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TIPS ON MALARIA

  • HOW CAN MOSQUITOES BE CONTROLLED?

    Mosquitoes around the home can be reduced significantly by minimizing the amount of standing water available for mosquito breeding. Residents are urged to reduce standing water around the home in a variety of ways.

  • HOW CAN I PROTECT MYSELF FROM MOSQUITO-BORN DISEASES?

    The best way is to avoid being bitten by mosquitoes.This can be accomplished using personal protecting  while outdoors when mosquitoes are present. Treated bed nets should be used sleeping. Mosquito repellent should be used when outdoor.

  • WHO ARE AT RISK?


    Nearly half of the world’s population is at risk of getting malaria. Pregnant women are particularly at risk of malaria. Children under 5 years are at high risk of malaria.
     

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Cut-to-fit Solutions

The generally-held opinion that about 40 per cent  of out-patient  hospital attendance in Ghana is attributable to malaria may no longer be tenable.

This data is generating arguments that there should  be  no  blanket  interventions  for controlling malaria across the country, without due diligence to varying transmission patterns among different communities.

The push is now for the fashioning of community malaria interventions tailor-made to fit into transmission patterns peculiar to the environment, population, climate and  other determining factors that impact on spread of  malaria in each locality.

Until now, clinical practice and national policy in Ghana have been informed by routine health service  data  suggesting  that  malaria  is universally prevalent throughout the country.

A  Ghana Urban Malaria Study 2013  Report released in Accra, has disputed the universal prevalence claim and shows a different picture that  the  burden  of malaria  in  Ghana  is substantially  lower in  large cities  than  in surrounding rural areas.

The report indicates that malaria data routinely reported  by health  facilities in the country do not provide a reliable indicator of the variations of the burden of malaria within various communities.

“In spite of striking differences in  the  true incidence of malaria - between urban and rural areas, between ecological zones and between seasons - routine health facility data suggest that clinical staff in all parts of the country and during  all seasons  presumptively  diagnose roughly 40 per cent of out-patients as having malaria,” it adds.

This  situation  is  largely  responsible  for presumptive  diagnosis and treatment  of the disease.   A major worry of the  prevailing practice of presumptive diagnosis is that actual spread and treatment of malaria in the country may be inadequately addressed.

The same goes for the handling of malaria in children.  The Ghana  Health Service  data reports that roughly 40 per cent of pediatric out-patients  are  diagnosed with  malaria throughout  the  year in  Accra as well as in smaller communities.

Citing findings from a particular study conducted in a public health facility, the report says that only 11 per cent of 605 sick children presenting with fever at hospital in Accra had malaria parasites detected by microscopy, yet 80 per cent of these children were diagnosed as having malaria, showing  that  presumptive diagnosis  of  suspected  malaria  cases  is resulting in massive misdiagnosis in the urban areas of the country.

“One consequence of the prevailing practice of presumptive diagnosis is that the true epidemiology  of malaria  in  Ghana may be inadequately  appreciated  by some  policy makers,  public  health  programmers, and clinicians,” the report notes.

Although, it is known that malaria transmission varies  between  continents,  regions  and countries,  it  is  now emerging that  little attention  has been paid to the fact that the disease can also vary  dramatically between adjacent communities and households, within a country, due to a number of occurrences like the malaria parasite, mosquito vector, human host,  socio-economic and environmental factors.

The study also showed that  in large  cities, neighborhoods close to  urban  agriculture activities  and  poorest  households  bear the greatest burden of malaria.

Policy makers in Ghana are beginning to accept the fact that understanding of these risk factors and how they specifically impact on the spread of malaria in different communities - rural and urban- could facilitate more efficient malaria control interventions, especially where misdiagnosis is prevalent.

The 2011  Multiple Indicator Cluster  Survey (MICS) has also shown that children living in Accra, Kumasi and Tamale, three of the largest urban communities in Ghana, are significantly less likely to  be infected with malaria compared to children living in smaller communities of the same ecological zone.

The Ghana Urban Malaria Study  2013  was therefore rolled out to take care of the variation in the spread of the disease in urban and rural areas. It was funded by the President's Malaria Initiative (PMI) through  the  USAID  Focus Region Health project.

The four-year (2009-2013)  study  aimed at helping policy makers, public health programmers and practitioners to be well informed by key findings on urban malaria and how to put in place effective control measures to cater for the growing urban population.

These findings suggest the  need to  expand research to cover all areas of malaria control efforts for tailor-made solutions. It is commendable that one organisation has over the  years led efforts  in  gathering  health information  through  research on  malaria transmission for context specific intervention to aid effective policy making.

The  International Network for the  Demo-graphic Evaluation of  Populations and their Health (INDEPTH) Network was established to fill an important gap in global epidemiology by supporting  the  generation  of longitudinal health and demographic evidence in low- and middle-income countries.

INDEPTH,  founded in 1998, is an  umbrella organization for a group of independent health research  centers operating health and demographic surveillance  systems  (HDSS) sites in and outside Africa.

A review  of INDEPTH Network's contribution to malaria research has, for instance, uncovered a vast body of knowledge on the changing patterns in malaria  transmission through research conducted in some of their sites across sub-Saharan Africa.

Some of the studies covered socioeconomic, environmental and  genetic factors  among others as significant determinants of malaria risk in endemic settings.
 
Other studies, for instance, showed interesting pieces of evidence that malaria transmission  could vary across relatively short distances, with significant differences in the risk of infection being observed even between neighbouring villages.

In addition, knowledge gaps were identified in vector and parasite  resistance including the impact of climate change and inequities in accessing malaria control interventions.

One study for instance assessed the risk of clinical malaria in a village in Burkina Faso among under-five children in a rural area. It found out that malaria infection risk varied even between the neighbouring villages thus highlighting the need for better understanding of malaria micro-epidemiology to inform control efforts.

Some vector and parasitological studies also conducted  by  INDEPTH  in  four sites  in Ghana, Tanzania and Mozambique showed that  malaria prevalence was much  higher during wet season than the dry season.

Another study in Burkina Faso on seasonal patterns of malaria morbidity and mortality, found out  that  morbidity  and  malaria mortality in children was significantly higher during  the  rainy  season  than  in the  dry season.

“The seasonal pattern in all-cause mortality in under-five children was to a large extent attributable to malaria,” it states.

However, the  study found out  that  the pattern of mortality in adults and the elderly in  the  Burkina  Faso was in  the  opposite direction, with highest mortality  rates occurring  in the  dry  season,”  the  study showed.

These INDEPTH Network initiatives support the fact that  malaria epidemiology studies demonstrate the need to holistically consider genetic, environmental and socioeconomic factors  when  designing malaria control  interventions within given communities.

Recommendations have also been made for a multi-sectoral approach to malaria control. Such an approach, it is thought, would ensure proper linkage and integration  between malaria control programmes and other key programmes within the ministries of health, as well as with others such as the Ministry of Environment,  to  ensure  effective  case management.

Thus, it boils down to “cut to fit” interventions that would fit in perfectly into different settings in relation to the spread of malaria.

These tailor-made interventions  would however only be possible with well-developed health  information systems  in place to  provide the  necessary data  for context specific solutions, be they urban or rural areas.

All  these  point to  the  need  to  better understand malaria micro-epidemiology and consider local context when implementing malaria control programs.

This is important because for instance urban malaria is still not  widely  understood  and policies,  public  health  programming  and health care practices are often based on the assumption that malaria is almost uniformly hyper-endemic throughout Ghana.

There  are  now concerns for  tailor-made programmes and  targeted  policies,  that would micro-manage malaria with in communities based  on the  peculiarities associated with these settings.

There is therefore an urgent need to put in place health information systems that  can provide the  necessary data  for a context specific  assessment   of malaria in  various settings and communities.

Governments  across Africa  must also be prepared to sink resources into  research institutions and fund studies so  malaria interventions can be evidence-based.

One major area of concern  is that Africa lacks effective research-based policies and programming. Politicians, researchers, policy-makers and other stakeholders must lead the crusade to gather data for effective policies.
 

Editions: 
INDEPTH Edition