Malaria surveillance data analysis in the Kintampo North Municipality, Bono East Region, Ghana, 2018-2022

Abstract

Introduction: Malaria remains the leading cause of morbidity and mortality in children under 5 years in many tropical countries. The study assessed the prevalence and distribution of malaria in the Kintampo North Municipality from 2018 to 2022. Methods: We extracted routine malaria data from the District Health Information Management System for the period 2018-2022. Variables included suspected and confirmed malaria cases, testing rates, test positivity and intermittent preventive treatment in pregnancy (IPTp) coverage. Data were analysed as frequencies and proportions. CUSUM2 threshold was applied to determine missed outbreaks. Results: Over the five-year period, 491,936 suspected uncomplicated malaria cases were recorded, of which 97.3% were tested and 40.0% confirmed positive by microscopy or rapid diagnostic test. Outpatient malaria cases per 1,000 population ranged from 229 in 2021 to 460 in 2019. Children under five accounted for 26.1% of cases, with a positivity rate of 31.5%. Malaria in pregnancy showed a 49.7% positivity rate. IPTp1 coverage declined substantially from 97.3% in 2018 to 63.7% in 2022, with IPTp dropout ranging 13.6%-44.2%. The CUSUM2 analysis indicated that epidemic thresholds were crossed five times during the review period, yet no outbreak was detected. Conclusion: Malaria remains highly prevalent in the Kintampo North Municipality, though a relative decline in the number of suspected cases was observed between 2019 and 2021. Declining IPTp coverage and missed epidemic signals highlight weaknesses in both preventive services and surveillance systems. Strengthened case definition adherence, systematic use of outbreak detection thresholds, and renewed efforts to improve IPTp uptake are urgently needed.