World Malaria Day – Ghana on course to achieving elimination

The mosquito is one of the smallest insects in the world but for centuries continues to be one of the deadliest in many parts of the world.

According to the latest World Malaria Report published in December 2022, in 2021, malaria caused 619,000 deaths with 247 million new cases recorded across the world.

Although a global issue, 95 percent of all malaria cases are in World Health Organisation (WHO) African Region, with nearly 80 percent of malaria deaths in the African Region being among children under the age of five.

Today, April 25 is World Malaria Day and it is being marked on the theme, “Time to deliver zero malaria: invest, innovate, implement”.

Within this theme, WHO is said to focus on the third “i” which is implemented, outlining the importance of reaching marginalized populations with the tools and strategies that are available today.

World Malaria Day

Malaria is an acute febrile illness caused by plasmodium parasites that people get infected with from the bite of an infected female anopheles mosquito.

Although preventable and curable, nearly half of the world’s population is at risk of malaria.

Some people are more susceptible to developing severe malaria than others.

Infants and children under five years of age, pregnant women, and patients with HIV/AIDS are particularly at risk.

Other vulnerable groups include people entering areas with intense malaria transmission who have not acquired partial immunity from long exposure to the disease, or who are not taking chemopreventive therapies, such as migrants, mobile populations and travelers.

Global targets

According to the WHO, the world is not on track to reach two critical targets of the WHO Global technical strategy for Malaria 2016 to 2030, that is reducing global malaria case incidence by 90 percent or more by 2030, and reducing the global malaria mortality rate by 90 percent or more by 2030.

Therefore it is calling for urgent and concerted action to set the world back on a trajectory toward achieving these targets, as well as Target 3.3. of the Sustainable Development Goals (SDGs), which calls for ending malaria by 2030.

Ghana’s progress

In Ghana, malaria, according to the WHO, is both endemic and perennial throughout the country, putting the entire population at risk.
In 2021, WHO estimated that there were about 5.3 million malaria cases with 12,500 estimated deaths recorded.

According to the Severe Malaria Observatory website, a knowledge-sharing site on severe malaria, with 2.1 percent of global malaria cases and deaths, and 1.9 percent of global malaria deaths, Ghana is among the 15 highest-burden malaria countries in the world.

The country, it says, accounts for 4.3 percent of malaria cases in West Africa.

However, it says, between 2017 to 2020, the country made significant progress in malaria control as cases decreased by 19 percent from 201 cases per 1,000 of the population at risk to 163 cases, although deaths remained similar at 0.39 per 1000 of the population at risk over the same period.

Malaria prevention

Access to insecticide-treated nets (ITNs) increased in the country steadily from 30 percent in 2008 to 67 percent in 2019.

ITN use among children under five years of age and pregnant women also followed the same trend as that of the general population.

ITN use among children under five increased from 22 percent in 2006 to 54 percent in 2019 while use among pregnant women increased from 20 per cent in 2008 to 49 per cent in 2019.

Ghana’s strategy for drug-based prevention includes both nationwide intermittent preventive treatment in pregnancy (IPTp) for the prevention of malaria during pregnancy and Seasonal Malaria Chemoprevention (SMC) targeting treatment of children under five years of age with Seasonal Malaria Chemoprevention (SMC) with sulfadoxine-pyrimethamine + amodiaquine (SPAQ).

Ghana is said to have achieved the highest rate of two doses of IPTp2 for pregnant women in sub-Saharan Africa, that is 78 per cent in 2016 and 80.2 per cent in 2019.

The percentage of pregnant women receiving the third dose of IPTp3 also increased from 39 per cent to 60 per cent between 2014 and 2016, and to 61 per cent in 2019 respectively.

As of 2017, it is estimated that less than 25 per cent of the country’s spending on health was from national resources.

Malaria vaccine

In Ghana, the malaria vaccine implementation programme was launched in May 2019 in 42 districts across seven regions and at the launch of this year’s World Malaria Day, the Programme Manager of the National Malaria Elimination Programme, Dr Keziah Malm, said as of December 2022, a total of 1.4 million doses of the vaccine had been administered to eligible children with 459,446 children receiving at least one dose and 184,418 children completing all the four doses.

According to her, Ghana Malaria Strategic Plan, 2021-2025 was to reduce malaria mortality by 90 per cent by 2025, using 2019 as baseline, reduce malaria case incidence by 50 per cent by 2025 using 2019 as baseline and achieve malaria pre-elimination in at least six districts by 2025.

Malaria Elimination

Ghana currently has moved from malaria control to elimination and according to the Director-General of the Ghana Health Service (GHS), Dr Patrick Kuma Aboagye, several activities had been conducted to steer the country in the right direction of delivering the zero malaria, saying the change in name was to reflect a shift in elimination efforts with a Malaria Elimination Strategic Plan (MESP), 2024-2028 in motion.

The objectives of the MESP is to ensure 100 per cent of the population have adequate knowledge, attitudes, practices and requisite skills for malaria elimination by 2028, to ensure 100 per cent of the population use at least, one malaria preventive measure to ensure that 100 per cent of malaria infections are identified by parasitological tests and treatment initiated within 24 hours by 2028 to ensure that 100 per cent of all confirmed malaria cases are appropriately, effectively and completely treated with parasite clearance within 72 hours by 2028 and to strengthen passive and active surveillance and monitoring and evaluation systems by 2028.

Also, it is to ensure that 100 per cent of all active infections in very low transmission areas are identified and eliminated through intensified surveillance, targeted vector and environmental management and human parasite reservoir interventions by 2028, to ensure timely and adequate supply of quality-assured malaria commodities to all service delivery points by 2028.

Others are to strengthen and maintain capacity for governance and programme management to achieve programmatic objectives at all levels of the healthcare system towards malaria elimination by 2028, as well as to improve mobilisation of resources and efficiently use available resources towards malaria elimination.

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