Takramah Wisdom Kwami, Afrane Yaw Asare, Aheto Justice Moses K
Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Ho, Ghana.
The West Africa Mathematical Modeling Capacity Development (WAMCAD) Consortium, Accra, Ghana.
BMC Infect Dis. 2025 Mar 28;25(1):430. doi: 10.1186/s12879-025-10787-9.
Malaria is a significant public health problem, particularly among children aged 6-59 months who bear the greatest burden of the disease. Malaria transmission is high and more pronounced in poor tropical and subtropical areas of the world. Climate change is positively correlated with the geographical distribution of malaria vectors. There is substantial evidence of spatial and temporal differences in under-five malaria risk. Thus, the study aimed to create intelligent maps of smooth relative risk of malaria in children under-5 years in Ghana that highlight high and low malaria burden in space and time to support malaria prevention, control, and elimination efforts.
The study extracted and merged data on malaria among children aged 6-59 months from the 2014 Ghana Demographic and Health Surveys (GDHS), 2016 and 2019 Ghana Malaria Indicator Surveys (GMIS). The outcome variable of interest was the count of children aged 6-59 months with a positive test on the rapid diagnostic test (RDT) result. Bayesian Hierarchical spatiotemporal models were specified to estimate and map spatiotemporal variations in the relative risk of malaria. The existence of local clustering was assessed using the local indicator of spatial association (LISA), and the points were mapped to display significant local clusters, hotpot, and cold spot communities.
The number of positive malaria cases in children aged 6-59 months decreased marginally from 946.7 (36.4%) in 2014 to 603.6 (22.9) in 2019 DHS survey periods. Smooth relative risk of malaria among children aged 6-59 months has consistently increased in the Northern and Eastern regions between 2014 and 2019. Socioeconomic and climatic factors such as household size [Posterior Mean: -0.198 (95% CrI: 3.52, 80.95)], rural area [Posterior Mean: 1.739 (95% CrI: 0.581, 2.867)], rainfall [Posterior Mean: 0.003 (95% CrI: 0.001, 0.005)], and maximum temperature [Posterior Mean: -1.069 (95% CrI: -2.135, -0.009)] were all shown as statistically significant predictors of malaria risk in children aged 6-59 months. Hot spot DHS clusters (enumeration areas) with a significantly high relative risk of malaria among children aged 6-59 months were repeatedly detected in the Ashanti region between 2014 and 2019.
The findings of the study would provide policymakers with practical and insightful information for the equitable distribution of scarce health resources targeted at reducing the burden of malaria and its associated mortality among children under five years.
疟疾是一个重大的公共卫生问题，尤其是在6至59个月大的儿童中，他们承担着该疾病的最大负担。疟疾传播率很高，在世界贫困的热带和亚热带地区更为明显。气候变化与疟疾媒介的地理分布呈正相关。有大量证据表明五岁以下儿童患疟疾风险存在时空差异。因此，该研究旨在绘制加纳5岁以下儿童疟疾平滑相对风险的智能地图，突出疟疾负担在空间和时间上的高低情况，以支持疟疾预防、控制和消除工作。
该研究从2014年加纳人口与健康调查（GDHS）、2016年和2019年加纳疟疾指标调查（GMIS）中提取并合并了6至59个月大儿童的疟疾数据。感兴趣的结果变量是快速诊断检测（RDT）结果呈阳性的6至59个月大儿童的数量。指定了贝叶斯分层时空模型来估计和绘制疟疾相对风险的时空变化。使用空间关联局部指标（LISA）评估局部聚类的存在，并绘制各点以显示显著的局部聚类、热点和冷点社区。
在2014年至2019年的DHS调查期间，6至59个月大儿童中疟疾阳性病例数从2014年的946.7例（36.4%）略有下降至2019年的603.6例（22.9%）。2014年至2019年期间，北部和东部地区6至59个月大儿童的疟疾平滑相对风险持续上升。家庭规模[后验均值：-0.198（95%可信区间：3.52，80.95）]、农村地区[后验均值：1.739（95%可信区间：0.581，2.867）]、降雨量[后验均值：0.003（95%可信区间：0.001，0.005）]和最高温度[后验均值：-1.069（95%可信区间：-2.135，-0.009）]等社会经济和气候因素均被证明是6至59个月大儿童疟疾风险的统计学显著预测因素。2014年至2019年期间，在阿散蒂地区反复检测到6至59个月大儿童中疟疾相对风险显著较高的热点DHS聚类（枚举区域）。
该研究结果将为政策制定者提供实用且有见地的信息，以便公平分配稀缺的卫生资源，目标是减轻五岁以下儿童的疟疾负担及其相关死亡率。
