Prevalence of malaria infection and associated factors among children under five years attending health facilities in the Nandom Municipality, Upper West Region, Ghana.

BACKGROUND: Over the years, malaria has remained a significant public health concern, particularly among children under five, with sub-Saharan Africa (SSA) bearing the greatest burden due to its high morbidity and mortality rates. Despite the increasing number of cases among this vulnerable age group in Nandom Municipality, there is a paucity of information on the prevalence and associated factors of malaria for planning and evaluation of elimination strategies. This study, therefore, investigated the prevalence of malaria parasite infection and its predictive factors among children under 5 years in the Nandom Municipality. METHODS: A facility-based cross-sectional study was conducted in six health facilities in the Nandom Municipality in July 2024. Children with febrile illness and their caregivers were systematically sampled and interviewed. Both malaria Rapid Diagnostic Test (RDT) and microscopy examinations were conducted on each eligible child. Bivariate and multivariate logistic regression analyses were done, using malaria test positivity through microscopy as the outcome variable, to identify factors associated with under-five malaria at a significance level of 0.05. Results were presented in tables and graphs. RESULTS: Of the total, 404 children with febrile illness enrolled in the study, those who tested positive for malaria were 125 (30.9%; CI 26.6‒35.6), through RDT and 105 (26.0% CI 21.9‒30.5) for microscopy. Children from the Gengenkpe sub-municipality were 4.58 times more likely to test positive for malaria compared to those in the Baseble sub-municipality (aOR: 4.58; 95% CI 1.58‒13.27). Children who did not sleep under insecticide-treated bed nets (ITNs) the night before the survey were 2.01 times more likely to test positive for malaria compared to those who slept in ITNs (aOR: 2.01, 95% CI 1.02‒3.93). Children whose caregivers travelled over thirty minutes to a local pharmacy shop to access antimalarial medications had greater odds of malaria compared to those who used less travel time (aOR: 2.19, 95% CI 1.08‒4.45). CONCLUSION: Malaria prevalence among under-five children attending healthcare facilities in Nandom Municipality was 26%, which is high compared to the 2024 Ghana National Malaria Elimination Programme target of 9.7%. The prevalence is associated with the sub-district of residence, ITN usage and travel time to the local pharmacy shop. Continuous education on ITN usage is needed among caregivers on malaria during community durbars, outreach sessions, and media advertisements to reduce the burden of under-five malaria.