Edusei Marian Yaa Abrafi, Alaba Olufunke, Okova Denis, Obse Amarech
Health Economics Unit, School of Public Health, Faculty of Health and Sciences, University of Cape Town, Anzio Road, Observatory, 7925, South Africa.
German-West African Centre for Global Health and Pandemic Prevention, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Malar J. 2025 May 8;24(1):147. doi: 10.1186/s12936-025-05349-y.
In a country with limited and unequally distributed resources, and plagued with malaria annually, under-five children are severely affected by this disease in Ghana. While the epidemiological burden of malaria on under-five children is well-documented, the extent and contributors of socio-economic inequalities in malaria prevalence remain under-explored. This study examined the intertemporal socioeconomic status (SES)-related inequalities in malaria prevalence among under-five children in Ghana from 2016 to 2019 and identified the key factors contributing to these disparities.
Data were drawn from the 2016 and 2019 Ghana Malaria Indicator Surveys (GMIS). The study population consisted of under-five children who were tested for malaria in both surveys. Malaria prevalence served as the outcome variable, with the wealth index used as a proxy for socio-economic status. Socio-economic inequalities in malaria prevalence were evaluated using concentration indices and concentration curves. A decomposition analysis was employed to identify the socio-economic factors contributing to the observed inequalities.
A total of 2323 children in 2016 and 1938 children in 2019 were tested for malaria. Malaria prevalence increased from 8% in 2016 to 10% in 2019. The concentration index for 2019 (Concentration Index = - 0.224; Standard Error = 0.059; p-value = 0.000) was statistically significant and negative, indicating higher malaria prevalence among children from lower socio-economic backgrounds. However, the concentration index for 2016 (Concentration Index = - 0.052; Standard Error = 0.044; p-value = 0.230) was not statistically significant. In 2019, socio-economic status, region, and ethnicity accounted for 59.38%, 23.66%, and 4.46%, respectively, of the observed inequalities in malaria prevalence.
The study revealed a persistent pro-poor inequality in malaria prevalence in under-five children in Ghana, underscoring the importance of targeted malaria control interventions. These interventions should prioritize socioeconomically disadvantaged groups to reduce inequalities in malaria prevalence which contributes to the 2030 Sustainable Development Goals of improving health (SDG 3) and reducing inequalities (SDG 10), among others.
在一个资源有限且分布不均、每年都饱受疟疾困扰的国家，加纳五岁以下儿童深受这种疾病的严重影响。虽然疟疾对五岁以下儿童的流行病学负担已有充分记录，但疟疾患病率方面社会经济不平等的程度和影响因素仍有待深入研究。本研究调查了2016年至2019年加纳五岁以下儿童中与社会经济地位（SES）相关的疟疾患病率的跨期不平等情况，并确定了导致这些差异的关键因素。
数据来自2016年和2019年加纳疟疾指标调查（GMIS）。研究人群包括在这两次调查中都接受疟疾检测的五岁以下儿童。疟疾患病率作为结果变量，财富指数用作社会经济地位的代理指标。使用集中指数和集中曲线评估疟疾患病率方面的社会经济不平等。采用分解分析来确定导致观察到的不平等的社会经济因素。
2016年共有2323名儿童和2019年共有1938名儿童接受了疟疾检测。疟疾患病率从2016年的8%上升到2019年的10%。2019年的集中指数（集中指数 = -0.224；标准误差 = 0.059；p值 = 0.000）具有统计学意义且为负数，表明社会经济背景较低的儿童中疟疾患病率较高。然而，2016年的集中指数（集中指数 = -0.052；标准误差 = 0.044；p值 = 0.230）无统计学意义。2019年，社会经济地位、地区和种族分别占观察到的疟疾患病率不平等的59.38%、23.66%和4.46%。
该研究揭示了加纳五岁以下儿童在疟疾患病率方面持续存在有利于穷人的不平等现象，凸显了有针对性的疟疾控制干预措施的重要性。这些干预措施应优先考虑社会经济弱势群体，以减少疟疾患病率方面的不平等，这有助于实现2030年改善健康（可持续发展目标SDG 3）和减少不平等（可持续发展目标SDG 10）等可持续发展目标。
