There were three articles this week in Malaria World related to Ghana. Two articles related to vaccination programmes. A retrospective assessment of a pilot RTS,S rollout in in 2019-2021 (Adjei et al) did not even attempt to examine if the vaccine actually worked at preventing the target disease. It just examined its administration.
And despite there being no evidence that the vaccine has a benefit, another article publicises WHO and UNICEF’s plan to roll out the RTS,S/AS01 malaria vaccine to an additional 200,000 children annually in Ghana.
The third article is a study of the illness using RDT testing, the SD Bioline Malaria Ag Pf (05FK50), to detect plasmodia in children and provides interesting data. Dosoo et al carried out a community‑based cross‑sectional survey of the prevalence and factors associated with malaria among children aged 6 months to 10 years in the Greater Accra Region of Ghana.
The study was extensive. It included 17,033 children (8,741 aged 6–59 months and 8,292 aged 5–10 years) from 8,305 households. It considered age, gender, location – urban, semi-rural or rural, use of insecticide treated nets, material of house construction – walls, floors and roofs, type of windows, use of screens on windows, source of water and whether the house had electricity.
The overall prevalence of plasmodia was low (4.1%) which is a level consistent with other studies for Ghana. But this low level makes statistical certainty of any hypothesis difficult to disentangle from confounding factors. Nonetheless, interesting observations are possible.
In their univariate analysis the authors found age of the child, location of residence, presence of net in windows of the house, main source of drinking water (open water source), presence of electricity and materials used for walls, floor and roof of the house were associated with malaria positivity while ITN use, gender and type of window were not.
At least one observation is counter-intuitive, the higher occurrence in older (5-10 years) children 4.9% vs 3.3% for children aged 6–59 months. Another very interesting observation was identical occurrences (4.1%) whether the participants used insecticide treated nets (ITN) or not.
Overall the factors that suggested higher occurrences of malaria plasmodia are factors that suggest poverty. Houses with mud walls had 11.3% positivity compared to 2.7% for painted cement or brick walls. Wood or rudiment floors had ~8% compared to 1.2% for ceramic tiles. Grass roofs 15.9% compared to 1.8% for tiled roofs. Houses without window screens had 12.1% compared to (3-4%) for houses with. Houses using open water sources, 10.8% compared to 3-4% for closed or bottled water sources. The few houses without electricity had 7.7% positivity.
Children living in poverty are more likely to have markers of poor health. Experience in Europe and North America showed that when communities become better off malaria disappeared. And the negative result for ITNs strongly suggests occurrence of malaria has nothing to do with mosquitos.