Daily Graphic (pg 19), Wed, May 5/10
By Rebecca Quaicoe-Duho
MALARIA, an infectious disease caused by a parasite known as the Plasmodium Falciparum found in the female anopheles mosquito, continues to be the bane of underdevelopment in most countries especially in the developing world.
Malaria is a global problem causing more than one million deaths per year and endemic to 109 countries across the globe with 45 of them found in Africa. Ninety-five per cent of deaths occur on the continent among children under five years and it is estimated that one child in Africa dies every 30 seconds due to malaria-related illnesses.
In Africa, the estimated annual economic burden of malaria is $1.7bn and in Ghana it accounts for the loss of one per cent of the country’s Gross Domestic Product (GDP). It is also estimated that a single bout of malaria costs a sum equivalent to over 10 working days in Africa.
Ghana continues to have its fair share of the burden of malaria among its people and the disease is responsible for a ‘growth penalty’ of up to 1.3 per cent every year in the country.
Due to the dynamic nature of the disease in the country, the health sector finds it difficult to cope despite the numerous interventions it has and continue to put in place such as in the 1950s and 60s when it introduced the indoor residual and aerial spraying and the Pinotti project which was the addition of salt to chloroquine. In the 1970s and 80s the Malaria Action and Control was also introduced through case management; from 1996 to 1997 the Accelerated Malaria Control Programme was also introduced, which also dealt with case management, building capacity in prompt treatment and pilots in 30 districts across the country.
Since 1999, the Ghana Health Service (GHS) has introduced the “Roll Back Malaria” initiative, which is a combination of preventive and curative methods such as the use of the Insecticide Treated Nets (ITNs).
Current malaria preventive strategies include the use of ITNs for children under five years and pregnant women; giving pregnant women sulphadoxine-pyrimethamine (SP) to prevent malaria during pregnancy; indoor residual spraying in some districts; environmental management and targeted killing of the mosquito larvids.
They also include curative measures such as an anti-malaria drug policy which would ensure a quick and long-lasting resolution of the clinical conditions of patients, reduce incidence of malaria and its accompanying complications, stop the progression of simple malaria to severe and potentially fatal disease and minimise the chance and rate of development of drug resistance, among others.
Also a case management policy has also been put in place to ensure that accurate diagnosis are made and an effective, safe, affordable and quality anti-malarials are on the market.
Despite all these interventions, last year a total of 3,600,000 of outpatient malaria cases were said to have been recorded throughout public hospitals in the country and 3,900 deaths due to malaria was recorded. One thousand five hundred of the deaths were children under five years and 80 were pregnant women.
However, according to health professionals in the country, all is not lost, and as the Programme Manager of the National Malaria Control Programme, Dr Constance Bart-Plange, puts it, the situation is not as gloomy as it seems, explaining that most of the cases which are classified as being malaria are sometimes not malaria but they present with similar fevers as malaria.
At a workshop for media personnel organised by the African Media and Malaria Research Network (AMMREN) in Accra as part of activities marking this year’s World Malaria Day, Dr Bart-Plange said the GHS was on course with its aim of reducing the malaria disease burden of the country by 75 per cent by 2015 in line with the Millennium Development Goals (MDGs).
According to her, so far, only 14 per cent of malaria cases were confirmed through microscopy and the aim of the GHS was to ensure that all fever cases were properly diagnosed, adding that only 10 per cent of presumptive treatment of malaria were true cases of malaria in urban areas.
For the laboratory confirmation of all malaria cases, the Rapid Diagnostic Test (RDT) kit has been introduced by the World Health organisation (WHO) and adopted by the GHS and this is aimed at, among other things, ensuring the better management of other febrile illnesses, enhancing better estimation of the real burden and impact of interventions put in place, ensuring the rational use of drugs, eliminating under exposure to drugs and also minimising pressure on malaria drugs.
According to health experts, investment in malaria control is saving lives and has far-reaching benefits, and according to Dr Bart-Plange, from 2003 to 2009, over 20,000 cases of malaria deaths were averted through the numerous interventions that had been put in place over the years.
Also, malaria control is rapidly advancing throughout Africa due to intensified efforts, and according to a Programme Officer of the NMCP (Northern Zone), Mr Sylvester Segbaya, a new initiative that would significantly reduce the cost of medicines for the effective treatment of malaria was to be piloted in seven African countries, i.e. Ghana, Cambodia, Kenya, Madagascar, Niger, Nigeria, Tanzania and Uganda.
Known as the Affordable Medicines Facility-malaria (AMF-m), it is an innovative financing mechanism to expand access to affordable Artemisinin-based combination therapy (ACT) for the treatment of malaria, thereby saving lives and reducing the use of inappropriate treatment.
At a similar media sensitisation programme to mark WMD, organised by the National Malaria Control Programme (NMCP) in collaboration with the John Hopkins University Centre for Communications - Voices for a Malaria-free Future Project in Accra, Mr Segbaya said the initiative would facilitate the increased use of ACT by reducing the cost of those drugs in malaria-endemic countries and also ensuring that additional activities were carried out to assist in the safe and effective implementation of AFM-m.
It is believed that malaria control, research and elimination activities, when effectively undertaken, would significantly impact on the country’s attainment of the MDGs, since, according to health experts, achievement of many of the MDGs depends heavily on a successful anti-malaria eradication effort.
According to health experts, malaria control interventions can help lift poor people out of poverty, since the disease burden of malaria on a household helps to reinforce the poverty level of the people in that house, and this, when done, can help contribute to achieving MDG1, which is aimed at poverty reduction.
On the MDG2, which calls for universal education, malaria control interventions can help achieve this goal, since it contributes to absenteeism and poor school performance, as malaria is a leading source of illnesses and absenteeism in school-age children and teachers.
On child survival, which is captured in the MDG4, an effective malaria control intervention can help reduce significantly child mortality, since malaria is a leading cause of child mortality in endemic areas.
With regard to the attainment of the MDG5, which is on maternal health, health experts estimate that pregnant women are four times more likely to contract malaria; the disease causes anaemia in pregnant women and low birth weight in infants. Malaria infections in Africa is said to cause 400,000 cases of severe anaemia contributing to maternal mortality across the continent and therefore effectively controlling malaria in pregnant women will help reduce maternal deaths and infant mortalities.
The MDG6 calls for a combat on infectious diseases including malaria and the GHS target of zero per cent deaths through malaria is in order.
The MDG7 also calls for environmental sustainability and according to health experts, poor co-ordination in the control, elimination and eventual eradication of malaria from the country could lead to lack of widespread access to essential drugs for malaria.
The last goal calls for developing global partnership and an improved co-ordination and collaboration among different actors and private-public partnership across the country, which could lead to the proper control of malaria in the country.
As this year’s World Malaria Day is marked on the theme “Counting Malaria Out”, 2010 can be said to be a milestone year for the fight against malaria and it holds multiple opportunities for global leaders to demonstrate their commitment to combat malaria with an increased resources and action.
As noted by Mr Emmanuel Fiagbe of the Voices of Malaria puts it “Let us remember that an insufficient investment in 2010 and beyond could lead to a reversal of the progress achieved to date and the malaria treat made worse, costing more in the future”.
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