By Joke Kujenya
FoOR A child under five in West Africa, the chance of testing positive for malaria depends heavily on where they sleep at night.
New evidence from laboratory-confirmed surveys shows that malaria risk is sharply uneven across borders, regions and even neighbouring communities, leaving some children far more exposed than others despite living in the same country.
The study examined thousands of children aged 6 to 59 months across eight countries namely Benin, Burkina Faso, Cote d’Ivoire, Ghana, Guinea, Liberia, Nigeria and Togo.
Only microscopy-confirmed results were included, ensuring every reported infection reflected a true Plasmodium falciparum diagnosis.
At national level, contrasts were stark.
The study states that Benin recorded the highest prevalence at 39.73 percent noting almost 4 in 10children tested positive.
Ghana, in contrast, had just 9.96 percent, while Togo fell in between at 29.83 percent.
Yet national averages masked sharp differences within countries.
It notes that in Burkina Faso, Ghana and Guinea, most communities stayed below the 30 percent threshold used to define high-burden areas, while Benin, Cote d’Ivoire, Nigeria and Togo contained clusters where more than 40 percent of children tested positive.
Furthermore, the study shows Southern Benin and central and eastern Cote d’Ivoire repeatedly emerged as high-risk zones, with pockets of intense malaria transmission in parts of Nigeria as well.
Also, some other patterns were consistent across the region.
It reveals that younger children under 2 were significantly less likely to test positive, with risk reductions ranging from 40 to 63 percent depending on the country.
It emphasises that sleeping under an insecticide-treated mosquito net also offered protection: in Burkina Faso, Benin, Cote d’Ivoire and Ghana as children using treated nets had 28 percent lower odds of infection than those who did not.
Other factors such as child sex, maternal age or education also showed little measurable impact, except in Cote d’Ivoire, where children in male-headed households faced slightly higher odds of infection.
On another end, geography emerged as the most powerful determinant as Malaria risk was clustered rather than randomly distributed, with hotspots visible in high-resolution maps created from the survey data.
Predicted in the study was the prevalence at a 10 × 10 km resolution which showed that while much of Burkina Faso, Ghana, Guinea and Liberia remained under 20 percent, southern Benin and parts of Cote d’Ivoire faced sustained high prevalence.
In Togo, malaria burden was more evenly distributed, hovering around 30 percent, and Nigeria displayed a patchwork of moderate and high-risk areas.
The study shows exceedance probability maps highlighted the places where prevalence consistently exceeded 30 percent.
Again, in Benin, southern regions carried the highest likelihood, while central and western Cote d’Ivoire and pockets of central and southern Nigeria also remained zones of concern.
These maps bring the numbers to life, showing where malaria is not just present but persistent, shaping the daily realities of childhood.
The study, which relied exclusively on nationally representative and microscopy-confirmed data, excluding five West African countries Gambia, Sierra Leone, Senegal, Niger and Mali where it says data were incomplete or only available through rapid diagnostic tests noted that all surveys followed ethical protocols, with informed consent obtained for every child tested.
It also notes that the resulting portrait is stark and human showing that in some communities, fewer than 1 in 10 children tested positive.
In others, nearly half did, it shows.
However, much of this difference was dictated by geography and simple protective measures like sleeping under a treated net adding that by mapping hotspots and linking risk to observable factors, its research provides a clear, actionable picture of where malaria still threatens childhood survival across West Africa.
