Socio-demographic factors, housing characteristics, and clinical symptoms associated with falciparum malaria in two rapidly urbanizing areas in the Ashanti region of Ghana.

Background: Malaria has been described as a disease of poverty, affecting the poorest populations typically living in rural areas. As hitherto rural areas transition into semi-urban environments, this study investigated the prevalence of falciparum malaria and associated risk factors in two rapidly urbanizing districts in the Ashanti Region of Ghana.

Methods: A cross-sectional, hospital-based study was conducted at Agona and Mankranso Government Hospitals located within the Sekyere South and Ahafo Ano Southwest districts respectively, in the Ashanti Region of Ghana. Five µL of venous blood was obtained from suspected malaria patients and tested for malaria using rapid diagnostic test (RDT). Data on socio-demographic factors, clinical symptoms, and housing characteristics were collected using a structured questionnaire. Univariate and multivariate logistic regression analysis were performed to identify risk factors associated with malaria.

Results: A total of 1739 participants were enrolled in the study between January and June 2021 with median age of 22 years (IQR = 6-36). Overall malaria prevalence was 24.8%. Compared to > 30-year-olds, children between 0 and 5 years (aOR = 3.36) and those aged between 6 and 14 (aOR = 6.71) were three and six times more likely to test positive for malaria, respectively. Similarly, farming (aOR = 1.74), compared to other occupations, living close to stagnant water (aOR = 1.34), experiencing chills (aOR = 1.5), and vomiting (aOR = 1.93) were associated with increased odds of malaria infection. Having roofing ceiling (aOR = 0.66) and screened doors (aOR = 0.75) were associated with decreased risk of malaria. However, sleeping under insecticide-treated nets (ITNs), using mosquito coils/repellents, and indoor residual spraying (IRS) were not statistically significantly associated with infection.

Conclusion: Children between 0 and 5 years and those aged between 6 and 14 years continue to shoulder the highest burden of malaria. Efforts to improve housing characteristics such as installation of roofing ceiling, screening doors, and clearing potential mosquito breeding sites should be encouraged in these rapidly urbanizing areas.