Please: Login/Register

The Latest Edition of "Eyes on malaria" magazine will be out very soon!! | CALL FOR ARTICLES: AMMREN is inviting journalists / writers / scientists interested in reporting on malaria to send articles for publication in its international magazine “Eyes on Malaria” and for posting on its website. Please contact the AMMREN Secretariat for more details click here. Enjoy your stay!. Volunteers and interns urgently needed to work with an NGO working in the area of malaria and health. Apply through - ammren1@gmail.com / ammren1@yahoo.com. Journalists interested in reporting on and writing articles on health issues should please reply through this email: ammren1@gmail.com

ANNOUNCEMENTS:::

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.
     

MAGAZINE EDITIONS

  • Sixth Edition

  • First Edition

  • Second Edition

  • Third Edition

  • Fourth Edition

  • Fifth Edition

  • Seventh Edition

  • Eighth Edition

  • Ninth Edition

  • Special Edition

  • INESS Edition

  • Tenth Edition

  • INDEPTH Edition

  • Eleventh Edition

  • Twelfth Edition

  • Special Edition

  • Special Edition

  • March Edition

The Path to Elimination

As an African physician, Dr Constance Bart-Plange knows the devastating impact of malaria on individuals and communities.

Having managed the National Malaria Control Programme (NMCP) for over a decade, Dr. Bart-Plange needs no reminder that waging a war against malaria is a herculean task given that Ghana’s malaria status is hyper-endemic and transmission being high throughout the year.

In fact Dr Bart-Plange could do with the advantage of her companions in places like Kenya and South Africa where malaria is not hyper-endemic and transmission is seasonal.  

She says, “Countries like Zambia and Zanzibar are making a lot of progress. In fact, Zanzibar is almost at the elimination stage. Rwanda is also doing well because they have seasonal transmission. They also have support from the top. The President is ensuring that rules are enforced. But comparing Ghana to our West African countries, we are doing well.”

Dr Bart-Plange’s task is to co-ordinate a public-private partnership of hundreds of stakeholders working together to scale up prevention, diagnostic and treatment programmes and develop new tools to control and eliminate malaria.

It has not been all rosy. Ghana’s number one anti-malaria advocate has seen the bad times (including personal attacks) and now relishes the good times in malaria control.

Looking back at the days when the NMCP needed about six (6) million bed nets for Ghanaians but only procured 174,100, Dr Bart-Plange reports with joy that over the past one year alone NMCP has distributed close to 10 million.

Her tenure over the 10-year period has seen a sustained advocacy culminating in the removal of taxes on malaria commodities and drugs and a government directive that 0.5% of district assembly funds be dedicated to malaria.

Among her achievements over the 10-year period is the averting of about 160,000 malaria deaths in Ghana.  

“Our records show that in the early 2,000s, we were recording about 40,000 deaths annually due to malaria. As of last year the number had dropped to 3,400. We have done the Multiple Indicator Cluster Survey in 2011, as conducted by the Statistical Service, and had good results.

“We checked for malaria parasite prevalence among children under-5 years in 2011. The results showed that only 4.1% of children in that age group had the parasite, which is remarkable, showing that all the interventions are working. It also showed that we have made the most impact in Greater Accra. I am stressing this, against the backdrop that Ghana is classified hyper-endemic.”

“Greater Accra, Volta, Eastern and Ashanti Regions are no longer hyper-endemic.  The forest belt has a prevalence rate of up to 50%. Greater Accra is just about 4 per cent, Ashanti Region, 22%, Volta Region, 17%, Brong-Ahafo, 37%, so we have made some progress. We would conduct another survey to re-classify the southern sector.”

Malaria in pregnancy
The vulnerability of pregnant mothers is of concern to the NMCP because of its harmful effect on the unborn child.

Dr. Bart-Plange says “We have been working to reduce malaria in pregnancy. This is important because when a pregnant woman catches malaria, she will have to abort if the parasite affects the foetus in the womb, and leads to either stillbirth, pre-mature birth, or other co-implications.”

She said the NMCP has introduced the intermittent preventive treatment (IPTp) to solve it.
“In 2003, they were on chloroquine but they were not happy taking that drug because they claimed it was causing abortion. We replaced it with Sulfadoxine-Pyrimethamine (SP), the IPTp for malaria.”

“Now, about 67% of pregnant women are on IPTp. During the period of pregnancy, they take at least two doses, to protect them and their unborn babies. This has led to a remarkable drop in malaria cases. In some district facilities there are no new cases of malaria in pregnancies. And when it comes to deaths due to malaria, we have made the most impact.”

The NMCP manager is happy that surveys from the Statistical Service show improved knowledge on malaria among mothers and child-care workers, indicating that 87 percent of Ghanaian mothers and guardians know the right thing to do when malaria strikes

Other interventions
Indoor residual spraying (IRS) was introduced into malaria control in Ghana by Dr. Bart-Plange’s NMCP. It is being done in the Northern Region and Obuasi where 48 districts have been targeted to benefit from the AngloGold Ashanti malaria project.

Reports show over 74% reduction in malaria cases in Obuasi within two years. IRS is aimed at complementing the use of the ITN.

In justifying the ongoing larviciding project to kill off mosquitoes at the larval stage, Dr. Bart-Plange says, “The mosquito is an enemy, and its babies are the larvae. If you remove the babies, they would not become adults. In partnership with the LabioPharm group of Cuba, we are doing larviciding in, Greater Accra and Brong-Ahafo Regions.”

“Larviciding is in urban areas because the WHO policy says to do larviciding you should find stagnant water, it should not be much, it should be fixed, so that you will be able to apply the medicine to it; that’s why we are doing it in the urban areas alone.

“Another promising development is the RTS,S malaria vaccine undergoing clinical trials at Ghanaian research centres in Agogo and Kintampo and in 6 other African countries.”
 
“Come 2015, barring any hitches, the malaria vaccine will be adopted as part of the interventions in Ghana. We have put in place a steering committee, and structures to administer the malaria vaccine through the Expanded Programme on Immunization (EPI).”

On RDTs, the NMCP Manager is optimistic that with assistance from the Global Fund and partners like PMI, USAID, the Rapid Diagnosis Test kit (RDT) which can diagnose malaria in 10 minutes, will be made more available in communities to help reduce the problem of presumptive treatment where people were treated for malaria, without first confirming it through diagnosis.

Use the net and stay alive
The National Malaria Control Programme (NMCP) is giving meaning to the truth that prevention is better than cure and is leading Ghana to a universal coverage with bed nets.

Using a formula of two persons to a bed net, NMCP has ensured that the “Hang up” campaign brings much joy to beneficiaries, donors and stakeholders.

“The beauty of this exercise is that we are not just distributing the nets, we are actually hanging them in people’s homes and sleeping places. We have covered eight regions already, and left with two, Greater Accra and the Northern Region. The NMCP is happy not only because of the mere idea of distribution but also the indication that more people are sleeping in the nets,” says Dr. Bart-Plange.

Quoting the Demographic and Health Survey (DHS) of the Ghana Statistical Service, Dr Bart-Plange said only 2.7% pregnant women were sleeping under treated nets, back in 2003. But recent results show that 32.6%, almost one-third of all pregnant women are sleeping under treated nets, showing an increase of more than a hundred-fold.

“Back in 2003 the under-5 year old children sleeping under the nets, were just 2.3 per cent.  In 2011, this went up to 39%. So you can see the tremendous jump. Now, almost half of all households have them. If the occupant of one room does not have a treated net, the next one has. In terms of ordinary untreated bed nets, more than half of Ghanaian households have them.”

“Now, 48.9% of all households in Ghana have treated nets. At the time this survey was done by the Ghana Statistical Service, the hang up campaign had been done in only two regions, and we had these results. That means if we are to do the survey after covering all regions, the figures would go up.”

“Statistics show that Ghana is not doing badly in Insecticide Treated Nets (ITNs) distribution and use. I think apart from Senegal who recently did a massive distribution, I think Ghana’s figures are quite high so we are not doing badly at all.

“Our innovations entail the hanging of the nets door-to-door to ensure people will sleep in them because in the past people complained of not knowing how to do the hanging. Some misused the bed nets while others re-sold the items received free of charge for their own protection. But now we remove it from the package and hang it to prevent misuse, reselling and other deviant practices.

“The communities have been very supportive. The community leaders and assemblymen help to recruit volunteers, pay allowances and motivate them to hang the nets for their folks. Sometimes before the hang up some households decline to be part of the registration. However, as soon as they see the nets, they begin clamouring to be included.

“In Ghana, we are now achieving the universal coverage of bed nets. By the time we cover the two regions, we would have achieved it because already, the surveys in those areas we’ve done show that household ownership of nets is above 80%, and so we will achieve universal coverage of bet nets.

“Recently, I visited a household where someone told me that ever since they started sleeping under treated nets six years ago, nobody has had malaria. This is a success story to tell.”

Yes we can…….says Dr. Bart-Plange
The NMCP Manager says Ghana can eliminate malaria if currents efforts towards bringing the disease under control are sustained.

“At the rate Ghana is going we can achieve elimination if donors continue to support us, vulnerable people allow their rooms to be sprayed and also sleep in bed nets. We need also to adhere to the new WHO approach to Test, Treat and Track, meaning we do not do presumptive diagnosis, but only treat and record those who are positive. Eradication of malaria seems a bit far in the future so we need to be realistic and focus on elimination,” she says.

“I am happy to say we are using behavior change strategies in collaboration with the National Commission on Civic Education (NCCE) and NGOs like the African Media and Malaria Research Network (AMMREN). We have teachers against malaria and beauty pageants like Miss Malaika dedicated to malaria. When churches are celebrating anniversaries they now do medical outreach. In the past they ignored malaria. Now more people have come to see malaria as a serious disease and they want to join the fight against it.”

With hindsight, Dr. Bart-Plange wishes a few things were done differently regarding the changeover from chloroquine to ACTs.

“The committee insisted we choose one drug even though I argued for more options. I suppose I should have ignored them and gone ahead to give people the benefit of choice because they deserve to be given a choice. You should not restrict people to a single option.”

“If I had the option and the funds available the indoor residual spraying which is limited to only a few places would be done everywhere in Ghana to benefit everybody and  bring down malaria faster than we can do now.”

Dr. Bart-Plange says she is “pushing for the WHO to introduce seasonal malaria treatment for areas where transmission is seasonal to help maintain the gains until the vaccines arrive to boost our quest for the elimination of malaria.”

Hurdles to be cleared
Significant progress has been far in the malaria fight. Just consider that over the last decade about 160,000 malaria deaths have been prevented in Ghana.  

However, there are challenges that must be overcome to eliminate malaria in Ghana. It is estimated that over 3.5 million still suffer from malaria each year and Dr. Bart-Plange thinks this is not necessarily the true reflection on the ground.  

She deplores the fact that every fever case is treated as malaria. This, she says, makes it impossible to see the drop.

“It is unthinkable that our own doctors and nurses, in spite of all our campaign, still go ahead and give the treatment for malaria, even when patients test negative, thereby inflate the numbers and waste medicine,” she points out.

“Another challenge is the refusal of some people to sleep in the bed nets, saying when they sleep in it, they feel hot.”

The NMCP manager notes that the existence of monotherapies also throws spanners in the works.

“We have moved away from the chloroquine to the artemisinin-based combination therapy (ACT) and do not want to see chloroquine and amodiaquine (monotherapies) on the market. But they still exist, even though a directive was given by the Health Minister banning monotherapies years ago when we first introduced ACT. There are still stubborn people who bring them in.”

She is concerned about the fact that malaria prevalence is still high in the Northern sector. “Why it is still high in spite of all these interventions is our headache. For that reason we are planning to conduct what we call mass treatment, where everyone in the region will be given treatment because the malaria transmission is so high, about 48% to about 50%.”

She has some words of caution to Ghanaians. “It is in our own interest to watch our attitude towards the environment. The mosquito is an enemy, and it breeds in stagnant waters. The least we can do is to avoid things that create potholes and collect stagnant water.”

“The anopheles mosquito likes relatively clean water, not toxic gutters or rubbish dumps, because this is where it can breed. We have to change our ways otherwise we are creating maternity homes for these mosquitoes to come back and kill us.”

The good news however is that Ghana has seen a remarkable reduction in hospital admission for severe malaria.

The WHO has commended the modest but steady progress made by Ghana in malaria control. According to the WHO’s Ghana Advisor on Malaria, Dr Felicia Owusu-Antwi, the impact made against the disease is worthy of commendation given that Ghana is situated in the high transmission zone.

She said “There has been about 30% reduction in under-five mortality rate and we all know that malaria is the main reason behind the deaths of children under 5 years of age.”

“On the continent there are three main transmission zones; the high, the low and the malaria free areas.  Some countries in the low transmission zone (for example, Morocco in North Africa) have been able to eliminate malaria. Other countries like Tanzania have been able to reduce malaria burden by 50%.  Ghana happens to be in the high transmission zone which is more difficult but there have been some gains.”

But it has been pointed out that the achievements in malaria control are fragile and could be reversed if current efforts are slackened. There is every reason to keep up the good work on malaria and scale up the effective interventions available at the moment.

The on-going inter-sectoral approach against malaria has created a private-public sector partnership which is a proactive way to deal with the disease.

So far so good! And the more hands on deck the better. All Ghana needs to do now is to run for the ultimate goal with purpose in every step.
 

Editions: 
Special Edition