Abstract
BACKGROUND: In a country with limited and unequally distributed resources, and plagued with malaria annually, under-five children are severely affected by this disease in Ghana. While the epidemiological burden of malaria on under-five children is well-documented, the extent and contributors of socio-economic inequalities in malaria prevalence remain under-explored. This study examined the intertemporal socioeconomic status (SES)-related inequalities in malaria prevalence among under-five children in Ghana from 2016 to 2019 and identified the key factors contributing to these disparities. METHODS: Data were drawn from the 2016 and 2019 Ghana Malaria Indicator Surveys (GMIS). The study population consisted of under-five children who were tested for malaria in both surveys. Malaria prevalence served as the outcome variable, with the wealth index used as a proxy for socio-economic status. Socio-economic inequalities in malaria prevalence were evaluated using concentration indices and concentration curves. A decomposition analysis was employed to identify the socio-economic factors contributing to the observed inequalities. RESULTS: A total of 2323 children in 2016 and 1938 children in 2019 were tested for malaria. Malaria prevalence increased from 8% in 2016 to 10% in 2019. The concentration index for 2019 (Concentration Index = - 0.224; Standard Error = 0.059; p-value = 0.000) was statistically significant and negative, indicating higher malaria prevalence among children from lower socio-economic backgrounds. However, the concentration index for 2016 (Concentration Index = - 0.052; Standard Error = 0.044; p-value = 0.230) was not statistically significant. In 2019, socio-economic status, region, and ethnicity accounted for 59.38%, 23.66%, and 4.46%, respectively, of the observed inequalities in malaria prevalence. CONCLUSION: The study revealed a persistent pro-poor inequality in malaria prevalence in under-five children in Ghana, underscoring the importance of targeted malaria control interventions. These interventions should prioritize socioeconomically disadvantaged groups to reduce inequalities in malaria prevalence which contributes to the 2030 Sustainable Development Goals of improving health (SDG 3) and reducing inequalities (SDG 10), among others.