Ghana has over the last decade recorded significant progress in general public health care delivery and also a major decline in the malaria prevalence from the high level of over 50 per cent in 2012 to 20.4 per cent in 2016.
These have resulted in major drops in malaria cases and deaths by 75 per cent over the years.
In spite of Ghana’s progress and that of many others in the sub-Region, the World Health Organisation (WHO) is urging countries and partners to accelerate the pace of action towards malaria prevention, especially in low-income areas with a high disease burden. This, it said will help save lives and help sustain the gains made so far.
It admitted that although there has been significant development in the general public health care delivery in various regions, especially in sub-Saharan Africa, including Ghana, the current slow pace of progress if maintained, would not yield the attainment of the Sustainable Development Goals (SDGs), despite ongoing efforts and investments.
This is because most countries are still confronted with serious health challenges, such as maternal mortality, child deaths, poor adolescent sexual and reproductive health, as well as malaria.
The WHO however applauds the hard work done in malaria-endemic countries including Ghana, to bring down the prevalence rate in the last decade, but said sustaining these achievements would require extra efforts, investment and double-up of strategies, to attain the envisaged global elimination.
The 2016 Ghana Malaria Indicator Survey (GMIS), confirms that in terms of malaria specific mortality, out of every 100 children admitted for the illness, fewer numbers were dying, and in technical terms, the under-five malaria case fatality rate had been dropping consistently showing a reduction from 14.4 per cent in 2000 to 0.32 per cent in 2016.
The 2016 World Malaria Report also indicated that the rate of new malaria cases fell by 21 per cent globally between 2010 and 2015, while death rates also fell by 29 per cent in the same five-year period. In sub-Saharan Africa, case incidence and death rates fell by 21 per cent and 31per cent respectively.
The WHO further reports that in sub-Saharan Africa, which shoulders about 90 per cent of the global malaria burden, more than 663 million cases have been averted since 2001, with the use of Insecticide-treated nets having had the greatest impact, accounting for an estimated 69 per cent of cases prevented through control tools.
Dr Constance Bart-Plange, the Programme Manager of the National Malaria Control Programme (NMCP), at the commemoration of the 2017 World Malaria Day in April, acknowledged that malaria-related deaths in all ages have reduced from 3,882 in 2010 to 1,264 in 2016, translating into about 4.2 per cent.
She attributed the drop to the various interventions put in place to address the health challenges of especially vulnerable groups, which include children and pregnant women, saying these efforts have yielded an increase in household ownership of Insecticide Treated bed Nets (ITNs), from 3.2 per cent in 2003 to 72 per cent in 2016, while the use of these nets by children under-five have also gone up from a low 3.5 per cent in 2003, to 52.3 per cent in 2016.
Dr Bart-Plange noted that these achievements could not have been made without the collective efforts by leadership and partnerships of stakeholders, whose efforts and resources have been harnessed to address malaria in an effective, sustainable and accountable manner.
Currently Intermittent Preventive Treatment of malaria in pregnancy (IPTp) which is a full therapeutic course of antimalarial medicine given to pregnant women at antenatal clinic visits, have improved. IPTs help in the prevention of maternal malaria episodes, maternal and foetal anaemia, placental parasitaemia, low birth weight and neonatal mortality.
The WHO however recommends a three-pronged approach for reducing the negative effects associated with malaria in pregnancy, which are: prompt diagnosis and treatment of confirmed infections, the use of Sulphadoxin-Pyrimethamine (SP) also known as Fansider in the IPTp uptake, which has increase from 0.8 per cent in 2003 to 78 per cent in 2016, and also the use of Long Lasting Insecticide Treated Nets (LLINs).
The malaria fight is therefore one of the most inspiring health stories resulting from great investments and strong partnerships leading to the dramatic progress against the disease over the years.
Over the years, government, donor agencies, health service workers, dedicated partners, civil society organisations, the media, traditional and community leaders as well as the communities themselves, have been working together to reached millions of Ghanaians with effective malaria control strategies, supported by massive deployment of logistics, such as the LLINs, Rapid Diagnostic Test (RTD) Kits, and Artemisinin-based Combination Therapy (ACTs).
Yet malaria, which is a parasitic disease transmitted through the bite of an infective female anopheles mosquito, has remain a bane to the public purse, and a major public health concern, which affect all ages of people, posing a greater risk for especially pregnant women and children under five years of being infected with severe malaria infection leading to often fatal outcomes.
Other African regions have also made substantial gains in their malaria responses, but the disease remains a major public health threat. In 2015 alone, the global tally of malaria reached 429 000 malaria deaths and 212 million new cases, with the death of one child recorded every two minutes, according to the WHO.
“Any death from malaria-a preventable and treatable disease- is simply unacceptable,” says Dr Pedro Alonso, the Director of WHO’s Global Malaria Programme.
The Ghana Health Service presently rates malaria cases as number one at all Out-Patient Departments (OPD) of health facilities across the country, even though the Strategic Plan for Malaria Control in Ghana from 2014 to 2020, require all children under age five, and pregnant women to sleep under an LLINs every night to prevent malaria complications.
The vision of achieving Universal Health Coverage (UHC) as recommended by the United Nations Sustainable Development Goals (SDGs) has now become a political priority for many African countries, but the difficulty is how to achieve these objectives.
Abstracts from a combined study by researchers from the Institute of Statistical Social and Economic Research (ISSER) of the University of Ghana Centre for Global Health Security, Chatham House, and the Royal Institute of International Affairs, estimated that around 400 million people lack access to at least one essential health service and that around 100 million are impoverished every year because of health care cost.
Many women in Ghana, especially those living in deprived communities, are often caught in a tangled web of inequalities, and are confronted by a myriad of challenges that ranges from socio-cultural, economic factors, access to swift transportation systems, to the delays that occur at the community and health institutional levels.
The United Nations Population Fund (UNFPA) in its mission has over the years been supporting governments to achieve universal access to sexual and reproductive health- including family planning services, and to realise reproductive rights, as well as reduce maternal mortality to accelerate progress in the ICPD and SDGs agenda.
The UNFPA’s is currently assisting governments implement various strategies aimed at delivering a world where every pregnancy is wanted, where every childbirth is safe and every young person’s potential is fulfilled.
Eliminating malaria therefore, would involve three key concepts: Parasite clearance, largely through drugs or a vaccine (a malaria vaccine does not yet exist, but some promising vaccines are under development); Keeping out the mosquito vector that facilitates transmission (such as spraying techniques) or blocking it from biting with the use of insecticide-treated nets and repellents; Minimizing the importation of the parasite that can be imported through human movements.
The 2016 GMIS suggests that to ensure an efficient malaria control programme, it is necessary to evaluate the attitudes and practices of people living in high risk areas. This, it said would help to identify approaches for involving the full participation of the community in surveillance and control activities such as early, prompt treatment of confirmed cases.
It further indicates that the Strategic Plan for malaria control in Ghana recommends that all suspected malaria cases are confirmed in accordance with the T3 which involves Testing, Treating and Tracking.
Making headway to sustaining the gains made in malaria prevention would require multi-sectorial collaboration and the effective use of scarce resources to reduce the prevalence with the ultimate aim of eliminating it.
By Christabel Addo