Abstract:
Background: Despite the significant investments to control malaria infection rates over the past years, infection
rates remain significant in sub-Saharan Africa. This study investigates the association with use of large-scale malaria
interventions such as: Indoor Residual Spraying (IRS), Insecticide Treated bed-Nets (ITN), and Behaviour Change
Communication (BCC) strategies, and the prevalence of malaria among children under-five in Ghana.
Methods: Cross-sectional data on 2, 449 children aged 6 to 59 months who were tested for malaria, through Rapid
Diagnostic Test (RDT), are drawn from the recent wave of the Ghana Demographic and Health Surveys (GDHS
2014). We use a logit model to analyse the heterogeneous association between control measures and malaria
infection among under five children of different age cohorts and household poverty statuses.
Results: Our estimates suggest that IRS offers much more protection than ITN use. The odds of malaria infection
among children who sleep in IRS is significantly lower (odds ratio [OR] = 0.312; 95% CI -1.47 -0.81; p = 0.00) compared
to those who are not protected. This association is even high (odds ratio [OR] = 0.372; 95% CI -1.76 -1.02; p = 0.00)
among children in poor households protected by IRS compared to those who have no IRS protection. ITN use did not
have a significant association with malaria infection among children, except among children whose mothers have at
least secondary education. For such children, the odds of malaria infection are significantly lower ([OR] =0.545; 95% CI
= − 0.84 -0.11; p = 0.011) compared to those who are not protected. Regarding BCC strategies, we found that malaria
education through television is the best strategy to covey malaria education as it significantly reduces the odds of
malaria infection ([OR] =0.715; 95% CI = − 0.55 -0.10; p = 0.005) compared to those who do not received malaria
education via television. BCC strategy via print media has a significant but limited protection for children of educated
mothers.
Conclusion: Policy makers should direct more resources to IRS, especially in communities where the use of ITN is less
likely to be effective, such as poor and rural households. The distribution of ITNs needs to be accompanied with
education programs to ensure its best protection.
