{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T18:23:19Z","timestamp":1791570199971,"version":"4.3.4"},"reference-count":91,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T00:00:00Z","timestamp":1755820800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Malar J"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Malaria remains a leading cause of morbidity and mortality among pregnant women and children under five in sub-Saharan Africa. Despite over two decades of efforts including insecticide-treated net (ITN) distribution and intermittent preventive treatment in pregnancy (IPTp), universal and equitable coverage has not been achieved. In Ghana, coverage disparities persist, particularly along socioeconomic and geographic lines. This study investigates temporal trends and decomposes both within-group and between-group socioeconomic inequalities in ITN use and IPTp coverage among children and pregnant women in Ghana.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study analysed nationally representative data from the Ghana Demographic and Health Surveys (2003, 2008, 2014, and 2022), focusing on ITN use among pregnant women and children under five, and IPTp uptake. Inequality was assessed using the Erreygers normalized concentration index (ENCI) and the Theil index (GE 2). Theil indices were then decomposed to quantify within- and between-group contributions by socioeconomic status (SES) and residence (urban versus. rural).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ITN use among under-five children increased modestly from 58.1% (2003) to 62.9% (2022); among pregnant women, usage fluctuated but returned to 60% in 2022. IPTp coverage rose markedly from 0.85% (2003) to 60% (2022). ENCI values showed that ITN use was consistently pro-poor, becoming more concentrated among the poor over time (e.g., ENCI for pregnant women: \u2212\u00a00.04 in 2003 to \u2212\u00a00.32 in 2022). In contrast, IPTp coverage shifted to a pro-rich distribution from 2008 onwards. Theil decomposition revealed that most observed inequalities were driven by within-group disparities (e.g., within SES or residence categories), though between-group inequality increased over time particularly for IPTp. For example, in 2022, 85% of ITN inequality among pregnant women was within SES groups, while 18% was attributable to between-group differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Despite overall improvements in malaria prevention uptake, substantial socioeconomic inequalities persist especially within social and geographic subgroups. Equity-focused strategies must complement national-level efforts by addressing barriers specific to underserved populations, including informal urban settlements and remote rural communities. Policymakers must prioritize targeted, locally responsive interventions to reduce both within- and between-group disparities and achieve Ghana\u2019s malaria elimination and health equity goals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12936-025-05512-5","type":"journal-article","created":{"date-parts":[[2025,8,22]],"date-time":"2025-08-22T03:53:30Z","timestamp":1755834810000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Between-and within-socioeconomic groups temporal inequality in the uptake of malaria prevention strategies among pregnant women and under-five children in Ghana (2003\u20132022)"],"prefix":"10.1186","volume":"24","author":[{"given":"Denis","family":"Okova","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akim Tafadzwa","family":"Lukwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marian","family":"Edusei","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paidamoyo","family":"Bodzo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Atta-Obeng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Plaxcedes","family":"Chiwire","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Hongoro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,22]]},"reference":[{"key":"5512_CR1","unstructured":"WHO. World malaria report 2023. Geneva. World Health Organization; 2023."},{"key":"5512_CR2","unstructured":"World Bank. Facts and figures of malaria. available here . https:\/\/data.worldbank.org\/indicator\/SH.MLR.INCD.P3. 2023."},{"key":"5512_CR3","doi-asserted-by":"publisher","first-page":"e1325","DOI":"10.1016\/S2214-109X(21)00216-3","volume":"9","author":"SW Lindsay","year":"2021","unstructured":"Lindsay SW, Thomas MB, Kleinschmidt I. Threats to the effectiveness of insecticide-treated bednets for malaria control: thinking beyond insecticide resistance. Lancet Glob Health. 2021;9:e1325\u201331.","journal-title":"Lancet Glob Health"},{"issue":"1","key":"5512_CR4","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-022-04205-7","volume":"21","author":"M Aberese-Ako","year":"2022","unstructured":"Aberese-Ako M, Doegah P, Acquah E, Magnussen P, Ansah E, Ampofo G, et al. Motivators and demotivators to accessing malaria in pregnancy interventions in sub-Saharan Africa: a meta-ethnographic review. Malar J. 2022;21(1): 170.","journal-title":"Malar J"},{"key":"5512_CR5","doi-asserted-by":"publisher","DOI":"10.1016\/j.parepi.2022.e00265","volume":"18","author":"NO Nlinwe","year":"2022","unstructured":"Nlinwe NO, Nchefor FG, Takwi NB. Impact of long lasting insecticidal nets on asymptomatic malaria during pregnancy, in a rural and urban setting in Cameroon. Parasite Epidemiology and Control. 2022;18: e00265.","journal-title":"Parasite Epidemiology and Control"},{"key":"5512_CR6","doi-asserted-by":"publisher","DOI":"10.1016\/j.crpvbd.2022.100101","volume":"2","author":"S Brake","year":"2022","unstructured":"Brake S, Gomez-Maldonado D, Hummel M, Zohdy S, Peresin MS. Understanding the current state-of-the-art of long-lasting insecticide nets and potential for sustainable alternatives. Current Research in Parasitology & Vector-Borne Diseases. 2022;2: 100101.","journal-title":"Current Research in Parasitology & Vector-Borne Diseases"},{"key":"5512_CR7","doi-asserted-by":"publisher","first-page":"355","DOI":"10.1186\/s12936-018-2505-0","volume":"17","author":"H Koenker","year":"2018","unstructured":"Koenker H, Arnold F, Ba F, Cisse M, Diouf L, Eckert E, et al. Assessing whether universal coverage with insecticide-treated nets has been achieved: is the right indicator being used? Malar J. 2018;17:355.","journal-title":"Malar J"},{"key":"5512_CR8","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1186\/s12884-022-04586-2","volume":"22","author":"D Klu","year":"2022","unstructured":"Klu D, Aberese-Ako M, Manyeh AK, Immurana M, Doegah P, Dalaba M, et al. Mixed effect analysis of factors influencing the use of insecticides treated bed nets among pregnant women in Ghana: evidence from the 2019 malaria indicator survey. BMC Pregnancy Childbirth. 2022;22:258.","journal-title":"BMC Pregnancy Childbirth"},{"key":"5512_CR9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0211365","volume":"14","author":"EW Kanmiki","year":"2019","unstructured":"Kanmiki EW, Awoonor-Williams JK, Phillips JF, Kachur SP, Achana SF, Akazili J, et al. Socio-economic and demographic disparities in ownership and use of insecticide-treated bed nets for preventing malaria among rural reproductive-aged women in northern Ghana. PLoS ONE. 2019;14: e0211365.","journal-title":"PLoS ONE"},{"key":"5512_CR10","first-page":"7481210","volume":"2017","author":"G Manu","year":"2017","unstructured":"Manu G, Boamah-Kaali EA, Febir LG, Ayipah E, Owusu-Agyei S, Asante KP. Low utilization of insecticide-treated bed net among pregnant women in the middle belt of Ghana. Malar Res Treat. 2017;2017:7481210.","journal-title":"Malar Res Treat"},{"key":"5512_CR11","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2023.1140604","volume":"11","author":"SK Afagbedzi","year":"2023","unstructured":"Afagbedzi SK, Alhassan Y, Kenu E, Malm K, Bandoh DAB, Peprah NY, et al. Universal coverage and utilization of free long-lasting insecticidal nets for malaria prevention in Ghana: a cross-sectional study. Front Public Health. 2023;11: 1140604.","journal-title":"Front Public Health"},{"key":"5512_CR12","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-023-04592-5","volume":"22","author":"L Nu\u00f1ez","year":"2023","unstructured":"Nu\u00f1ez L, Skjefte M, Asamoah OE, Owusu P, Malm K, Miller JE. Successful implementation of ITN distribution through health facilities in Ghana. Malar J. 2023;22: 224.","journal-title":"Malar J"},{"key":"5512_CR13","unstructured":"Ghana Statistical Service (GSS) and ICF. Ghana demographic and health survey 2022: Key indicators report [Internet]. Accra, Ghana, and Rockville, Maryland: GSS and ICF Accra, Ghana; 2023 May. Available from: https:\/\/www.dhsprogram.com\/pubs\/pdf\/PR149\/PR149.pdf"},{"key":"5512_CR14","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-022-04388-z","volume":"21","author":"E Budu","year":"2022","unstructured":"Budu E, Okyere J, Mensah F, Azure SA, Seidu A-A, Ameyaw EK, et al. Inequalities in the use of insecticide-treated nets by pregnant women in Ghana, 2011 and 2017. Malar J. 2022;21: 376.","journal-title":"Malar J"},{"key":"5512_CR15","volume":"23","author":"JE Ataguba","year":"2023","unstructured":"Ataguba JE, Nwosu CO, Obse AG. Is socioeconomic inequality in antenatal care coverage widening or reducing between- and within-socioeconomic groups? A case of 19 countries in sub-Saharan Africa. SSM. 2023;23: 101402.","journal-title":"SSM"},{"key":"5512_CR16","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-017-0948-8","volume":"15","author":"K Galactionova","year":"2017","unstructured":"Galactionova K, Smith TA, de Savigny D, Penny MA. State of inequality in malaria intervention coverage in sub-Saharan African countries. BMC Med. 2017;15: 185.","journal-title":"BMC Med"},{"key":"5512_CR17","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph21121656","volume":"21","author":"D Okova","year":"2024","unstructured":"Okova D, Lukwa AT, Oyando R, Bodzo P, Chiwire P, Alaba OA. Malaria prevention for pregnant women and under-five children in 10 sub-Saharan Africa countries: socioeconomic and temporal inequality analysis. Int J Environ Res Public Health. 2024;21: 1656.","journal-title":"Int J Environ Res Public Health"},{"key":"5512_CR18","unstructured":"Ghana Statistical Service (GSS), Noguchi Memorial Institute for Medical Research (NMIMR), ORC Macro. Ghana Demographic and Health Survey 2003 [Internet]. Ghana Statistical Service, Ghana Health Service, and ICF International. Accra, Ghana; 2003 Sep. Available from: https:\/\/www.dhsprogram.com\/pubs\/pdf\/FR152\/FR152.pdf"},{"key":"5512_CR19","unstructured":"Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF Macro. Ghana demographic and health survey 2008 [Internet]. Ghana Statistical Service, Ghana Health Service, and ICF International. Accra, Ghana; 2009 Sep. https:\/\/dhsprogram.com\/publications\/publication-fr221-dhs-final-reports.cfm"},{"key":"5512_CR20","unstructured":"Ghana Statistical Service (GSS), Ghana Health Service (GHS), ICF International. Ghana demographic and health survey 2014 [Internet]. Ghana Statistical Service, Ghana Health Service, and ICF International. Rockville, Maryland, USA; 2015 Aug. Available from: https:\/\/dhsprogram.com\/pubs\/pdf\/fr307\/fr307.pdf"},{"key":"5512_CR21","unstructured":"DHS. Guide-to-DHS-Statistics: Use of Mosquito Nets by Pregnant Women. https:\/\/dhsprogram.com\/data\/Guide-to-DHS-Statistics\/Use_of_Mosquito_Nets_by_Pregnant_Women.htm. 2024."},{"key":"5512_CR22","doi-asserted-by":"publisher","DOI":"10.1177\/11786302231164287","volume":"17","author":"W Kebede","year":"2023","unstructured":"Kebede W, Tolcha A, Soboksa NE, Negassa B, Kanno GG, Aregu MB. Utilization of insecticide-treated nets in households for under-5 children and associated factors in East Mesekan District, Gurage Zone, Southern Ethiopia. Environ Health Insights. 2023;17: 11786302231164288.","journal-title":"Environ Health Insights"},{"key":"5512_CR23","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-020-03230-8","volume":"19","author":"MK Martin","year":"2020","unstructured":"Martin MK, Venantius KB, Patricia N, Bernard K, Keith B, Allen K, et al. Correlates of uptake of optimal doses of sulfadoxine-pyrimethamine for prevention of malaria during pregnancy in East-Central Uganda. Malar J. 2020;19: 153.","journal-title":"Malar J"},{"key":"5512_CR24","unstructured":"Rutstein SO, Johnson K. The DHS Wealth Index. DHS Comparative Reports No. 6. Calverton, Maryland: ORC Macro. 2004."},{"key":"5512_CR25","unstructured":"Giammatteo M. The bidimensional decomposition of inequality: a nested Theil approach. LIS Working Paper Series; 2007."},{"key":"5512_CR26","unstructured":"Bell\u00f9 LG, Liberati P. Policy impacts on inequality: decomposition of income inequality by subgroups. 2006 [cited 2025 Jun 17]; Available from: https:\/\/openknowledge.fao.org\/server\/api\/core\/bitstreams\/35c2d071-828b-45bf-97bc-7ba5d817f458\/content"},{"key":"5512_CR27","doi-asserted-by":"publisher","DOI":"10.1186\/s12982-022-00112-z","volume":"19","author":"KU Mare","year":"2022","unstructured":"Mare KU, Aychiluhm SB, Tadesse AW, Mohammed OA. Individual and community-level determinants of non-use of contraceptive among women with no fertility desire in Ethiopia: a multilevel mixed-effect analysis. Emerg Themes Epidemiol. 2022;19: 2.","journal-title":"Emerg Themes Epidemiol"},{"key":"5512_CR28","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1016\/j.jhealeco.2011.10.009","volume":"31","author":"G Erreygers","year":"2012","unstructured":"Erreygers G, Clarke P, Van Ourti T. \u2018Mirror, mirror, on the wall, who in this land is fairest of all?\u2019 -Distributional sensitivity in the measurement of socioeconomic inequality of health. J Health Econ. 2012;31:257\u201370.","journal-title":"J Health Econ"},{"key":"5512_CR29","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1016\/j.jhealeco.2008.02.003","volume":"28","author":"G Erreygers","year":"2009","unstructured":"Erreygers G. Correcting the concentration index. J Health Econ. 2009;28:504\u201315.","journal-title":"J Health Econ"},{"key":"5512_CR30","unstructured":"Erreygers G. Beyond the health Concentration Index: an Atkinson alternative for the measurement of the socioeconomic inequality of health. 2006. Available from: https:\/\/www.researchgate.net\/publication\/4726429_Beyond_the_Health_Concentration_Index_An_Atkinson_Alternative_for_the_Measurement_of_the_Socioeconomic_Inequality_of_Health"},{"key":"5512_CR31","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1002\/hec.953","volume":"14","author":"A Wagstaff","year":"2005","unstructured":"Wagstaff A. The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality. Health Econ. 2005;14:429\u201332.","journal-title":"Health Econ"},{"key":"5512_CR32","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1016\/j.jhealeco.2008.12.003","volume":"28","author":"A Wagstaff","year":"2009","unstructured":"Wagstaff A. Correcting the concentration index: A comment. J Health Econ. 2009;28:516\u201320.","journal-title":"J Health Econ"},{"key":"5512_CR33","doi-asserted-by":"publisher","first-page":"881","DOI":"10.2471\/BLT.11.087536","volume":"89","author":"AR Hosseinpoor","year":"2011","unstructured":"Hosseinpoor AR, Victora CG, Bergen N, Barros AJD, Boerma T. Towards universal health coverage: the role of within-country wealth-related inequality in 28 countries in sub-Saharan Africa. Bull World Health Organ. 2011;89:881\u201390.","journal-title":"Bull World Health Organ"},{"key":"5512_CR34","doi-asserted-by":"crossref","unstructured":"O\u2019Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing Health Equity Using Household Survey Data. A Guide to Techniques and Their Implementation. Washington, DC: The World Bank [Internet]. 2007;1\u2013220. Available from: https:\/\/books.google.com\/books?id=8krsjfKv2vgC&pgis=1","DOI":"10.1596\/978-0-8213-6933-3"},{"key":"5512_CR35","doi-asserted-by":"publisher","first-page":"1225","DOI":"10.1016\/S0140-6736(12)60113-5","volume":"379","author":"A Barros","year":"2012","unstructured":"Barros A. Equity in maternal, newborn, and child health interventions- a retrospective review of survey data in Countdown to 2015- a retrospective review of survey data from 54 countries. Lancet. 2012;379:1225\u201333.","journal-title":"Lancet"},{"key":"5512_CR36","doi-asserted-by":"publisher","first-page":"817","DOI":"10.2307\/1912934","volume":"48","author":"H White","year":"1980","unstructured":"White H. A heteroskedasticity-consistent covariance matrix estimator and a direct test for heteroskedasticity. Econometrica. 1980;48:817.","journal-title":"Econometrica"},{"key":"5512_CR37","doi-asserted-by":"crossref","unstructured":"Concei\u00e7\u00e3o P, Ferreira P. The young person\u2019s guide to the Theil index: suggesting intuitive interpretations and exploring analytical applications. SSRN Electronic Journal. 2000. Available from: https:\/\/www.researchgate.net\/publication\/228279075_A_Young_Person's_Guide_to_the_Theil_Index_Suggestive_Intuitive_Interpretations_and_Exploring_Analytical_Applications","DOI":"10.2139\/ssrn.228703"},{"key":"5512_CR38","doi-asserted-by":"publisher","DOI":"10.2307\/2297303","volume":"47","author":"FA Cowell","year":"1980","unstructured":"Cowell FA. On the structure of additive inequality measures. Rev Econ Stud. 1980;47: 521.","journal-title":"Rev Econ Stud"},{"key":"5512_CR39","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-024-05072-0","volume":"23","author":"PF Doe","year":"2024","unstructured":"Doe PF, Druye AA, Azu TD, Boso CM, Commey IT, Agyare DF, et al. Ownership and usage of insecticide-treated nets in Ghana: a scoping review of facilitators and barriers. Malar J. 2024;23: 238.","journal-title":"Malar J"},{"key":"5512_CR40","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1186\/s12936-020-03481-5","volume":"19","author":"EK Ameyaw","year":"2020","unstructured":"Ameyaw EK, Adde KS, Dare S, Yaya S. Rural\u2013urban variation in insecticide-treated net utilization among pregnant women: evidence from 2018 Nigeria demographic and health survey. Malar J. 2020;19:407.","journal-title":"Malar J"},{"key":"5512_CR41","doi-asserted-by":"publisher","first-page":"6340482","DOI":"10.1155\/jotm\/6340482","volume":"2025","author":"A Barrow","year":"2025","unstructured":"Barrow A, Kinteh B, Badjie M, Kongira A, Adebayo AM, Kuye RA, et al. Determinants of insecticide-treated net utilization for malaria prevention among under-five children in The Gambia: evidence from national survey. J Trop Med. 2025;2025:6340482.","journal-title":"J Trop Med"},{"key":"5512_CR42","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1353\/cpr.2011.0018","volume":"5","author":"DG Rickard","year":"2011","unstructured":"Rickard DG, Dudovitz RN, Wong MD, Jen HC, Osborn RD, Fernandez HE, et al. Closing the gap between insecticide treated net ownership and use for the prevention of malaria. Prog Community Health Partnersh. 2011;5:123\u201331.","journal-title":"Prog Community Health Partnersh"},{"key":"5512_CR43","first-page":"39","volume":"7","author":"P Krezanoski","year":"2016","unstructured":"Krezanoski P. Delivering insecticide-treated nets for malaria prevention: innovative strategies. Res Rep Trop Med. 2016;7:39\u201347.","journal-title":"Res Rep Trop Med"},{"key":"5512_CR44","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1186\/s12936-022-04373-6","volume":"21","author":"JE Miller","year":"2022","unstructured":"Miller JE, Malm K, Serge AA, Ateba MJ, Gitanya P, Sene D, et al. Multi-country review of ITN routine distribution data: are ANC and EPI channels achieving their potential? Malar J. 2022;21:366.","journal-title":"Malar J"},{"key":"5512_CR45","doi-asserted-by":"publisher","DOI":"10.7554\/eLife.09672","volume":"4","author":"S Bhatt","year":"2015","unstructured":"Bhatt S, Weiss DJ, Mappin B, Dalrymple U, Cameron E, Bisanzio D, et al. Coverage and system efficiencies of insecticide-treated nets in Africa from 2000 to 2017. Elife. 2015;4: e09672.","journal-title":"Elife"},{"key":"5512_CR46","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1186\/s12936-021-03738-7","volume":"20","author":"J Scott","year":"2021","unstructured":"Scott J, Kanyangarara M, Nhama A, Macete E, Moss WJ, Saute F. Factors associated with use of insecticide-treated net for malaria prevention in Manica District, Mozambique: a community-based cross-sectional survey. Malar J. 2021;20:200.","journal-title":"Malar J"},{"key":"5512_CR47","doi-asserted-by":"publisher","first-page":"1337803","DOI":"10.3389\/fpubh.2024.1337803","volume":"12","author":"AB Adusei","year":"2024","unstructured":"Adusei AB, Bour H, Amu H, Afriyie A. Community-based health planning and services programme in Ghana: a systematic review. Front Public Health. 2024;12:1337803.","journal-title":"Front Public Health"},{"key":"5512_CR48","doi-asserted-by":"publisher","first-page":"1188","DOI":"10.1093\/heapol\/czac063","volume":"37","author":"HE Huffstetler","year":"2022","unstructured":"Huffstetler HE, Bandara S, Bharali I, Kennedy Mcdade K, Mao W, Guo F, et al. The impacts of donor transitions on health systems in middle-income countries: a scoping review. Health Policy Plan. 2022;37:1188\u2013202.","journal-title":"Health Policy Plan"},{"key":"5512_CR49","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1080\/13563467.2022.2084517","volume":"28","author":"BJ Dye","year":"2023","unstructured":"Dye BJ. When the means become the ends: Ghana\u2019s \u2018good governance\u2019 electricity reform overwhelmed by the politics of power crises. New Polit Econ. 2023;28:91\u2013111.","journal-title":"New Polit Econ"},{"key":"5512_CR50","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2020-003896","volume":"6","author":"W Mao","year":"2021","unstructured":"Mao W, McDade KK, Huffstetler HE, Dodoo J, Abankwah DNY, Coleman N, et al. Transitioning from donor aid for health: perspectives of national stakeholders in Ghana. BMJ Glob Health. 2021;6: e003896.","journal-title":"BMJ Glob Health"},{"key":"5512_CR51","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-019-3004-7","volume":"18","author":"E Roman","year":"2019","unstructured":"Roman E, Andrejko K, Wolf K, Henry M, Youll S, Florey L, et al. Determinants of uptake of intermittent preventive treatment during pregnancy: a review. Malar J. 2019;18: 372.","journal-title":"Malar J"},{"key":"5512_CR52","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s12889-023-17529-z","volume":"24","author":"K Koita","year":"2024","unstructured":"Koita K, Bognini JD, Agboraw E, Demb\u00e9l\u00e9 M, Yabr\u00e9 S, Bihoun B, et al. Increasing the uptake of intermittent preventive treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) through seasonal malaria chemoprevention channel delivery: protocol of a multicenter cluster randomized implementation trial in Mali and Burkina Faso. BMC Public Health. 2024;24:43.","journal-title":"BMC Public Health"},{"key":"5512_CR53","doi-asserted-by":"publisher","DOI":"10.1016\/j.parepi.2021.e00222","volume":"15","author":"F Dun-Dery","year":"2021","unstructured":"Dun-Dery F, Meissner P, Beiersmann C, Kuunibe N, Winkler V, Albrecht J, et al. Uptake challenges of intermittent preventive malaria therapy among pregnant women and their health care providers in the Upper West Region of Ghana: a mixed-methods study. Parasite Epidemiol Control. 2021;15: e00222.","journal-title":"Parasite Epidemiol Control"},{"key":"5512_CR54","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2022-010079","volume":"7","author":"Y Alonso","year":"2022","unstructured":"Alonso Y, Lusengi W, Manun\u2019Ebo MF, Rasoamananjaranahary AM, Rivontsoa NM, Mucavele E, et al. The social dimensions of community delivery of intermittent preventive treatment of malaria in pregnancy in Madagascar, Mozambique, Nigeria and the Democratic Republic of the Congo. BMJ Glob Health. 2022;7: e010079.","journal-title":"BMJ Glob Health"},{"key":"5512_CR55","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1186\/s12936-021-03950-5","volume":"20","author":"PS Larson","year":"2021","unstructured":"Larson PS, Eisenberg JNS, Berrocal VJ, Mathanga DP, Wilson ML. An urban-to-rural continuum of malaria risk: new analytic approaches characterize patterns in Malawi. Malar J. 2021;20:418.","journal-title":"Malar J"},{"key":"5512_CR56","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1186\/s12936-021-03891-z","volume":"20","author":"P Doumbe-Belisse","year":"2021","unstructured":"Doumbe-Belisse P, Kopya E, Ngadjeu CS, Sonhafouo-Chiana N, Talipouo A, Djamouko-Djonkam L, et al. Urban malaria in sub-Saharan Africa: dynamic of the vectorial system and the entomological inoculation rate. Malar J. 2021;20:364.","journal-title":"Malar J"},{"key":"5512_CR57","doi-asserted-by":"publisher","first-page":"110","DOI":"10.4269\/ajtmh.14-0834","volume":"93","author":"ML Wilson","year":"2015","unstructured":"Wilson ML, Krogstad DJ, Arinaitwe E, Arevalo-Herrera M, Chery L, Ferreira MU, et al. Urban malaria: understanding its epidemiology, ecology, and transmission across seven diverse ICEMR network sites. Am J Trop Med Hyg. 2015;93:110\u201323.","journal-title":"Am J Trop Med Hyg"},{"key":"5512_CR58","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1038\/nrmicro1069","volume":"3","author":"SI Hay","year":"2005","unstructured":"Hay SI, Guerra CA, Tatem AJ, Atkinson PM, Snow RW. Urbanization, malaria transmission and disease burden in Africa. Nat Rev Microbiol. 2005;3:81\u201390.","journal-title":"Nat Rev Microbiol"},{"key":"5512_CR59","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1186\/s12936-018-2319-0","volume":"17","author":"V Were","year":"2018","unstructured":"Were V, Buff AM, Desai M, Kariuki S, Samuels A, ter Kuile FO, et al. Socioeconomic health inequality in malaria indicators in rural western Kenya: evidence from a household malaria survey on burden and care-seeking behaviour. Malar J. 2018;17:166.","journal-title":"Malar J"},{"key":"5512_CR60","doi-asserted-by":"publisher","first-page":"1593","DOI":"10.1111\/tmi.13689","volume":"26","author":"A Bawuah","year":"2021","unstructured":"Bawuah A, Ampaw S. Ownership and use of insecticide-treated nets under Ghana\u2019s National Malaria Control Program: what are the correlates? Trop Med Int Health. 2021;26:1593\u2013608.","journal-title":"Trop Med Int Health"},{"key":"5512_CR61","doi-asserted-by":"publisher","first-page":"466","DOI":"10.1177\/00494755221110374","volume":"52","author":"TO Ojo","year":"2022","unstructured":"Ojo TO, Anjorin OE, Babatola AO, Akinlosotu MA. Sociodemographic factors associated with the use of insecticide treated nets among under-fives in Nigeria: evidence from a national survey. Trop Doct. 2022;52:466\u201373.","journal-title":"Trop Doct"},{"key":"5512_CR62","doi-asserted-by":"publisher","first-page":"289","DOI":"10.1093\/inthealth\/ihac024","volume":"15","author":"W Haileselassie","year":"2023","unstructured":"Haileselassie W, Habtemichael M, Adam R, Haidar J, David RE, Belachew A, et al. Regional and socio-economic disparity in use of insecticide-treated nets to prevent malaria among pregnant women in Kenya. Int Health. 2023;15:289\u201398.","journal-title":"Int Health"},{"key":"5512_CR63","doi-asserted-by":"publisher","DOI":"10.1186\/s40249-023-01110-2","volume":"12","author":"ST Wafula","year":"2023","unstructured":"Wafula ST, Habermann T, Franke MA, May J, Puradiredja DI, Lorenz E, et al. What are the pathways between poverty and malaria in sub-Saharan Africa? A systematic review of mediation studies. Infect Dis Poverty. 2023;12: 58.","journal-title":"Infect Dis Poverty"},{"issue":"1","key":"5512_CR64","doi-asserted-by":"publisher","DOI":"10.1186\/s12936-022-04193-8","volume":"21","author":"YK Aung","year":"2022","unstructured":"Aung YK, Zin SS, Tesfazghi K, Paudel M, Thet MM, Thein ST. A comparison of malaria prevention behaviours, care-seeking practices and barriers between malaria at-risk worksite migrant workers and villagers in Northern Shan State, Myanmar\u2014a mixed method study. Malar J. 2022;21(1): 162.","journal-title":"Malar J"},{"key":"5512_CR65","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1645\/17-141","volume":"105","author":"SS Diarra","year":"2019","unstructured":"Diarra SS, Konat\u00e9 D, Diawara SI, Tall M, Diakit\u00e9 M, Doumbia S. Factors associated with intermittent preventive treatment of malaria during pregnancy in Mali. J Parasitol. 2019;105:299\u2013302.","journal-title":"J Parasitol"},{"key":"5512_CR66","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1186\/s13690-021-00707-z","volume":"79","author":"EKM Darteh","year":"2021","unstructured":"Darteh EKM, Dickson KS, Ahinkorah BO, Owusu BA, Okyere J, Salihu T, et al. Factors influencing the uptake of intermittent preventive treatment among pregnant women in sub-Saharan Africa: a multilevel analysis. Arch Public Health. 2021;79:182.","journal-title":"Arch Public Health"},{"key":"5512_CR67","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001488","volume":"10","author":"J Hill","year":"2013","unstructured":"Hill J, Hoyt J, van Eijk AM, D\u2019Mello-Guyett L, ter Kuile FO, Steketee R, et al. Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-Saharan Africa: a systematic review and meta-analysis. PLoS Med. 2013;10: e1001488.","journal-title":"PLoS Med"},{"key":"5512_CR68","doi-asserted-by":"publisher","first-page":"1860","DOI":"10.1186\/s12889-020-09967-w","volume":"20","author":"FM Muhammad","year":"2020","unstructured":"Muhammad FM, Majdzadeh R, Nedjat S, Sajadi HS, Parsaeian M. Socioeconomic inequality in intermittent preventive treatment using sulphadoxine pyrimethamine among pregnant women in Nigeria. BMC Public Health. 2020;20:1860.","journal-title":"BMC Public Health"},{"key":"5512_CR69","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1186\/s12936-022-04299-z","volume":"21","author":"EK Ameyaw","year":"2022","unstructured":"Ameyaw EK. Uptake of intermittent preventive treatment of malaria in pregnancy using sulfadoxine-pyrimethamine (IPTp-SP) in Uganda: a national survey. Malar J. 2022;21:285.","journal-title":"Malar J"},{"key":"5512_CR70","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-047606","volume":"11","author":"EK Ameyaw","year":"2021","unstructured":"Ameyaw EK, Njue C, Amoah RM, Appiah F, Baatiema L, Ahinkorah BO, et al. Is improvement in indicators of women\u2019s empowerment associated with uptake of WHO recommended IPTp-SP levels in sub-Saharan Africa? A multilevel approach. BMJ Open. 2021;11: e047606.","journal-title":"BMJ Open"},{"key":"5512_CR71","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-015-2222-3","volume":"15","author":"K Elmusharaf","year":"2015","unstructured":"Elmusharaf K, Byrne E, O\u2019Donovan D. Strategies to increase demand for maternal health services in resource-limited settings: challenges to be addressed. BMC Public Health. 2015;15: 870.","journal-title":"BMC Public Health"},{"key":"5512_CR72","first-page":"230","volume":"10","author":"HA Bawadi","year":"2023","unstructured":"Bawadi HA, Abu Abed AS, Al-Hamdan ZM, Alzubi SM. Receiving antenatal care via mobile clinic: lived experiences of Jordanian mothers. Int J Nurs Sci. 2023;10:230\u20137.","journal-title":"Int J Nurs Sci"},{"key":"5512_CR73","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez R, Manun\u2019Ebo MF, Meremikwu M, Rabeza VR, Sacoor C, Figueroa-Romero A, et al. The impact of community delivery of intermittent preventive treatment of malaria in pregnancy on its coverage in four sub-Saharan African countries (Democratic Republic of the Congo, Madagascar, Mozambique, and Nigeria): a quasi-experimental multicentre evaluation. Lancet Glob Health. 2023;11:e566\u201374.","DOI":"10.1016\/S2214-109X(23)00051-7"},{"key":"5512_CR74","doi-asserted-by":"crossref","unstructured":"Mbuagbaw L, Medley N, Darzi AJ, Richardson M, Habiba Garga K, Ongolo-Zogo P. Health system and community level interventions for improving antenatal care coverage and health outcomes. Cochrane Database Syst Rev. 2015;2015:CD010994.","DOI":"10.1002\/14651858.CD010994"},{"key":"5512_CR75","unstructured":"Ogba P, Baumann A, Chidwick H, Banfield L, DiLiberto DD. Barriers and facilitators to access and uptake of intermittent preventive treatment with sulfadoxine-pyrimethamine among pregnant women in Nigeria: a scoping review. Malariaworld J. 2022;13."},{"key":"5512_CR76","unstructured":"Baciu A, Negussie Y, Geller A, Weinstein JN, National Academies of Sciences and Medicine E. The root causes of health inequity. Communities in action: pathways to health equity. National Academies Press (USA); 2017."},{"key":"5512_CR77","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-10630-1","volume":"21","author":"H Alderwick","year":"2021","unstructured":"Alderwick H, Hutchings A, Briggs A, Mays N. The impacts of collaboration between local health care and non-health care organizations and factors shaping how they work: a systematic review of reviews. BMC Public Health. 2021;21: 753.","journal-title":"BMC Public Health"},{"issue":"1","key":"5512_CR78","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-11852-z","volume":"21","author":"VJ McGowan","year":"2021","unstructured":"McGowan VJ, Buckner S, Mead R, McGill E, Ronzi S, Beyer F, et al. Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review. BMC Public Health. 2021;21(1): 1888.","journal-title":"BMC Public Health"},{"key":"5512_CR79","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1111\/1467-9566.13181","volume":"43","author":"G McCartney","year":"2021","unstructured":"McCartney G, Dickie E, Escobar O, Collins C. Health inequalities, fundamental causes and power: towards the practice of good theory. Sociol Health Illn. 2021;43:20\u201339.","journal-title":"Sociol Health Illn"},{"key":"5512_CR80","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m1175","volume":"369","author":"M Remme","year":"2020","unstructured":"Remme M, Vassall A, Fernando G, Bloom DE. Investing in the health of girls and women: a best buy for sustainable development. BMJ. 2020;369: m1175.","journal-title":"BMJ"},{"key":"5512_CR81","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1146\/annurev-publhealth-031816-044628","volume":"39","author":"A Zajacova","year":"2024","unstructured":"Zajacova A, Lawrence EM. The relationship between education and health: reducing disparities through a contextual approach. Annu Rev Public Health. 2024;39:273\u201389.","journal-title":"Annu Rev Public Health"},{"key":"5512_CR82","doi-asserted-by":"publisher","first-page":"336","DOI":"10.2174\/1874944502114010336","volume":"14","author":"R Chinyakata","year":"2021","unstructured":"Chinyakata R, Roman NV, Msiza FB. Stakeholders\u2019 perspectives on the barriers to accessing health care services in rural settings: a human capabilities approach. Open Public Health J. 2021;14:336\u201344.","journal-title":"Open Public Health J"},{"key":"5512_CR83","doi-asserted-by":"crossref","unstructured":"le R Booysen F. Urban\u2013rural inequalities in health care delivery in South Africa. Dev South Afr. 2003;20:659\u201373.","DOI":"10.1080\/0376835032000149298"},{"key":"5512_CR84","doi-asserted-by":"publisher","first-page":"503","DOI":"10.1016\/j.jamda.2019.01.120","volume":"20","author":"D Siconolfi","year":"2019","unstructured":"Siconolfi D, Shih RA, Friedman EM, Kotzias VI, Ahluwalia SC, Phillips JL, et al. Rural-urban disparities in access to home- and community-based services and supports: stakeholder perspectives from 14 States. J Am Med Dir Assoc. 2019;20:503\u20138.","journal-title":"J Am Med Dir Assoc"},{"key":"5512_CR85","doi-asserted-by":"publisher","first-page":"210","DOI":"10.7758\/rsf.2017.3.2.09","volume":"3","author":"CR Browning","year":"2017","unstructured":"Browning CR, Calder CA, Krivo LJ, Smith AL, Boettner B. Socioeconomic segregation of activity spaces in urban neighborhoods: does shared residence mean shared routines? RSF. 2017;3:210\u201331.","journal-title":"RSF"},{"key":"5512_CR86","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1093\/esr\/jcae015","volume":"40","author":"A Zahl-Thanem","year":"2024","unstructured":"Zahl-Thanem A, Rye JF. Spatial inequality in higher education: a growing urban\u2013rural educational gap? Eur Sociol Rev. 2024;40:1067\u201381.","journal-title":"Eur Sociol Rev"},{"key":"5512_CR87","doi-asserted-by":"publisher","DOI":"10.3389\/feduc.2021.649730","volume":"6","author":"M Mutisya","year":"2021","unstructured":"Mutisya M, Muchira JM, Abuya BA. Understanding wealth inequalities in education access in urbanizing sub-Saharan Africa. Front Educ. 2021;6: 649730.","journal-title":"Front Educ"},{"key":"5512_CR88","doi-asserted-by":"publisher","DOI":"10.4084\/mjhid.2012.048","volume":"4","author":"F Ricci","year":"2012","unstructured":"Ricci F. Social implications of malaria and their relationships with poverty. Mediterr J Hematol Infect Dis. 2012;4: e2012048.","journal-title":"Mediterr J Hematol Infect Dis"},{"key":"5512_CR89","doi-asserted-by":"crossref","unstructured":"Polec LA, Petkovic J, Welch V, Ueffing E, Ghogomu ET, Pardo JP, et al. Strategies to increase the ownership and use of insecticide\u2010treated bednets to prevent malaria. Cochrane Database Syst Rev. 2015;2015:CD009186.","DOI":"10.1002\/14651858.CD009186.pub2"},{"key":"5512_CR90","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-022-01190-y","volume":"17","author":"L Sacca","year":"2022","unstructured":"Sacca L, Shegog R, Hernandez B, Peskin M, Rushing SC, Jessen C, et al. Barriers, frameworks, and mitigating strategies influencing the dissemination and implementation of health promotion interventions in indigenous communities: a scoping review. Implement Sci. 2022;17: 18.","journal-title":"Implement Sci"},{"key":"5512_CR91","unstructured":"Malaria Knowledge Hub (MESA). National Malaria Elimination Strategic Plan (NMESP) of Ghana: 2024 \u2013 2028 [Internet]. Accra; 2024 Jan. Available from: https:\/\/mesamalaria.org\/resource-hub\/national-malaria-elimination-strategic-plan-nmesp-of-ghana-2024-2028\/"}],"container-title":["Malaria Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-025-05512-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12936-025-05512-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12936-025-05512-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T11:08:03Z","timestamp":1757416083000},"score":1,"resource":{"primary":{"URL":"https:\/\/malariajournal.biomedcentral.com\/articles\/10.1186\/s12936-025-05512-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,22]]},"references-count":91,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["5512"],"URL":"https:\/\/doi.org\/10.1186\/s12936-025-05512-5","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-4920246\/v1","asserted-by":"object"}]},"ISSN":["1475-2875"],"issn-type":[{"value":"1475-2875","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,22]]},"assertion":[{"value":"15 August 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 August 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 August 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study utilized secondary data from the Ghana Demographic and Health Surveys (DHS) for the years 2003, 2008, 2014, and 2022. As the analysis was based on publicly available datasets, no additional ethics approval was required for this study. However, it is important to note that the original DHS surveys obtained ethical approval and consent from participants. Ethical protocols were strictly followed during data collection, ensuring that all participants provided informed consent and that their privacy and confidentiality were protected.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All authors have reviewed and consented to the publication of this manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"273"}}