Ghana Malaria Indicator Survey 2016 [MIS26] - Ghana Statistical Service

Ghana

Malaria Indicator Survey

2016

GHANA Malaria Indicator Survey 2016

Ghana Statistical Service Accra, Ghana National Malaria Control Programme Accra, Ghana National Public Health Reference Laboratory Accra, Ghana The DHS Program ICF Rockville, Maryland, USA

May 2017

The 2016 Ghana Malaria Indicator Survey (2016 GMIS) was implemented by the Ghana Statistical Service (GSS), in close collaboration with the Ghana National Malaria Control Programme (NMCP) and the National Public Health Reference Laboratory (NPHRL) of the Ghana Health Service. Financial support for the survey was provided by the United States Agency for International Development, the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the Government of Ghana. ICF provided technical assistance through The DHS Program, a USAID-funded project that offers support and technical assistance in the implementation of population and health surveys in countries worldwide. Additional information about the 2016 GMIS may be obtained from the Ghana Statistical Service, Head Office, P.O. Box GP 1098, Accra, Ghana; Telephone: 233-302-682-661/233-302-663-578; Fax: 233-302-664-301; Email: [email protected]. Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; Telephone: +1-301-407-6500; Fax: +1-301-407-6501; Email: [email protected]; Internet: www.DHSprogram.com. Recommended citation: Ghana Statistical Service (GSS), Ghana Health Service (GHS), and ICF. 2017. Ghana Malaria Indicator Survey 2016. Accra, Ghana, and Rockville, Maryland, USA: GSS, GHS, and ICF.

CONTENTS TABLES AND FIGURES ............................................................................................................................ v FOREWORD ............................................................................................................................................... ix READING AND UNDERSTANDING TABLES FROM THE 2016 GHANA MIS (GMIS) ............... xi ACRONYMS AND ABBREVIATIONS .................................................................................................. xix MAP OF GHANA ....................................................................................................................................... xx 1

INTRODUCTION AND SURVEY METHODOLOGY .............................................................. 1 1.1 Survey Objectives ................................................................................................................ 1 1.2 Sample Design ..................................................................................................................... 1 1.3 Questionnaires ..................................................................................................................... 2 1.4 Anaemia and Malaria Testing.............................................................................................. 3 1.5 Pretest .................................................................................................................................. 4 1.6 Training of Field Staff ......................................................................................................... 4 1.7 Fieldwork............................................................................................................................. 4 1.8 Data Processing ................................................................................................................... 4 1.9 Ethical Considerations ......................................................................................................... 5 1.10 Response Rates .................................................................................................................... 5

2

HOUSING CHARACTERISTICS, HOUSEHOLD POPULATION, AND WOMEN’S CHARACTERISTICS .................................................................................................................... 7 2.1 Drinking Water Sources and Treatment .............................................................................. 7 2.2 Sanitation (Toilet Facility)................................................................................................... 8 2.3 Housing Characteristics ....................................................................................................... 9 2.4 Household Wealth ............................................................................................................. 10 2.5 Household Population and Composition ........................................................................... 11 2.6 Background Characteristics of Women Respondents ........................................................ 12 2.7 Educational Attainment of Women ................................................................................... 12 2.8 Literacy of Women ............................................................................................................ 12 2.9 Health Insurance Coverage ................................................................................................ 13

3

MALARIA PREVENTION .......................................................................................................... 25 3.1 Ownership of Mosquito Nets ............................................................................................. 26 3.2 Household Access and Use of LLINs ................................................................................ 28 3.3 Use of ITNs by Children and Pregnant Women ................................................................ 30 3.4 Malaria in Pregnancy ......................................................................................................... 31

4

MALARIA IN CHILDREN ......................................................................................................... 41 4.1 Care Seeking for Fever in Children ................................................................................... 41 4.2 Diagnostic Testing of Children with Fever ....................................................................... 42 4.3 Use of Recommended Antimalarials ................................................................................. 43 4.4 Prevalence of Low Haemoglobin in Children ................................................................... 43 4.5 Prevalence of Malaria in Children ..................................................................................... 45

5

MALARIA KNOWLEDGE AND MESSAGING ...................................................................... 55 5.1 Exposure to Malaria Messages .......................................................................................... 56 5.2 Knowledge and Awareness ............................................................................................... 57 5.3 Self-report of Malaria Episodes and Care Seeking ............................................................ 58

Contents • iii

REFERENCES............................................................................................................................................ 69 APPENDIX A A.1 A.2 A.3 A.4 A.5

SAMPLE DESIGN ........................................................................................................... 71 Introduction ....................................................................................................................... 71 Sample Frame .................................................................................................................... 71 Sample Allocation and Sampling Procedures .................................................................... 72 Sample Probabilities and Sampling Weights ..................................................................... 74 Survey Implementation...................................................................................................... 75

APPENDIX B ESTIMATES OF SAMPLING ERRORS ...................................................................... 77 APPENDIX C DATA QUALITY TABLES ............................................................................................ 87 APPENDIX D PERSONS INVOLVED IN THE 2016 GMIS ................................................................ 91 APPENDIX E QUESTIONNAIRES ........................................................................................................ 95

Contents • iv

TABLES AND FIGURES 1

INTRODUCTION AND SURVEY METHODOLOGY .............................................................. 1 Table 1.1 Results of the household and individual interviews ............................................... 5

2

HOUSING CHARACTERISTICS, HOUSEHOLD POPULATION, AND WOMEN’S CHARACTERISTICS .................................................................................................................... 7 Table 2.1 Household drinking water .................................................................................... 16 Table 2.2 Household sanitation facilities ............................................................................. 16 Table 2.3 Household characteristics .................................................................................... 17 Table 2.4 Household possessions......................................................................................... 18 Table 2.5 Wealth quintiles ................................................................................................... 18 Table 2.6 Household population by age, sex, and residence................................................ 19 Table 2.7 Household composition ....................................................................................... 19 Table 2.8 Women’s background characteristics .................................................................. 20 Table 2.9 Women’s educational attainment ......................................................................... 21 Table 2.10 Women’s literacy ................................................................................................. 22 Table 2.11 Women’s health insurance coverage.................................................................... 23 Figure 2.1 Figure 2.2 Figure 2.3 Figure 2.4 Figure 2.5 Figure 2.6

3

MALARIA PREVENTION .......................................................................................................... 25 Table 3.1 Household possession of mosquito nets............................................................... 34 Table 3.2 Source of mosquito nets ....................................................................................... 35 Table 3.3 Access to a long-lasting insecticidal net .............................................................. 36 Table 3.4 Use of mosquito nets by persons in the household .............................................. 37 Table 3.5 Use of existing long-lasting insecticidal nets ....................................................... 37 Table 3.6 Use of mosquito nets by children ......................................................................... 38 Table 3.7 Use of mosquito nets by pregnant women ........................................................... 39 Table 3.8 Use of intermittent preventive treatment (IPTp) by women during pregnancy ... 40 Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 Figure 3.5 Figure 3.6 Figure 3.7 Figure 3.8 Figure 3.9 Figure 3.10

4

Household drinking water by residence ................................................................. 8 Household sanitation facilities by residence .......................................................... 9 Household wealth by residence............................................................................ 10 Population pyramid .............................................................................................. 11 Educational attainment of women by residence................................................... 12 Trends in national health insurance coverage by region ...................................... 14

Household ownership of LLINs ........................................................................... 26 Trends in household ownership of LLINs ........................................................... 27 LLIN ownership by household wealth ................................................................. 27 LLIN ownership by region................................................................................... 27 Source of mosquito nets ....................................................................................... 28 Access to and use of LLINs ................................................................................. 28 LLIN access by region ......................................................................................... 29 LLIN use by household population ...................................................................... 29 LLIN use by children and pregnant women ......................................................... 30 Trends in IPTp use by pregnant women .............................................................. 32

MALARIA IN CHILDREN ......................................................................................................... 41 Table 4.1 Prevalence, diagnosis, and prompt treatment of children with fever ................... 48

Tables and Figures • v

5

Table 4.2 Table 4.3 Table 4.4 Table 4.5 Table 4.6

Source of advice or treatment for children with fever ......................................... 49 Type of antimalarial drugs used ........................................................................... 50 Coverage of testing for anaemia and malaria in children..................................... 51 Haemoglobin