Association of Community Habitat Manipulation Practices with Malaria Parasitaemia Among Adults in the Ada West and North Tongu districts, Ghana

Habitat manipulation is a recurrent, community-deliverable form of larval source management; however, its association with human malaria infection has rarely been quantified. This cross-sectional analysis, nested within a randomised two-district cluster trial of integrated environmental management, examined associations between eight self-reported habitat management practices and malaria parasitaemia among adults in Ada West and North Tongu, Ghana, between July and December 2024. In this study, 1,400 adults enrolled 18 years or older (700 per district) were tested with the Abbott Bioline Malaria Ag P.f/Pan HRP2/pLDH rapid diagnostic test. District-specific prevalence differences, risk ratios, and odds ratios were estimated; odds ratios were pooled using the Mantel–Haenszel method and mutually adjusted for co-reported practices by logistic regression. Results showed that the prevalence of parasitaemia was 50.4% in Ada West and 50.6% in North Tongu. Clearing of vegetation from drains was associated with a prevalence 13.0 and 14.9 percentage points lower and persisted after mutual adjustment (adjusted odds ratios 0.61 and 0.64). Scheduled draining of waterlogged land (pooled odds ratio 0.66) and settlement planning (0.62) were also associated with lower parasitaemia. Flushing of streams, flood-control participation and vegetation near dwellings showed no association with parasitaemia. It was concluded that among habitat manipulation practices, drain clearance is associated with reduced parasitaemia.