Mediation of behavioural and socioeconomic risk factors associated with malaria in children in Ghana

Abstract Background and objectives Malaria remains a major global public health concern leading cause of morbidity mortality especially among children <5 years in Ghana. While an association between poverty malaria has long been recognised, evidence on the causal pathways socioeconomic position (SEP) is scarce. Our study contributes to addressing this gap by investigating whilst taking mediation through potential behavioural factors into account. This can help identify more specific targets for interventions structural level. Methods Using data 3,004 from Indicator Survey Demographic Health Surveys Program conducted Ghana 2019, household wealth index (quintiles) was derived using principal component analysis based assets. Causal multiple analyses investigated mediating effects treatment-seeking, bed net (LLIN) use, educational attainment, housing conditions children's fever events. Results Higher maternal attainment jointly mediate 18% events (OR = 0.98; 95%CI 0.96-0.99). Maternal seeking formal prenatal care 20% total effect 0.95-1.00), presence lower position. No strong found with use LLINs 0.99; 0.97-1.01). Conclusions As shown proportions mediated position, findings suggest that current control efforts could be strengthened investments at levels, such as increased (female) education, targeted improvements housing, stronger integration informal care. Key messages