Degradative alteration of ecological systems worldwide is progressing at a time when their influence on human wellbeing is becoming more evident. For some ecosystems and aspects of wellbeing, more concrete knowledge exists. Insights into the science of mangrove-health relationships are however limited and fragmented, with no assessments of human perspectives around these phenomena.

This study investigated the nature of the mangrove-human health nexus by assessing the impacts of mangrove ecosystem interventions on health-related ecosystem goods and services and self-reported malaria experiences. Using a mix of methods comprising a systematic literature review, key informant interviews, health questionnaires and Qualitative Comparative Analysis (QCA), this study merges three bodies of work. Research participant viewpoints were synthesised regarding the evolution of mangrove characteristics and use patterns over time, and how these are affected by ecosystem restoration. Survey respondents were also engaged in a recall exercise of malaria experiences over the same period, to provide a basis for causal inference analysis using QCA methodology. Results show that mangrove dependence is declining with ecosystem degradation in Ghana, but ecosystem restoration can modulate some negative health impacts of mangrove degradation, such as infectious disease risk and threats to protein nutrition. Further, specific ecological conditions elicited by ecosystem interventions work together diversely to decrease malaria incidence, but mainly to amplify benefits of current malaria vector control interventions.

The causal relationships reveal that certain aspects of wetland restoration can be strengthened to deliver conditions that improve consequences of current malaria management strategies. Environment and health managers must collaborate in policy reorientation, monitoring, evaluation, and capacity building to realise more tangible scientific evidence and sustainable cross-sector outcomes. Ecosystem interventions could plug the shortfalls arising from resource constraints in health policy implementation, towards more uniform outcomes especially in marginal communities.