Regional heterogeneity of malaria prevalence and associated risk factors among children under five in Togo: evidence from a national malaria indicators survey

Abstract

Background Malaria remains a major cause of morbidity and death among children less than 5 years of age. In Togo, despite intensification of malaria control interventions, malaria remained highly prevalent, with significant heterogeneity from one region to another. The aim of this study is to explore further such regional differences in malaria prevalence and to determine associated risk factors. Methods Data from a 2017 cross-sectional nationally representative malaria indicator survey was used. Children aged 6–59 months in selected households were tested for malaria using a rapid diagnostic test (RDT), confirmed by microscopy. Univariate and multivariate logistic regression analysis were performed using Generalized Linear Models. Results A total of 2131 children aged 6–59 months (1983 in rural areas, 989 in urban areas) were enrolled. Overall 28% of children tested positive for malaria, ranging from 7.0% in the Lomé Commune region to 4% 7.1 in the Plateaux region. In multivariate analysis, statistically significant differences between regions persisted. Independent risk factors identified were higher children aged (aOR = 1.46, 95% CI [1.13–1.88]) for those above 24 months compared to those below; households wealth quintile (aOR = 0.22, 95% CI [0.11–0.41]) for those richest compared to those poorest quintiles; residence in rural areas (aOR = 2.02, 95% CI [1.32–3.13]). Conclusion Interventions that target use of combined prevention measures should prioritise on older children living in poorest households in rural areas, particularly in the regions of high malaria prevalence.

Bayesian spatiotemporal modelling and mapping of malaria risk among children aged below 5 years in Ghana

“…It has been revealed in the current study that rural areas have a higher risk of malaria among children aged 6-59 months. The same results were found in a recent study that used data from a cross-sectional nationally representative malaria indicator survey conducted in Togo in 2017 [28].…”

Care-seeking behaviour among febrile children under five in Togo

“…Interventions to improve universal primary health care coverage in terms of geographical accessibility, literacy and health education are to be encouraged. The regional differences highlighted are additional considerations for such interventions [ 31 ]. Qualitative studies could provide a further understanding of advice or care-seeking behaviour for fever among children in Togo.…”

Malaria risk mapping among children under five in Togo

“…Children under five years of age represented 31.6% of cases 2 , 3 . According to the distribution of cases reported in the country by the National Malaria Control Program (PNLP), malaria infection is regionally heterogeneous: in 2019, malaria prevalence was 18% in the Lomé commune region, 39% in the Plateaux region and 42% in the Kara region 4 . A recent study in Togo on spatio-temporal analysis used district-level health system data (2008–2017) to analyze the trend and change in malaria incidence 5 .…”

“…A recent study in Togo on spatio-temporal analysis used district-level health system data (2008–2017) to analyze the trend and change in malaria incidence 5 . Other studies have explored the burden of malaria in children under five 6 – 9 at the regional level 4 using individual and household level factors, but contextual factors such as the climate and environmental may play an important role in malaria transmission also 10 . Thus, the spatial variation observed may be related to different ecological conditions, variations in health care systems, and socioeconomic differences or intervention coverage 11 .…”