A Contextual Association between Malaria and Urbanization: Temporal and Spatial Analysis in Ghana

Background: 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 and transmission remains unclear. Methods: 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. Findings: We find that depending on the degree of urbanization, different drivers contribute to the infection. Interpretation: For example, in well-urbanized areas, the density of the population and the vegetation cover determine the incidence, with denser population leading to higher malaria incidence. Likewise, dense vegetation cover also fuels malaria incidence. The findings suggest the association between malaria incidence and urbanization is complex and requires further investigation. Funding Information: This study was supported by the Ministry of Culture and Science of North Rhine-Westphalia, Germany, through grant no. 9000055 offered to the University of Bonn’s One Health Graduate School. Declaration of Interests: None to declare. Ethics Approval Statement: This study was approved by both the ethics committees of ZEF and the Institute of Statistical, Social and Economic Research (ISEER), University of Ghana.