ArticleBMC public health2026
Malaria incidence, severity and mortality in children under five in Ghana: evidence from generalised additive models.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
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3 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundUnder-five malaria remains a public-health priority in Tarkwa-Nsuaem, Ghana. This study analysed 132 monthly observations (2013–2023) to characterise trends, weather sensitivity, and near-term risk.
methodsSurveillance counts (incidence, severe cases, and deaths) were linked with monthly rainfall and temperature. Negative-binomial generalized additive models (NB-GAMs) with smooth long-term trends and cyclic monthly effects were fitted. Weather influences were evaluated as contemporaneous, lagged (1–3-month), and accumulated (3–6-month) rainfall indices. Model selection employed AIC, adjusted R2, deviance explained, dispersion, and residual autocorrelation. A 12-month forecast was generated using the selected model.
resultsMonthly incidence was high (median = 847 cases), while severe cases (median = 2) and deaths were rare. Adding rainfall “memory” (1–3-month lags; 3–6-month accumulations) improved the incidence NB-GAM (AIC 1,269 → 1,234; ΔAIC = − 35; deviance explained ≈ 80%; adjusted R2 ≈ 0.88). In the pruned incidence model, trend (χ2≈334, p < .001), Rain_lag1 (χ2≈15.4, p = .002) and Rain_roll6 (χ2≈9.7, p = .002) remained significant. Out-of-sample errors were MAE/RMSE = 96/116 (train) and 190/232 (test). Severe malaria showed a secular decline with weak weather effects (deviance explained ≈ 0.85). Deaths were best modeled with zero-inflated NB (AIC = 104.1 vs 113.3 for NB), with a trend-only signal. Pearson dispersions indicated acceptable fit (incidence 0.95; severe 1.32; deaths 0.76). Twelve-month projections centered at ~ 600–670 incidence cases/month (95% PI ≈ 250–1,350), with deaths ~ 0–1/month.
conclusionsTransmission reflects recent rainfall history rather than concurrent totals. Declines in severity and mortality likely mirror improved care. NB-GAMs with rainfall-memory terms yield interpretable, operational forecasts for early warning and resource planning.
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