Seasonal and socio-economic variations in clinical and self-reported malaria in Accra, Ghana: evidence from facility data and a community survey.

OBJECTIVES This study characterizes the variations in malaria morbidity for Accra. METHODS Both routine reporting of presumptive, clinically diagnosed malaria in out-patient clinics and results from a longitudinal household survey are used in the analysis. In the household survey, cases of suspected malaria were self-reported by patients, based on diagnoses from health centers, hospitals, pharmacies, chemical sellers or traditional healers. RESULTS Although the malaria ascertainment is not based on parasitology, we see systematic and plausible patterns by season and by district associated with variations in rainfall by month and year. There are significant differences in malaria incidence by socioeconomic group, possibly linked with place, work or residence. CONCLUSIONS Understanding these seasonal and geographic patterns have implications for both prevention and treatment of malaria-like morbidity in both children and adults in urban settings.