Prevalence and risk factors of malaria among children under five years in High and Low altitude rural communities in the Hohoe Municipality of Ghana

Abstract

Background: Malaria due to P. falciparum remains one of the most important causes of morbidity and early mortality in endemic regions of sub-Saharan Africa. This study assessed the prevalence of malaria among children less than five years residing in High-Altitude and Low-Altitude rural communities in the Hohoe Municipality. Methods: A community-based cross-sectional survey involving children less than ve years in our selected rural communities. Information was collected on the background of the children, ownership and use of LLIN and fever. Anthropometric indices and axillary temperature were measured, as well as RDT and blood fIlm for malaria parasites and haemoglobin levels. Proportions were analyzed using Chi-square and Multivariable logistic regression was used to determine the association between dependent and independent variables. Results: A total of 325 children with 174 (53.5%) from Low-Altitude and 151(46.5%) from High-Altitude communities were surveyed. The prevalence of malaria among Low-Altitude and High-Altitude children as indicated by RDT was 56.9% and 19.9% respectively and by microscopy was 41.4% and 3.3% respectively. Ownership and use of LLIN among Low-Altitude and High-Altitude children were high and similar (96.6% vs. 97.4%) and (79.9% vs. 75.5%) respectively. High-Altitude children were 96% less likely to have malaria as compared to Low-Altitude (AOR=0.04, p<0.001). Children aged 24-35,36-47 and 48-59 months were 6.73, 4.10 and 7.16 times more likely to have malaria as compared to those aged 6-11 months (AOR=6.73, p=0.007), (AOR=4.10, p=0.050) and (AOR=7.16, p=0.007) respectively. Children with mild anaemia and low-Hb (Hb<8.0g/dl) were 2.49 and 4.15 times more likely to have malaria as compared to those with normal haemoglobin concentration (AOR=2.49, p=0.026) and (AOR=4.15, p=0.023) respectively. Those with a history of fever within one week were 4.91 times more likely to have malaria (AOR=1.74, p<0.001) respectively. Conclusion: Malaria prevalence was higher among Low-Altitude than High-Altitude children, despite high LLIN ownership and usage in both areas. Altitude, therefore, has a major efect on malaria prevalence. Age of child, history of fever within one week and anaemia were other factors associated with malaria. Additional control measures are needed to reduce the burden of malaria in Low-Altitude areas in the Hohoe municipality of Ghana