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    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.


    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.


    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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The people of Dangwe West district, a rural community  in  the  Greater Accra region, are mostly subsistence farmers, fishermen, petty traders, artisans and civil servants.

The district, with some 376  communities like Dodowa, Ningo,  Prampram, Ayikuma and Osudoku, has steadily increased over the years with a total population of 89, 371 in 2006 rising to 108,378 by mid-2009.

People in these  communities have a  lot going for them in terms of malaria control intervention and have been  recipients of various malaria control services. They have, for instance, benefitted from the distribution of free bed nets, free anti-malarials, and intermittent preventive treatment  for pregnant women, among others.

All these benefits have resulted from the community's engagement, dating from the past, with the  Dodowa  Health  Research Centre (DHRC),  which  is located  in  the district.

The centre has over the years run various malaria studies from which the community has been involved.

The  DHRC is  one  of the  three  health research institutions of the Ghana Health Service, the main implementing agency of all policies and programmes of the Health Ministry.

The  community's engagement  with  the Dodowa Health Research Centre is  done largely through  the  Health  and  Demo- graphic Surveillance System (HDSS), which operates  within the  boundaries of the Dangme West district.

The running of the HDSS is a core activity of the research centre and serves as a tool to collect data from the people in the community over a period of time in order to monitor health  threats,  track  population changes, and also assess  policy interventions including those on malaria.

This has enabled the centre to run various malaria projects with the collaboration of local government  agency and the  health team, known as the District Health Management Team  (DHMT) to  roll  out intervention programmes such as bed net distribution to vulnerable groups through the data generated by the HDSS.

Even more significantly, the HDSS has also linked the people of Dangwe West district, with various international malaria projects because  the  Dodowa Health  Research Centre is member of the INDEPTH Network.

According to Dr Margaret Gyapong, Director of the  Dodowa Health  Research Centre, the HDSS is the engine that drives all that  is  happening in the  centre. She admits  that  it is through the  HDSS that malaria studies have been conducted.

Although, Dodowa became a member  of the INDEPTH Network in 2007 by virtue of having the HDSS, which attracted  a lot of attention from funders interested in malaria research, it established its HDSS in 2005.

“In 2005, we stared the HDSS. Before you become an INDEPTH member, you have to conduct a baseline study. In 2005 we did this to know the boundary of the district, the  total  population, breakdown by sex, age, ethnic back ground, educational background, etc.”

“Then twice a year, we update the information  on  a  new birth,  pregnant women, deaths, migration etc and demonstrate to INDEPTH that I have done my baseline, those are some of the statistics I  have generated from my  site, so now I want to become a member of INDEPTH.”

The Network will then screen you for your qualification and see if you qualify to be a full member, half member or whatever.”

She said the new rule is that every year the centres running the HDSS status are revised with some sites being downgraded perhaps because of inadequate  updates on demographic data. So a lot of criteria are needed to be a member.

Dr Gyapong said because of the presence of the  HDSS it  is  easy to  figure out  one's population, track and follow it.

“The HDSS is an attractive  platform  for anyone who wants to do a study. Because of HDSS, we are able to distribute bed nets. So if you take our HDSS form, you will find out that  if  that  person is  pregnant,  we ask whether the person has a bed net, whether that person slept under a bed net and we ask the same for under-fives. It is detailed.

We provide this information for the DHMT and they  use it  for planning. With  the information we gather, the DHMT is able to plan better for the community and it is part of the community benefits.”

“Through the HDSS, we are able to know the houses that do not have a bed net and we are able to do the distribution,” she added.

This is because the HDSS has captured the target group for bed net distribution which is under-5 and pregnant  women.  HDSS has facilitated the DHMT's work and these local health  officials  are able to  plan for the districts health needs and intervene appropriately.

According to Dr Gyapong, because the HDSS is in place, the malaria studies  a n d programmes are  operating from it. “For instance,  if  they  need  to  know where children under-5 are located, if you pop the HDSS data base, you are able to pick children under-5. So if  someone  is  looking  for information on pregnant  women, if you come to the HDSS, you will get the information.”

One study that the HDSS has facilitated is the research into the efficacy and safety of new anti malarials. The Dodowa Centre has joined other  research sites in and outside Ghana to carry out a Phase 4 studies of anti malarials in Africa, known as INESS.

The project is to enable researchers to gather practical evidence for the effective treatment of malaria in order to allow policy decision to be based on the assessment of the effectiveness of anti-malarial drugs and their determinants in real life situations. It is also to  evaluate the  safety of  new anti-malaria treatment  through comprehensive pharma-covigilance within the  context  of African health systems through a number of modules  such as  access to  the  drugs, adherence, efficacy, provider  compliance, community and provider acceptability and reporting of adverse drug reactions to the anti malarials.

“For instance in the INESS study, if you need to know the location of people, if we did not have the numbers of the houses, we will not be able to  track the  people  to  get  their reactions to the drugs,” Dr Gyapong noted.

“The INESS  study is looking at  new  anti malarials,  its effectiveness and  safety  in regular health system. So people who attend health  facilities  receive  drugs and  are followed up  to  check on the  safety and effectiveness of the drugs.”

“Through the INESS we have been able to strengthen  the  district  safety  committee and linked  up with the  Food  and  Drugs Board. We fill the blue form from FDB on adverse drug  reactions and send them  to FDB. The FDB comes out with feedback after finding out about drug safety.”

Under the INESS project the research centre is about to begin a study into the new ACT drug, eurartesim.

“We are preparing to  start  the  eurartism study. We have conducted the training of staff. We are trying to put our laboratory in place. The drugs  will  soon arrive  in the country and the study will roll out before the end of the year. It will be the same as was done in phase one in the health facilities. So anyone who goes to  the  health  centre is given eurartism and then we follow up in the houses to  find  out  their reactions to  the drugs in terms of safety, efficacy, adverse drug reactions and everything else. All this has been made possible because of HDSS, which has generated data for tracking the homes of study participants.

On some of the successes and challenges in running the HDSS and the various studies, Dr Gyapong said: “The projects' taking off is a success story in itself. She however noted that community fatigue with questions such as 'what is in it for us,' has been sometimes a test.

“We tell them because of the projects, we were able to bring bed nets and intermittent preventive  treatment  to  them  so it  is  a constant  engagement with the  communities, because they need to understand what is going on. They ask lot of questions and we explain to them. And before we embark on any study we have to talk to them about what we plan to do and its impact, so the more you have malaria studies  the  more they are aware of malaria issues.”

Another challenge she said is funding and staff turnover as members of staff  have to go for further studies.

“Core funding for the HDSS is a nightmare. INDEPTH does not fund the HDSS, like every year get this to fund your HDSS. You have to strengthen and improve your HDSS to merit being a member of INDEPTH. So if today you stop running the HDSS, you are no longer a member, so you have to maintain it. It cost close to 300,000 dollars a year to run the HDSS  effectively. You have to  get  field workers, field  supervisors,  motor  bikes, bicycles, hire  accommodation,  print  out forms and fill them out. So we have moved to the personal digital appliances (PDF), a paperless form of  work to  cut down on printing out forms”.

On some contributions from INDEPTH, she said it usually came in the form of capacity building by being invited to workshops on proposal writing, data  analysis workshops and sharing data.

“Through some of the studies, you get to have equipments, technical  support  and share data on the international front.”

By Eunice Menka - Ghana