A contextual association between malaria and urbanization: Temporal and spatial analysis in Ghana

Abstract In West Africa, malaria is a leading cause of disease-induced fatalities. While it is generally thought that urbanization reduces malaria incidence, the relationship between urbanicity, i.e., the impact of living in urban areas, and transmission remains unclear. This study aims to explore this association in Ghana, using eight district-level datasets comprising epidemiological, health, hygiene, and education data over four years (2015–2018) aggregated by sex and age groups. Applying a series of aspatial and spatial quantitative analysis methods, we showed significant heterogeneity in malaria incidences across space and socio-demographic groups. We find that the determinants of malaria incidence vary depending on the degree of urbanization. Moreover, there is a seasonal signature of malaria temporal dynamic that is not perceptible in big urban regions. A denser population in urban areas is associated with an increased malaria incidence. In peri-urban areas, an increase in malaria incidence is associated with a denser vegetation cover. In rural areas, built areas are associated with an increase in malaria incidence. The findings suggest that understanding and addressing malaria incidences vis-à-vis urbanization will require a focus on these contextual factors.