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Background <p>Malaria remains a major public health concern in Ghana, but regional variations in clinical presentation, parasitaemia, anaemia, and preventive measure uptake are not well characterized. This study assessed these parameters across three ecological zones.</p> Methods <p>A cross-sectional study was conducted among 459 participants in Ho (forest zone), Keta (coastal zone), and Nkwanta (savannah zone). Clinical assessments recorded signs and symptoms, malaria was diagnosed using rapid diagnostic tests (RDTs) and microscopy, and parasitaemia was categorized as low, moderate, high, or hyper-parasitaemia. Haemoglobin concentration was measured to determine anaemia prevalence and severity, while insecticide-treated net (ITN) ownership and usage were also assessed. Data were summarized as means with standard deviations and proportions, with site comparisons using Chi-square/Fisher’s exact, Kruskal–Wallis, and Mann–Whitney tests.</p> Results <p>Overall malaria prevalence was 15.2% by RDT and 9.7% by microscopy, highest in Nkwanta. Most cases were uncomplicated (88.7%), though severe malaria anaemia was most frequent in Nkwanta (24.4%). Fever (86.9%) and anaemia (79.3%) were the most common signs, while headache (64.9%), nausea (55.8%), and chills/rigor (47.1%) were the leading symptoms. Geometric mean parasite density was significantly higher in Keta (11,715.6 parasites/µL) compared to Nkwanta (7616.4) and Ho (5880.1; p = 0.0003). Anaemia prevalence was 79.3% overall, with location-specific differences (Nkwanta: 94.1%, Keta: 82.9%, Ho: 69.8%; p &lt; 0.0001), and was most severe among hyper-parasitaemic individuals. ITN ownership was 69.7% overall, highest in Nkwanta (85.2%), but usage among owners was only 61.3%, with significant location differences (Nkwanta: 70.4%, Keta: 60.0%, Ho: 51.6%; p = 0.008).</p> Conclusion <p>Malaria presentation, parasite density, anaemia burden, and LLIN uptake vary significantly across ecological zones in Ghana. These findings underscore the inadequacy of a one-size-fits-all approach and reinforce the importance of Ghana’s subnational tailoring (SNT) strategy, with implications for refining age, ecology and timing-specific interventions.</p>

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Clinical malaria in three ecological zones in the Volta and Oti Regions of Ghana

  • 期刊论文

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  • 发表日期：

    2025年11月10日

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  • Wisdom Kudzo Axame,
  • Bismarck Dinko,
  • Margaret Kweku,
  • Fred Newton Binka

摘要

Background

Malaria remains a major public health concern in Ghana, but regional variations in clinical presentation, parasitaemia, anaemia, and preventive measure uptake are not well characterized. This study assessed these parameters across three ecological zones.

Methods

A cross-sectional study was conducted among 459 participants in Ho (forest zone), Keta (coastal zone), and Nkwanta (savannah zone). Clinical assessments recorded signs and symptoms, malaria was diagnosed using rapid diagnostic tests (RDTs) and microscopy, and parasitaemia was categorized as low, moderate, high, or hyper-parasitaemia. Haemoglobin concentration was measured to determine anaemia prevalence and severity, while insecticide-treated net (ITN) ownership and usage were also assessed. Data were summarized as means with standard deviations and proportions, with site comparisons using Chi-square/Fisher’s exact, Kruskal–Wallis, and Mann–Whitney tests.

Results

Overall malaria prevalence was 15.2% by RDT and 9.7% by microscopy, highest in Nkwanta. Most cases were uncomplicated (88.7%), though severe malaria anaemia was most frequent in Nkwanta (24.4%). Fever (86.9%) and anaemia (79.3%) were the most common signs, while headache (64.9%), nausea (55.8%), and chills/rigor (47.1%) were the leading symptoms. Geometric mean parasite density was significantly higher in Keta (11,715.6 parasites/µL) compared to Nkwanta (7616.4) and Ho (5880.1; p = 0.0003). Anaemia prevalence was 79.3% overall, with location-specific differences (Nkwanta: 94.1%, Keta: 82.9%, Ho: 69.8%; p < 0.0001), and was most severe among hyper-parasitaemic individuals. ITN ownership was 69.7% overall, highest in Nkwanta (85.2%), but usage among owners was only 61.3%, with significant location differences (Nkwanta: 70.4%, Keta: 60.0%, Ho: 51.6%; p = 0.008).

Conclusion

Malaria presentation, parasite density, anaemia burden, and LLIN uptake vary significantly across ecological zones in Ghana. These findings underscore the inadequacy of a one-size-fits-all approach and reinforce the importance of Ghana’s subnational tailoring (SNT) strategy, with implications for refining age, ecology and timing-specific interventions.