Counting malaria out - With preventive, control measures

Article: Salome Donkor
Ghana joins the international community and the rest of the African continent to observe World Malaria Day, today (April 25), on the theme: “Counting Malaria Out”
Commemorative activities to mark the day in the country include countrywide advocacy and educational programmes organised by the National Malaria Control Programme (NMCP), in collaboration with other stakeholders to intensify action aimed at minimising malaria infection, facilitate prompt treatment and prevent unnecessary deaths.
The World Health Organisation (WHO) states that malaria continues to haunt 40 per cent of the world's population and affects more than 500 million people a year, killing more than one million.
The burden of malaria is heaviest in sub-Saharan Africa but the disease also afflicts Asia, Latin America, the Middle East and even parts of Europe.
Malaria is a parasitic infection that can have a serious negative impact on pregnant women and young children in sub-Saharan Africa and other tropical areas. The WHO says the disease is also a major cause of maternal and child mortality and in pregnancy, it leads to low birth weight of babies, premature delivery, untreated low blood glucose and may cause brain damage in babies with low-birth weight.
A woman’s immunity to malaria may be compromised by HIV infection. The prevalence and intensity of malaria infection during pregnancy is higher among HIV-positive women and the risk to the woman and her new-born may be higher.
According to a statement by the Department of Social Affairs of the African Union, African children below five years of age and pregnant women are at highest risk of malaria. As they grow older, childhood malaria infection, including cerebral malaria, can have long-term effects such as delayed physical growth, impaired cognitive development, and persistent neurological damage on them. Malaria during pregnancy can be prevented, reduced and managed with appropriate, low-cost interventions.
Presentations made at a day’s media seminar in Accra to mark this year’s World Malaria Day, indicated that children experience between two and three episodes of malaria each year and the fever reduces their appetite and worsens their malnutrition, while recurrent episodes of malaria in children result in the loss of substantial amounts of time from school. The country records about 1,500 deaths from malaria among children under five years, while 60 pregnant women die every year from malaria.
Realising the devastating impact of the disease, African leaders declared April 25 of each year as Africa Malaria Day in all member states, at the Special Summit on Roll Back Malaria (RBM) held in April 2000 in Abuja Nigeria. Known as the Abuja Declaration on Roll Back Malaria in Africa, the initiative taken in accordance with the Millennium Development Goals, culminated in the celebration of Africa Malaria Day. The leaders committed themselves under the Abuja Declaration, to “halving malaria burden in Africa by 2010.”
During the 3rd Session of the AU Conference of Ministers of Health (Johannesburg, April 2007), the Chairperson of the AU Commission launched the “Malaria Elimination Campaign.”
During the same year, the World Health Assembly at its 60th Session, instituted the World Malaria Day as a day for recognising the global effort at providing effective control of malaria. It is also an opportunity for countries in the affected regions to learn from each other's experiences, support each other's efforts and encourage new donors to join a global partnership against malaria.
Furthermore, on September 25, 2008, the UN Secretary-General’s Special Envoy for Malaria convened the 2008 MDG Malaria Summit on the theme “World Leaders Unite”, at which the Global Action Plan on Malaria was adopted and over US$3 Billion were committed to the fight against the disease.
Delivering a paper on Ghana’s malaria situation and the way forward at an international conference on malaria at Steyning in England recently, the Minister of Health, Dr George Sipa Yankey, was reported to have stated that malaria had been very expensive for Ghana in terms of human and financial losses, explaining for instance that, the disease cost the nation over $760 million in 2006, which was about 10 per cent of Gross Domestic Product (GDP). The minister also outlined possible measures to completely combat the disease, which would include the identification of all malaria endemic areas and mosquito breeding zones and destroying all mosquito lava.
The World Health Organisation (WHO) has adopted a pronged approach to ease the burden of malaria on women and children in endemic areas and that includes intermittent preventive treatment (IPT) for pregnant women, malaria illness management during pregnancy, and the use of insecticide-treated bed nets (ITNs) for the entire population living in malaria affected areas. The WHO approach to malaria prevention and treatment emphasises initiating preventive measures during antenatal care and effective case management for all clinical cases of malaria. As another routine part of focused antenatal care, women should be given information and counselling on the dangers that malaria poses to them and their babies, and the steps they can take to help protect themselves. These messages should address the importance of practices such as continuing antenatal care, receiving the next scheduled dose of IPT and iron/folate, sleeping under an ITN and covering their arms and legs in the evening.
In support of the national malaria prevention programmes, the United States Government announced in December 2006, that Ghana had been selected as one of the eight countries to benefit from an initiative to rapidly scale up malaria prevention and treatment interventions in countries in sub-Saharan Africa, where the disease was most prevalent under a five-year, $1.2 billion project.
The most up-to-date information on nationwide coverage of key malaria prevention and control measures in Ghana comes from a Multiple Indicator Cluster Survey, conducted from August to early October 2006, which indicates that approximately 30 per cent of households reportedly own at least one bed net (of any type) while almost 19 per cent reportedly own one or more insecticide-treated nets (ITN).
A survey conducted by Netmark indicated that the number of people aware of ITNs has increased from 91.1 per cent in 2004 to 99.1 percent in 2008. Also, the proportion of households owning one ITN increased from 10.7 percent in 2004 to 61.6 per cent for the urban communities and from 11.2 per cent in 2004 to 66 per cent in 2008 for the rural communities.
In order to extend the reach of malaria interventions to the community level, the President’s Malaria Initiative (PMI) was instituted to reduce malaria mortality by 50 per cent in vulnerable groups; namely pregnant women, children under five years of age, and people living with HIV/AIDS.
This will be accomplished by achieving 85 per cent coverage of groups at risk with four key interventions which are the use of artemisinin-based combination therapy (ACT), intermittent preventive treatment (IPT) for malaria in pregnancy, use of ITNs, and indoor spraying with residual insecticides (IRS). Another goal of the PMI is to strengthen and improve the capacity of indigenous non-governmental organisations (NGOs) to undertake malaria prevention and control activities under the leadership of the National Malaria Control Programme (NMCP).
It is evident that bringing malaria control to zero would boost socio-economic development of Africa. Because malaria-carrying mosquitoes bite from dusk to dawn, long-lasting insecticide mosquito nets provide the best known means of effective protection. There is growing scientific evidence to demonstrate that combining mosquito net distribution with follow-on "hang up" campaigns carried out by trained volunteers in communities significantly reduces incidences of malaria. Trained volunteers who live in the same community as the beneficiary population and speak the same local language are ideally placed to help families overcome any social or cultural barriers that could prevent the effective use of nets.
Malaria control, elimination and eventual eradication are everyone’s business. “All of us: Children, youth, adults, educated, uneducated, rich and poor, have a role to play because malaria is predictable, preventable and curable, says the AU Social Affairs Department.
The department is of the view that funding for malaria is no longer a major constraint for implementation of programmes. What Africans need now is the unwavering commitment of leadership at all levels to mobilise the whole society by providing an enabling environment at households, community, district, sector and institutional levels for the battle against malaria to be won. Africa could then move nearer to achieving the MDGs by 2015.
The continent has support from the UN Secretary-General, WHO, the Roll Back Malaria Partnership, UNICEF, the World Bank, the Global Fund to Fight AIDS, TB and Malaria, the Gates Foundation and the USA President’s Malaria Initiative and other partners to mobilise capacity, resources and harmonise all existing malaria initiatives in order to finally eliminate malaria from Africa.