Household characteristics, water, sanitation and hygiene (WASH) and malaria prevalence among children aged 6–59 months in Ghana: an analysis of the 2022 Ghana Demographic and Health Survey

BACKGROUND: Malaria remains a major public health challenge, particularly in sub-Saharan Africa, which accounted for approximately 95% of global malaria cases and 96% of malaria deaths in 2022. This study examined the prevalence of malaria among children aged 6-59 months in Ghana and assessed the influence of household characteristics and water, sanitation, and hygiene (WASH) factors on malaria prevalence. METHODS: We analyzed data from the 2022 Ghana Demographic and Health Survey (GDHS), using a weighted sample of 3255 households with children aged 6-59 months. Malaria testing was performed with rapid diagnostic tests (RDTs). Descriptive statistics, chi-square tests, and multivariate logistic regression models were used to identify factors associated with malaria prevalence. RESULTS: The prevalence of malaria among children aged 6-59 months was 3.7%. Insecticide-treated net (ITN) ownership was high (78.9%), but only 51.5% of children slept under ITNs. Approximately 41.5% of children were anaemic. In multivariate analysis, children in households headed by persons aged 40-49 years (aOR = 0.22; CI 0.08-0.62) and 50-59 years (aOR = 0.18; CI 0.04-0.72) had lower odds of malaria compared to those in households headed by persons aged 70 + . Children from wealthier households had significantly lower odds of malaria (aOR = 0.15; CI 0.03-0.71). Unexpectedly, children who did not sleep under ITNs had lower odds of malaria (aOR = 0.52; CI 0.30-0.92) compared to those who did. Anaemic children had more than twice the odds of malaria (aOR = 2.03; CI 1.36-3.04). Drinking untreated water (aOR = 0.47; Cl 0.26-0.47) and improved sanitation (aOR = 0.59; Cl 0.39-0.90) were associated with lower malaria risk, whereas having toilets located outside (aOR = 16.64; CI 2.06-134.57) the dwelling was associated with higher odds of malaria. CONCLUSION: These findings emphasise the need for targeted interventions in households with lower wealth and inadequate sanitation, alongside enhanced ITN distribution programs and sustainable WASH improvements to reduce malaria prevalence in children.