Subnational malaria surveillance for elimination planning: Analysis of routine district data from Bole District, Ghana, 2018–2022

Introduction: Malaria remains a major public health concern, as the Savannah Region of Ghana reported institutional malaria incidence of 3,485 per 100,000 people in 2021. Limited analysis of routine data is conducted at the district level in Ghana. We conducted a descriptive trend analysis of malaria surveillance data in the Bole District to illustrate the trend of malaria positivity rate over five years. Methods: The study was a descriptive analysis of secondary data on OPD malaria morbidity from 2018 to 2022, retrieved from the District Health Information System 2 (DHIMS2) database. Variables collected included suspected, tested, and positive malaria cases. The data were exported into MS Excel Professional 2016, cleaned, and analyzed by person, place, and time. We estimated outbreaks by calculating the cumulative sum (CUSUM 2) average. The results were presented in tables, charts, and maps, along with frequencies and percentages. Results: A total of 269,351 malaria cases were suspected, of which 228,343 were tested, and 173,692 were positive during the study period, resulting in an overall positivity rate of 76.1%. Males accounted for 41.3% of the positive cases, with a positivity rate of 78.0% (71,666/91,894). Approximately 43.1% of all positive cases involved children under five years, with a positivity rate of 79.4% (70,603/88,922). Among children aged 5-14 years, the positivity rate was 82.1% (36,959/45,017). We observed a longer period of case positivity rates in 2022, from March to September, even though the peaks in other years occurred between July and September. Mandari sub-district recorded the highest positivity rate at 84.0% (8,375/9,975). The positivity rate declined consistently from 76.9% in 2018 to 74.1% in 2022. There were four outbreaks, with a prolonged period of case plateau in 2022. Conclusion: The malaria positivity rate in the Bole District declined over the five years. The positivity rate was higher among males, school-age children (5-14 years), and in the Mandari sub-district. There were four observed outbreaks, with a prolonged plateau of cases observed in 2022. There is a need for the Bole District Health Directorate to intensify malaria control measures among males, school-going children and children under five years.