using ITN due to the use of other preventive measures (AOR = 0.06; 95% CI = 0.01-0.61, p = .017).

CONCLUSION

There was a high prevalence of malaria infection among study respondents despite the high usage of preventive measures for malaria in this study. It is therefore crucial that stakeholders in malaria control identify effective strategies to curb malaria transmission globally.