Abstract / Summary
Abstract Background Night workers may experience occupational exposure to malaria vectors because their work can coincide with peak biting periods. However, malaria prevention and care seeking in this occupational group are poorly described in Ghana. This study assessed malaria prevention practices, care seeking behaviours, and factors associated with adequate prevention, prompt care seeking, malaria testing, and appropriate care seeking among night workers in the Greater Accra Region of Ghana. Methods A multicentre cross-sectional study included 420 night workers from 14 urban and periurban districts. Data were collected using a structured questionnaire. Adequate prevention was a prespecified composite defined as at least five of eight assessed practices. Prompt care seeking meant seeking external care within 24 hours of fever onset. Appropriate care seeking required prompt care, initial use of a formal provider, malaria testing, and no self medication before testing. Modified Poisson regression estimated adjusted prevalence ratios and 95% confidence intervals. Results Overall, 189 (45.0%) workers were mostly outdoors between 10 p.m. and 4 a.m., 111 (26.4%) had adequate malaria knowledge, and 103 (24.5%) met the definition of adequate prevention. Among 134 (31.9%) workers reporting fever, 95 (70.9%) sought care within 24 hours, 116 (86.6%) received a malaria test, and 52 (38.8%) met all criteria for appropriate care seeking. Adequate prevention was associated with senior high or tertiary education (aPR 1.53, 95% CI 1.02 to 2.29), employer provided prevention (aPR 2.17, 95% CI 1.40 to 3.35), and adequate malaria knowledge (aPR 2.11, 95% CI 1.61 to 2.78). Health insurance was associated with prompt care seeking (aPR 1.83, 95% CI 1.37 to 2.46) and appropriate care seeking (aPR 3.57, 95% CI 1.42 to 8.98). Conclusions Only one quarter of participants met the study definition of adequate malaria prevention, although most workers who reported fever received a malaria test. Workplace prevention, targeted education, employer engagement, and improved access to insured care may strengthen malaria control for occupations involving routine night work.