ABSTRACT: Background: Malaria is endemic throughout Ghana and continues to be a major public
health concern especially among pregnant women and children under the age of five. The
Ministry of Health (MoH) estimates that over the past ten years, there have been 2-3
million cases of malaria each year, representing 40 percent of outpatient cases, while
severe malaria accounts for 33-36 percent of in-patients. Malaria also accounts for 25
percent of the deaths in children under the age of five (GHS, 2001).
Correct identification of risk factors could focus interventions at reducing malaria
mortality in children. Demographic Surveillance System (DSS) sites have been
established and they generate high quality population based longitudinal health and
demographic data. The DSS conduct Verbal Autopsies to determine probable causes of
death.
Objective: This study examines factors affecting childhood malaria mortality in Northern
Ghana, using longitudinal data collected by the Navrongo DSS during the period 1995-
2000. It deals especially with the role of socioeconomic factors (mother’s education,
family wealth index based on the possessions and housing characteristics and residence, and possession of bed net) and the demographic characteristics (child’s sex and age, and
mother’s age).
Design: Secondary data analysis of longitudinal data collected by the Navrongo Health
Research Centre. Multinomial logistic regression was used to compare the relative risk in
three groups of children i.e. those who died of Malaria and those who died of other
causes to those who survived as base. Results: Overall, for the deaths due to malaria, older children (1-5years) had a higher risk
(RRR 1.4, 95%CI 1.25-1.57 P <0.0001) of dying compared to the infants. Equally,
children born of older mothers (maternal age at birth of child >30 years) had a higher risk
(RRR 1.28, 95%CI 1.15-1.42 P <0.0001).
However, maternal education and residence had a protective effect, with children born of
mothers who had some education (RRR 0.79, 95%CI 0.67-0.93 P=0.004) and residing in
urban area (RRR 0.61, 95%CI 0.46-0.82 P=0.001) having a lower risk. Similarly, those
children whose families are in the highest wealth index had a lower risk (RRR 0.76,
95%CI 0.63-0.91 P=0.003).
Interestingly, the same factors were associated with deaths occurring due to other causes,
but with varying degree of association. Whereas sex of child was not associated with
malaria deaths, being female offered a lower risk of dying from other causes (RRR 0.9, 95%CI 0.84-0.98 P=0.017). It was observed that children in the older age group (1-5
years) were at higher risk of dying (RRR 1.14, 95%CI 1.05-1.25 P=0.002) just as those
born of older mothers (RRR 1.16, 95%CI 1.07-1.26 P <0.0001). Even in this group, maternal education (RRR 0.87, 95%CI 0.76-0.98 P=0.023), a higher wealth index (RR
0.87, 95%CI 0.77-0.99 P=0.032 and RRR 0.63 95%CI 0.54-0.73 P <0.0001 for the two
highest categories of wealth indices respectively), and area of residence (RRR 0.67,
95%CI 0.55-0.83 P <0.0001) offered a reduction in the risk of dying.
Conclusion: The study identified the risk factors (age and sex of the child and mother’s
age, maternal education, wealth and residence of the family) associated with malaria
mortality and other causes of death in childhood in northern Ghana and this should help
formulate cost effective interventions such as health education
