The effect of malaria prevention and control interventions on malaria morbidity among children under 5 years and pregnant women in Kintampo North Municipality, Ghana

Abstract

Background: Malaria prevention and control interventions have been scaled-up in the last decade in Ghana. We analysed the malaria surveillance data to assess the trends and the association between some malaria prevention interventions and malaria incidence in Kintampo North Municipality (KNM). Methods: We extracted data on malaria indicators and interventions from the District Health Information Management System 2 database for 2012–2016. Proportions and cumulative incidence of malaria episodes were computed using STATA 14 software. We performed correlation analysis between malaria interventions and malaria morbidity. We used linear regression models to determine the association between Long-Lasting Insecticide-treated Nets (LLINS) distribution, Intermittent Preventive Treatment in Pregnancy (IPTp) and episodes of malaria in children <5 years old and pregnant women. Results: A total of 280,890 episodes of malaria were recorded in the KNM from 2012–2016. Of the total malaria episodes, 64,953 (23.1%) were children <5 years and 57.5% (161,486/280,890) were females. The incidence of malaria in KNM declined from 650/1,000 population in 2012 to 444/1,000 population in 2016. The proportion of confirmed malaria increased from 35.2% in 2012 to 80.7% in 2015, and subsequently declined to 77.5% in 2016. The malaria Case Fatality Rate decreased by 65% in 2012 to 0.04% (16/37646) in 2016. Long Lasting Nets distribution to children showed a weak negative linear relationship with malaria morbidity in children <5 years (R= –0.20). IPTp1, IPTp2 showed a weak negative linear relationship with malaria morbidity in pregnancy, IPTp3 showed a weak positive linear relationship while IPTp4 and IPTp5 showed a negative moderate linear relationship with malaria morbidity in pregnancy. A unit increase in LLINs distribution to pregnant women was significantly associated with a reduction in malaria in pregnancy episodes by 0.21 (R2 = 0.19, 95% CI: -0.3 ─ -0.7). The IPTp first dose (IPTp1) coverage declined from 75.5% in 2012 to 69.0% in 2014, but rose to 80.9% in 2016. IPTp5 (fifth dose) increased from 0.7% in 2014 to 4.8% in 2016. A percentage increase in the coverage of only IPTp4 was associated with a reduction of malaria in pregnancy by two episodes (R2 = 0.34, 95% CI = ─ 1.68 – (─0.78). Conclusion: Malaria morbidity trend declined in the municipality. Increase coverage in LLINs and IPTp were associated with declines in malaria episodes in children <5years old and pregnancy women. Coverage of IPTp4 and IPTp5 were relatively low. Health staff should intensify promotion of the use of malaria prevention interventions among pregnant women and children < 5 years old. Midwives should promote uptake of optimal IPTp doses through health education and community antenatal outreach services.