Effect of a Malaria Control Program on the Prevalence of Malaria, Fever and Anaemia in Children under Five Years in the Hohoe Municipality of Ghana: A Comparative Analysis of Cross-Sectional Surveys

Abstract

Background: Malaria and anaemia continue to adversely impact the health of children in Ghana. Hohoe is an area of intense and prolonged, seasonal malaria transmission. In 2006, malaria control programme activities which provided Insecticide Treated Bed-Nets (ITNs) to resident children under five years and Artemisinin Combination Therapies (ACTs) for the management of malaria were introduced into the Hohoe Municipality. Before the introduction of the control programme, baseline surveys were carried out in communities in the Hohoe municipality to determine the prevalence of malaria, fever, anaemia, malaria parasite density, gametocytaemia and ITN ownership and use in June and November 2006 ahead of the intervention programme. Similar surveys were conducted in 2010 after the intervention to assess changes in the earlier indicators in the same communities. This report presents an evaluation of the intervention by comparing findings before and after the malaria control interventions. Methods: In 2010, two communitybased surveys were carried out in thirty communities among children aged five years and below. The first one was at the beginning of the rainy and high malaria transmission season in June and the other was in November at the end of the rainy season. The surveys were to determine the prevalence of malaria, fever, anaemia and ITN ownership, use and effectiveness among children less * Corresponding author. M. Kweku et al. 181 than 5 years. Data were collected in the form of interviews using questionnaire and collection of biological samples. Findings were compared to those similar surveys conducted in the same communities and age groups in 2006. Pr-testi was used to analyze two sample tests for proportions and t-test was used for means. Findings: Malaria prevalence decreased by 20% [9.0% vs. 7.2%; p = 0.0.40], fever decreased by 47.8% [2.3% vs. 1.2%; p = 0.008] and anaemia decreased by 32.9% [7.8% vs. 5.3%; p = 0.002]. ITN ownership increased by 67.9% [20.8% vs. 64.8%; p < 0.001], ITN use increased by 64.2% [15.1% vs. 42.2%; p < 0.001] and ITN effectiveness increased by 41.7% [20.0% vs. 34.3%; p < 0.001]. The proportion of children with high density parasitaemia reduced by 17.9% [2.8% vs. 2.3%; p = 0.223]. Gameto-cytaemia decreased by 82.5% [0.8% vs. 0.14%; p = 0.002. Similarly data comparing 2006 and 2010 post-rainy season showed that malaria prevalence decreased by 16.8% [40.4% vs. 33.6%; p < 0.001], fever decreased by 14% [5.0% vs. 4.3%; p = 0.347] and anaemia decreased by 64.2% [12% vs. 4.3%; p < 0.001]. The proportion of children with high density parasitaemia also reduced by 69.5% [10.5% vs. 3.2%; p < 0.001] and gametocytaemia decreased by 78.5% [0.8% vs. 0.17%; p = 0.008]. Conclusion: This study suggested that there was an association between the current intervention and reduction in the prevalence of malaria, fever and anaemia. High parasite density and gametocytaemia prevalence have also significantly reduced over the five years of the introduction of the control measures. There has also been a signifi...

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