Malaria and associated factors after RTS,S/AS01 vaccination in children in Komenda-Edina-Eguafo-Abrem Municipality, Ghana: A facility-based cross-sectional study
Enoch Aninagyei, Comfort Addo Boatey, Sadat Musah, Kelvin Fafah Danzo, Jonathan Seth Corley, Kelvin Senyo Tanson, Georgina ZilevuObjective
Malaria remains a major public health challenge in Ghana despite the implementation of multiple control measures, including the RTS,S/AS01 (Mosquirix) malaria vaccine. This study assessed malaria rapid diagnostic test positivity and associated factors among individuals presenting with suspected malaria in the Komenda-Edina-Eguafo-Abrem District, Ghana.
Methods
This facility-based cross-sectional study included 400 individuals of all age groups who presented with suspected malaria at the Salvation Army Hospital, Ajumako Ba. Malaria was diagnosed using rapid diagnostic tests. Data on sociodemographic characteristics, malaria control practices, environmental exposures, and vaccination status were collected using structured questionnaires. Associations were assessed using chi-square tests and binary logistic regression to identify independent predictors of malaria infection.
Results
The overall malaria rapid diagnostic test positivity rate was 20.8% (83/400). Malaria test positivity differed significantly by age (p < 0.001), with the highest burden observed among children and adolescents. Sleeping under a mosquito net the preceding night was strongly protective (adjusted odds ratio = 0.17, 95% confidence interval: 0.07–0.40, p < 0.001). In contrast, sharing mosquito nets with one person (adjusted odds ratio = 4.51, 95% confidence interval: 1.31–15.50, p = 0.02), with more than one person (adjusted odds ratio = 4.76, 95% confidence interval: 0.92–24.47, p = 0.06), prolonged nocturnal outdoor activity (adjusted odds ratio = 4.49, 95% confidence interval: 1.44–14.03, p = 0.01), and proximity to gullies or stagnant water (adjusted odds ratio = 2.49, 95% confidence interval: 1.24–5.01, p = 0.01) significantly increased malaria risk. Among children younger than 7 years, malaria prevalence was lower in RTS,S/AS01-vaccinated children (29.6%) compared to unvaccinated children (60%), although differences were not statistically significant overall. Significant associations in this age group were observed with mosquito net use, nocturnal outdoor activity, and nearby vegetation.
Conclusion
Malaria rapid diagnostic test positivity remains high in the Komenda-Edina-Eguafo-Abrem Municipality, particularly among children. Mosquito net use, nocturnal outdoor activity, and proximity to potential mosquito breeding sites were associated with rapid diagnostic test positivity. The small vaccine-eligible subgroup limited conclusions on RTS,S/AS01 vaccination. Integrated, community-based malaria control strategies remain essential for sustained reductions in malaria transmission.