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.

A quantitative, explorative, descriptive contextual study was conducted to determine to what extent the malaria control measures proposed by the Tanzanian government had been implemented by parents of children between the ages 0-5 years who lived in Bukumbi village. Structured interviews were conducted with 40 parents of children who had been admitted for malaria treatment during 2007, and the data analysed by computer. Although respondents had a basic knowledge of preventive measures they did not implement actions preventing the anopheles mosquitoes’ breeding in this tropical area. The vicious cycle of poverty, malaria episodes and lack of proper malaria health education hampered the implementation of control measures such as the spraying of houses with insecticides. Although the government of Tanzania subsidises insecticide treated bed nets the respondents did not maintain these nets and did not renew the insecticide treatment of these nets. The incidence of malaria is unlikely to decline in the Bukumbi village unless all identified factors are addressed. / Health Studies / M.A.

A quantitative, explorative, descriptive contextual study was conducted to determine to what extent the malaria control measures proposed by the Tanzanian government had been implemented by parents of children between the ages 0-5 years who lived in Bukumbi village. Structured interviews were conducted with 40 parents of children who had been admitted for malaria treatment during 2007, and the data analysed by computer. Although respondents had a basic knowledge of preventive measures they did not implement actions preventing the anopheles mosquitoes’ breeding in this tropical area. The vicious cycle of poverty, malaria episodes and lack of proper malaria health education hampered the implementation of control measures such as the spraying of houses with insecticides. Although the government of Tanzania subsidises insecticide treated bed nets the respondents did not maintain these nets and did not renew the insecticide treatment of these nets. The incidence of malaria is unlikely to decline in the Bukumbi village unless all identified factors are addressed. / Health Studies / M.A.