Between-and within-socioeconomic groups temporal inequality in the uptake of malaria prevention strategies among pregnant women and under-five children in Ghana

Background Malaria is one of the leading causes of mortality among pregnant women and children in Africa. Despite efforts to distribute insecticide-treated nets (ITNs) and provide intermittent preventive treatment in pregnancy (IPTp) in Ghana, significant socioeconomic inequalities persist. This study investigates the temporal trends in socioeconomic inequalities related to ITN and IPTp coverage among children and pregnant women in Ghana. Methods We utilized data from the Ghana Demographic and Health Surveys (DHS) for 2003, 2008, 2014, and 2022. We assessed ITN use by pregnant women and children under five, and IPTp coverage, employing the Erreygers normalized concentration index (ENCI) and Theil index to measure and decompose inequalities by socioeconomic status (SES) and residence. Results ITN use among children under five increased from 58.11% in 2003 to 62.86% in 2022, while ITN use among pregnant women showed fluctuations, dropping in 2008 and 2014 but rising to 60% in 2022. IPTp coverage increased steadily from 0.85% in 2003 to 60% in 2022. Overall socioeconomic inequalities in ITN use and IPTp coverage were predominantly driven by within-group rather than between-group inequalities. ITN use was higher among the poorest households, while IPTp coverage showed a pro-rich distribution in recent years. Conclusion Despite improvements in malaria prevention uptake, significant inequalities persist in Ghana. Addressing these disparities requires a multipronged approach, including strengthening supply chains, tailoring interventions to specific population needs, and reducing healthcare access barriers. Policies must focus on localized factors and specific barriers faced by disadvantaged groups to achieve equitable health outcomes in malaria prevention.