Background: Malaria remains a dominant health issue among children in Ghana. We monitored the trend of long lasting insecticide net (LLIN) ownership and use and its impact on malaria and anaemia among children under five over the past decade in an area of intense, prolonged and seasonal malaria transmission. Methods: A total of 1717, 2155 and 1915 children were surveyed in June and 1717, 2155 and 1697 in November in 30 communities of the Hohoe Municipality in 2006, 2010 and 2015 respectively. The primary outcomes monitored were the trend of LLIN ownership, use and prevalence of malaria and anaemia through cross-sectional surveys. Findings: Results showed a significantly positive trend (p < 0.001) in ownership of LLIN at 20.8%, 64.8% and 83.2% for 2006, 2010 and 2016 respectively. The sharp increase in ownership between 2006 and 2010 accounted for a highly significant departure from trend (p < 0.001). Similarly, the prevalence of LLIN use was 15.1%, 42.2% and 68.3% for 2006, 2010 and 2016 respectively with a significant positive trend (p < 0.001). The prevalence of malaria parasitaemia in June showed no significant drop over the three years studied. Anaemia prevalence was 7.9%, 5.3% and 11.1% for 2006, 2010 and 2015 respectively—Anaemia significantly increased (p < 0.001) between 2010 and 2015 accounting for a significant departure from the initially decreasing trend (p < 0.001). Malaria parasitaemia over the November surveys was 40.4%, 33.2% and 26.6% for 2006, 2010 and 2016 respectively, depicting a significant decline over the years of the study (p < 0.001). A significant decrease (p = 0.006) in anaemia was observed at 12.0%, 4.3% and 8.9% for 2006, 2010 and 2015 respectively. A significant departure from the decreasing trend (p < 0.001) was noted with increasing anaemia between 2010 and 2016. Interpretation: Ownership of LLIN and its use together with other indicators of malaria prevalence generally improved five years after the implementation of a malaria control programme. Ten years after programme implementation, consistent improvement was only in LLIN ownership and use. Also malaria prevalence indicators improved in the post as compared to the pre-rainy season in the study communities.
Koram, K.A., Abuaku, B., Duah, N. and Quashie, N. (2005) Comparative Efficacy of Antimalarial Drugs including ACTs in the Treatment of Uncomplicated Malaria among Children under 5 Years in Ghana. Acta Tropica, 95, 194-203. https://doi.org/10.1016/j.actatropica.2005.06.018
Kweku, M., Liu, D., Adjuik, M., Binka, F., Seidu, M., Greenwood, B. and Chandramohan, D. (2008) Seasonal Intermittent, Preventive Treatment for the Prevention of Anaemia and Malaria in Ghanaian Children: A Randomized, Placebo Controlled Trial. PLoS ONE, 3, e4000. https://doi.org/10.1371/journal.pone.0004000
Ghana Statistical Service (GSS)/Ghana Health Service (GHS) (2009) ICF International. Ghana Demographic and Health Survey 2008. Accra, Ghana: Ghana Statistical Service, Ghana Health Service, and ICF Macro.
Curtis, C., Maxwell, C., Magesa, S., Rwegoshora, R. and Wilkes, T. (2006) Insecticide-Treated Bed-Nets for Malaria Mosquito Control. Journal of the American Mosquito Control Association, 22, 501-506. https://doi.org/10.2987/8756-971X(2006)22[501:IBFMMC]2.0.CO;2
Bhattarai, A., Ali, A.S., Kachur, S.P., Martensson, A., Abbas, A.K., Khatib, R., Al-Mafazy, A.W., Ramsan, M., Rotllant, G., Gerstenmaier, J.F., Molteni, F., Abdulla, S., Montgomery, S., Kaneko, A. and Bjorkman, A. (2007) Impact of Artemisinin-Based Combination Therapy and Insecticide-Treated Nets on Malaria Burden in Zanzibar. PLoS Medicine, 4, Article ID: e309. https://doi.org/10.1371/journal.pmed.0040309
Delacollete, C., D’Souza, C., Chrstophel, E., Thimasaran, K., Abdur, R., Bell, D., Dai, T.C., Gopinath, D., Lu, S., Mendoza, R., Ortega, L., Rastrogi, R., Tantinimitkul, C. and Ehrenberg, J. (2009) Malaria Trends and Challenges in the Greater Mekoy Subregion. Southeast African Journal Tropical Medicine Public Health, 40, 17.
Otten, M., Aregawi, M., Were, W., Karema, C., Medin, A., Bekele, W., et al. (2009) Initial Evidence of Reduction of Malaria Cases and Deaths in Rwanda and Ethiopia Due to Rapid Scale-Up of Malaria Prevention and Treatment. Malaria Journal, 8, 14. https://doi.org/10.1186/1475-2875-8-14
Pardo, G., Descalzo, M.A., Molina, L., Custodio, E., Lwanga, M., Mangue, C., et al. (2006) Impact of Different Strategies to Control Plasmodium Infection and Anaemia on the Island of Bioko (Equatorial Guinea). Malaria Journal, 5, 10. https://doi.org/10.1186/1475-2875-5-10
Baume, C.A. and Marin, M.C. (2008) Gains in Awareness, Ownership and Use of Insecticide-Treated Nets in Nigeria, Senegal, Uganda and Zambia. Malaria Journal, 7, 153. https://doi.org/10.1186/1475-2875-7-153
Binka, F. and Akweongo, P. (2006) Prevention of Malaria Using ITNs: Potential for Achieving the Millennium Development Goals. Current Molecular Medicine, 6, 261-267. https://doi.org/10.2174/156652406776055203
Oresanya, O.B., Hoshen, M. and Sofola, O.T. (2008) Utilization of Insecticide-Treated Nets by Under-Five Children in Nigeria: Assessing Progress towards the Abuja Targets. Malaria Journal, 7, 145. https://doi.org/10.1186/1475-2875-7-145
Kweku, M., Appiah, E.K., Takramah, W., Enuameh, Y., Norman, I. and Binka, F. (2015) Effect of a Malaria Control Program on the Prevalence of Malaria, Fever and Anaemia in Children under Five Years in the Hohoe Municipality of Ghana: A Comparative Analysis of Cross-Sectional Surveys. Advances in Infectious Diseases, 5, 180. https://doi.org/10.4236/aid.2015.54023
Drakeley, C.J., Jawara, M., Targett, G.A.T., Walraven, G., Obisike, U., Coleman, R., Pinder, M. and Sutherland, C.J. (2004) Addition of Artesunate to Chloroquine for Treatment of Plasmodium Falciparum Malaria in Gambain Children Casues a Significant but Short-Lived Reduction in Infectiousness for Mosquitoes. Tropical Medicine & International Health, 9, 53-61. https://doi.org/10.1046/j.1365-3156.2003.01169.x
Atieli, H.E., Zhou, G., Afrane, Y., Lee, M.C., Mwanzo, I., Githeko, A.K., et al. (2011) Insecticide-Treated Net (ITN) Ownership, Usage, and Malaria Transmission in the Highlands of Western Kenya. Parasites & Vectors, 4, 113. https://doi.org/10.1186/1756-3305-4-113
Ezeigbo, O., Ejike, E. and Nwachukwu, I. (2016) Insecticide-Treated Bed Net (ITN): Ownership and Usage in the Control of Malaria in Abia State, Nigeria. American Journal of Epidemiology and Infectious Disease, 4, 42-46.
Pettifor, A., Taylor, E., Nku, D., Duvall, S., Tabala, M., Meshnick, S., et al. (2008) Bed Net Ownership, Use and Perceptions among Women Seeking Antenatal Care in Kinshasa, Democratic Republic of the Congo (DRC): Opportunities for Improved Maternal and Child Health. BMC Public Health, 8, 331. https://doi.org/10.1186/1471-2458-8-331
Korenromp, E.L., Miller, J., Cibulskis, R.E., Kabir, C.M., Alnwick, D. and Dye, C. (2003) Monitoring Mosquito Net Coverage for Malaria Control in Africa: Possession versus Use by Children under 5 Years. Tropical Medicine & International Health, 8, 693-703. https://doi.org/10.1046/j.1365-3156.2003.01084.x
Deressa, W., Fentie, G., Girma, S. and Reithinger, R. (2011) Ownership and Use of Insecticide-Treated Nets in Oromia and Amhara Regional States of Ethiopia Two Years after a Nationwide Campaign. Tropical Medicine & International Health, 16, 1552-1561. https://doi.org/10.1111/j.1365-3156.2011.02875.x
Rickard, D.G., Dudovitz, R.N., Wong, M.D., Jen, H.C., Osborn, R.D., Fernandez, H.E., et al. (2011) Closing the Gap between Insecticide Treated Net Ownership and Use for the Prevention of Malaria. Progress in Community Health Partnerships: Research, Education, and Action, 5, 123-131. https://doi.org/10.1353/cpr.2011.0018
Kuile, F.O., Terlouw, D.J., Kariuki, S.K., Phillips-Howard, P.A., Mirel, L.B., Hawley, W.A., et al. (2003) Impact of Permethrin-Treated Bed Nets on Malaria, Anemia, and Growth in Infants in an Area of Intense Perennial Malaria Transmission in Western Kenya. The American Journal of Tropical Medicine and Hygiene, 68, 68-77. https://doi.org/10.1186/1475-2875-11-122
Phillips-Howard, P.A., Nahlen, B.L., Kolczak, M.S., Hightower, A.W., Kuile, F.O., Alaii, J.A., et al. (2003) Efficacy of Permethrin-Treated Bed Nets in the Prevention of Mortality in Young Children in an Area of High Perennial Malaria Transmission in Western Kenya. The American Journal of Tropical Medicine and Hygiene, 68, 23-29.