Abstract
BACKGROUND: Head porters popularly known as 'Kayayeis in Ghana, face challenges in accessing essential health care services due to the mobile nature of their trade, low formal education, poor settlements, low-income among others. Kayayeis are predominantly females and form part of the mobile population who are at increased risk of malaria infection. Despite their increased risk of malaria, mobile populations are difficult to target for malaria interventions, hence serving as potential drivers of transmission even if malaria in the general population is controlled. The study, therefore, assessed the patterns and predictors of malaria among the Kayayei population in Ghana to inform policy decisions. METHODS: A mixed methods study was conducted among Head-porters and their leaders in the three main hubs of Head-porters in Ghana; namely Accra, Kumasi, and Tamale. Blood samples were collected from participants and tested for malaria parasites using Rapid Diagnostic Test (RDT). Additionally, data including socio-demographics, malaria knowledge, attitude and practice were collected using a semi-structured questionnaire. Associations between malaria status and participants characteristics were determined by logistic regression (p < 0.05). Thematic analysis was used to analyse transcripts from the key informant interviews. RESULTS: Out of 754 head porters studied, 10.48% (79) tested positive for malaria. The majority 43.10% (325/754) of the head porters were twenty years and below, and most 67.11% (506/754) had no formal education. Nearly half (50.4%) were not on any health insurance. Receiving malaria education in the past 6 months [AOR = 0.48, (0.26-0.88), p-value 0.02], and having poor knowledge of malaria [AOR = 2.23, (1.26-4.27), p < 0.02], were the factors significantly associated with malaria infection. CONCLUSION: The prevalence of malaria among 'Kayayei's was estimated at 10.46%. A majority of them sleeps outside and in structures without mosquito screens. Receiving malaria education in the past 6 months reduced the odds of malaria infection whilst poor knowledge of malaria increased the odds of malaria infection among the porters. The authors recommend that the National Malaria Elimination Programme and partners should provide long-lasting insecticidal nets (LLIN) and other outdoor interventions for use by this special group. Designated state institutions should arrange free National Health Insurance Scheme (NHIS) registration for 'Kayayeis' to narrow the health access gap.