I was recently down with malaria. My friends kept making fun of me about how I have allowed ‘a small insect, mosquito’ to knock me out. Malaria has been with us since time immemorial and yet is still a major health challenge. Many factors account for this state of affairs. Poor environmental conditions, inappropriate medication and lack of adequate medical care to manage cases, are many of the challenges that continue to confront African countries.

According to health experts, malaria, which has remained a major health problem in Ghana just like many African countries, is a complex health problem that demand a combination various interventions to eliminate it.

The basic knowledge most Ghanaians have is that the female anopheles mosquito which causes malaria, breeds in dirty surrounding and stagnant waters. Hence, most preventive measures in Ghana are aimed at educating the populace to keep their surroundings clean and get rid of stagnant waters. But the anopheles mosquito prefers clean water.

"The anopheles is choosy in terms of where it breeds," says the Manager of the National Malaria Control Programme(NMCP), Mrs. Constance Bart-Plange. She explains that the anopheles mosquito lays its eggs in areas where it can get clean stagnant water such as in flower pots, ponds, pot holes, dugout pits, hoof prints, puddles, rice fields and streams.

A number of interventions have been introduced over the years to bring the disease under control. One intervention that has received a lot of promotion and  patronage is the use of Insecticide Treated Nets (ITNs).The World Health Organisation and Ghana’s Ministry of Health (MOH) have stated that ITNs are the most effective, efficient and cost-effective tool in controlling mosquitoes and reducing malaria transmission.

Since Ghana started promoting the use of ITNs, the results has been encouraging. A research conducted by the Navrongo Health Research Centre in the Kasena Nankana District of the Upper East Region of Ghana showed that using permethrin insecticide to treat the nets achieved an 18-33 per cent reduction in all-cause mortality in children under  five.

Furthermore, 3.5 million nets were distributed in Ghana from 1998 to 2007 while households with bed nets increased from 48.3 per cent in 2005 to 51.1 per cent in 2006.

But there is more room for improvement as the country has a long way to go to achieve extensive coverage and use of ITNs nation-wide. Dr Constance Bart-Plange says the government has highly subsidized the nets, reducing the price from about 3 dollars to 20 cents  to encourage people to use it. The nets can be purchased at designated centre throughout the country.

While all these efforts are in the right direction, it is important for Ghana’s  Health Ministry to find out why people are not using the ITNs .

 Another  major step in Ghana’s efforts to control malaria was in 2005 when she reviewed the antimalarial drug policy and switched to the use of Artemisin-based Combination Therapy (ACT), Artesunate+Amodiaquine, as the first line drug for the treatment of uncomplicated malaria due to the increasing resistance to chloroquine.

The use of ACT in Ghana came with some problems initially, as some patients were said to have had adverse reactions to the Artesunate-amodaiquine combination

That came with its problems initially, as some patients were said to have had adverse reactions to the Artesunate-amodiaquine combination. In 2005, two brands of artesunate-amodiaquine were recalled following safety concerns. Following the recall, the government put in place a task force to examine what went wrong. The Ministry of Health has  since introduced coartem as a second line drug for malaria treatment.

Worthy of mention is the new strategy for the treatment of malaria in infants known as Intermittent Preventive Treatment of Malaria in Infants (IPTi).This involves giving infants a single dose of fansidar two or three times in the first year of the infant at the same time as routine immunisation, regardless of whether they have malaria or not.

This strategy which is being implemented by UNICEF in Ghana and some other African countries has been found to be safe, efficacious and affordable and is expected to be rolled out in Ghana soon. Pregnant women are also being given, , sulphadoxine-pyrimethamine as intermittent preventive treatment during their ante-natal care visits in addition to being encouraged to  sleep under ITNs.

It is evident that a lot of interventions are taking place to eradicate malaria but despite the progress, Ghana still falls short of global malaria goals. Perhaps the icing on the cake would the discovery of a vaccine for malaria hopefully in 2011.

One major boost in this direction is the pioneering efforts of INDEPTH Network, an international NGO, of which Ghana is at the forefront in the establishment of the Malaria Clinical Trials Alliance (MCTA) with a $17 million grant from the Bill and Melinda Gates Foundation. Currently there are 16 MCTA trial sites in 10 African countries; Burkina Faso, Gabon, Ghana, Kenya, Nigeria, Malawi, Mozambique, Senegal, Tanzania and The Gambia.

Until a vaccine is discovered, it is important that political and financial commitments are strengthened, clear and timely policy guidelines drawn and implemented.