County and Health-Service Sector Variation in Malaria Diagnostic Positivity
in Liberia: A Longitudinal Multilevel Analysis of Routine Surveillance Data,
2021–2025

Germue M. Gbawoquiya

doi:10.46609/IJSSER.2026.v11i10.002

Title: County and Health-Service Sector Variation in Malaria Diagnostic Positivity in Liberia: A Longitudinal Multilevel Analysis of Routine Surveillance Data, 2021–2025
Authors: Germue M. Gbawoquiya
Journal: International Journal of Social Science and Economic Research (IJSSER) ISSN: 2455-8834 Volume: 11 Issue: 10 Publication Date: October 2026 DOI: 10.46609/IJSSER.2026.v11i10.002
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Germue M. Gbawoquiya Department of Epidemiology, Cuttington University School of Graduate and Professional Studies, Liberia
MLA 8 Gbawoquiya, Germue M. "County and Health-Service Sector Variation in Malaria Diagnostic Positivity in Liberia: A Longitudinal Multilevel Analysis of Routine Surveillance Data, 2021–2025." Int. j. of Social Science and Economic Research, vol. 11, no. 10, Oct. 2026, pp. 5393-5414, doi.org/10.46609/IJSSER.2026.v11i10.002. Accessed Oct. 2026. APA 6 Gbawoquiya, G. (2026, October). County and Health-Service Sector Variation in Malaria Diagnostic Positivity in Liberia: A Longitudinal Multilevel Analysis of Routine Surveillance Data, 2021–2025. Int. j. of Social Science and Economic Research, 11(10), 5393-5414. Retrieved from https://doi.org/10.46609/IJSSER.2026.v11i10.002 Chicago Gbawoquiya, Germue M. "County and Health-Service Sector Variation in Malaria Diagnostic Positivity in Liberia: A Longitudinal Multilevel Analysis of Routine Surveillance Data, 2021–2025." Int. j. of Social Science and Economic Research 11, no. 10 (October 2026), 5393-5414. Accessed October, 2026. https://doi.org/10.46609/IJSSER.2026.v11i10.002.
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ABSTRACT: Malaria surveillance records describe diagnostic activity across geographic and health-service settings, but positivity in routine records is not a direct measure of population prevalence. This study examined temporal, county, and health-service-sector variation in malaria diagnostic positivity in Liberia from 2021 to 2025. A retrospective longitudinal ecological analysis was conducted using routine malaria surveillance data supplied by the Liberia Ministry of Health/National Malaria Control Program. The dataset contained 300 county-sector-year observations covering all 15 counties and four service sectors; 220 observations had complete diagnostic information. Diagnostic positivity was calculated from positive microscopy and RDT results among all recorded positive and negative tests. Across complete observations, 7,097,294 tests were recorded, including 3,914,734 positive results. Observed positivity declined from 59.1% in 2021 to 51.2% in 2025 while testing increased from 1,463,900 to 1,624,400 tests. Private services recorded the highest positivity (62.9%) and Concession services the lowest (44.9%). In the beta-binomial mixed-effects model, the odds of a positive recorded result were higher in Private than Public services (OR 1.450, 95% CI 1.220–1.722) and in Faith Based than Public services (OR 1.195, 95% CI 1.022–1.396); the year effect was not statistically supported (OR 0.963, 95% CI 0.921–1.005). The findings show that routine diagnostic positivity varied across counties, sectors, and years and should be interpreted with testing volume and reporting completeness in view.

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