Investment Plan for Under-5 Child Survival in Northern Ghana: A Cost-Effectiveness Analysis of Malaria Interventions

Investment Plan for Under-5 Child Survival in Northern Ghana: A Cost-Effectiveness Analysis of Malaria Interventions Authors: Dr. Prajakta S Khairkar, BDS, MPHAdvisor: Dr. Rudolf KnippenbergInstitution: NYU School of Global Public HealthDate: November 2025 ABSTRACT Background: The northern regions of Ghana experience significantly elevated child mortality, with under-five death rates of 150 per 1,000 live births—dramatically exceeding the nationwide figure of 36 (Ghana Statistical Service [GSS], Ghana Health Service [GHS], & ICF International, 2015). Endemic malaria constitutes a primary driver of this disparity, affecting 40% of young children in the Northern region and 38% in Upper West, contributing to approximately 3,000 daily pediatric deaths across malaria-endemic territories globally. Objective: This investigation evaluates both population-level effectiveness and economic efficiency of two evidence-supported malaria control strategies—Insecticide-Treated Nets (ITNs) and Artemisinin-based Combination Therapy (ACT)—to guide resource allocation priorities for child survival enhancement in Northern Ghana. Methods: Utilizing data from the 2014 Ghana Demographic and Health Survey (GSS, GHS, & ICF International, 2015), we quantified population effectiveness and mortality impact for ITN provision through community-based distribution and ACT delivery via health facilities coupled with conditional cash incentives. Population effectiveness quantification employed the formula: PE = [(Increase in Effective Coverage × Intervention Efficacy × Disease-Specific Attributable Mortality)] / [1 - (Baseline Coverage × Intervention Efficacy × Affected Fraction)] (Hazel et al., 2010). Economic evaluation determined lives preserved per million USD invested. Results: The ITN strategy demonstrated capacity to avert 15.91 deaths per 100,000 protected children (initial coverage 43%, target coverage 93%, effectiveness 65%; Lengeler, 2004), whereas ACT intervention showed 30.57 deaths averted per 100,000 treated children (initial coverage 8%, target coverage 87%, effectiveness 99%; World Health Organization [WHO], 2015). The combined mortality impact projected prevention of 39 deaths per 1,000 live births (ITN: 11.46, ACT: 28.15). Implementation required USD 22,000 in operational expenditure, yielding approximately 37-38 lives preserved per million USD investment, with per-capita expenditure of USD 0.008-0.009. Conclusions: The dual-intervention approach of ITNs and ACT represents an exceptionally cost-efficient strategy for reducing pediatric malaria mortality in Northern Ghana. ACT exhibits superior population effectiveness, while ITNs provide comprehensive preventive coverage. Addressing geographical and sociocultural obstacles through voucher subsidies, conditional incentives, community health worker mobilization, and female provider recruitment enhances uptake. Given negligible per-capita costs relative to Ghana's economic capacity, these interventions warrant immediate resource allocation and expanded implementation.