Okova Denis, Lukwa Akim Tafadzwa, Edusei Marian, Bodzo Paidamoyo, Atta-Obeng Christian, Chiwire Plaxcedes, Hongoro Charles
Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Division of Family Medicine, Family, Community and Emergency Care (FaCE), Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
Malar J. 2025 Aug 22;24(1):273. doi: 10.1186/s12936-025-05512-5.
Malaria remains a leading cause of morbidity and mortality among pregnant women and children under five in sub-Saharan Africa. Despite over two decades of efforts including insecticide-treated net (ITN) distribution and intermittent preventive treatment in pregnancy (IPTp), universal and equitable coverage has not been achieved. In Ghana, coverage disparities persist, particularly along socioeconomic and geographic lines. This study investigates temporal trends and decomposes both within-group and between-group socioeconomic inequalities in ITN use and IPTp coverage among children and pregnant women in Ghana.
This study analysed nationally representative data from the Ghana Demographic and Health Surveys (2003, 2008, 2014, and 2022), focusing on ITN use among pregnant women and children under five, and IPTp uptake. Inequality was assessed using the Erreygers normalized concentration index (ENCI) and the Theil index (GE 2). Theil indices were then decomposed to quantify within- and between-group contributions by socioeconomic status (SES) and residence (urban versus. rural).
ITN use among under-five children increased modestly from 58.1% (2003) to 62.9% (2022); among pregnant women, usage fluctuated but returned to 60% in 2022. IPTp coverage rose markedly from 0.85% (2003) to 60% (2022). ENCI values showed that ITN use was consistently pro-poor, becoming more concentrated among the poor over time (e.g., ENCI for pregnant women: - 0.04 in 2003 to - 0.32 in 2022). In contrast, IPTp coverage shifted to a pro-rich distribution from 2008 onwards. Theil decomposition revealed that most observed inequalities were driven by within-group disparities (e.g., within SES or residence categories), though between-group inequality increased over time particularly for IPTp. For example, in 2022, 85% of ITN inequality among pregnant women was within SES groups, while 18% was attributable to between-group differences.
Despite overall improvements in malaria prevention uptake, substantial socioeconomic inequalities persist especially within social and geographic subgroups. Equity-focused strategies must complement national-level efforts by addressing barriers specific to underserved populations, including informal urban settlements and remote rural communities. Policymakers must prioritize targeted, locally responsive interventions to reduce both within- and between-group disparities and achieve Ghana's malaria elimination and health equity goals.
在撒哈拉以南非洲地区，疟疾仍然是孕妇和五岁以下儿童发病和死亡的主要原因。尽管经过二十多年的努力，包括分发经杀虫剂处理的蚊帐（ITN）和孕期间歇性预防治疗（IPTp），但仍未实现普遍和公平的覆盖。在加纳，覆盖差距依然存在，尤其是在社会经济和地理方面。本研究调查了加纳儿童和孕妇使用ITN及IPTp覆盖情况的时间趋势，并分解了组内和组间的社会经济不平等情况。
本研究分析了来自加纳人口与健康调查（2003年、2008年、2014年和2022年）的具有全国代表性的数据，重点关注孕妇和五岁以下儿童对ITN的使用情况以及IPTp的接受情况。使用埃雷格斯归一化浓度指数（ENCI）和泰尔指数（GE 2）评估不平等情况。然后对泰尔指数进行分解，以量化社会经济地位（SES）和居住情况（城市与农村）在组内和组间的贡献。
五岁以下儿童使用ITN的比例从2003年的58.1%略有上升至2022年的62.9%；孕妇的使用率有所波动，但在2022年回升至60%。IPTp的覆盖率从2003年的0.85%显著上升至2022年的60%。ENCI值表明，使用ITN一直有利于穷人，且随着时间的推移，穷人中的集中度更高（例如，孕妇的ENCI：2003年为-0.04，2022年为-0.32）。相比之下，自2008年起，IPTp的覆盖情况转向有利于富人的分布。泰尔分解显示，观察到的大多数不平等是由组内差异驱动的（例如，在SES或居住类别内），尽管组间不平等随着时间的推移有所增加，尤其是对于IPTp。例如，在2022年，孕妇中85%的ITN不平等存在于SES组内，而18%可归因于组间差异。
尽管疟疾预防措施的总体采用情况有所改善，但社会经济不平等现象依然严重，尤其是在社会和地理亚组内部。以公平为重点的战略必须通过解决服务不足人群（包括城市非正式定居点和偏远农村社区）特有的障碍来补充国家层面的努力。政策制定者必须优先考虑有针对性的、因地制宜的干预措施，以减少组内和组间的差距，实现加纳的疟疾消除和健康公平目标。
