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MALARIA PREVENTION AND CONTROL IN GHANA The mission of CompAfriCare is to bring relief to all ethnic groups, particularly focusing on orphans and deserted children and families in remote parts of the world. Directing people toward a new vision and assisting them with the skills and resources for a better future. The care that we provide is directed in numerous ways. Our efforts include fund raising through donations and gifts, which are then judiciously disbursed where the needs are most pressing. One area which has recently been identified by Compafricare Foundation is the disease prevention and control of “MALARIA” in Ghana BED NET MOSQUITO NETS DISTRIBUTION: With your assistance, Compafricare Foundation has made substantial donations of Mosquito Bed Net to a number of beneficiaries in Ghana, as part of our efforts to help the prevention and control of Malaria in Ghana. PARTNERSHIP We are hoping to form partnership with various international organizations with representatives in Ghana for the fight against malaria, prevention and control, including: Plan Ghana USAID UNICEF UNHCR UNDP FHI RED CROSS GHANA BRITISH COUNCIL EU DELEGATION IN GHANA WHO EFFECT OF MALARIA Malaria contributes substantially to the poor health situation in Ghana. It is on record that, Sub-Saharan Africa accounts for 90% of the world’s 300 – 500 million cases and 1.5 to 2.7 million Deaths annually. About 90% of all these deaths in Africa occur in young children. This has serious demographic consequences for the continent. Between 20 and 40 percent of outpatient visits and between 10 and 15 percent of hospital admissions in Africa are attributed to malaria (WHO, 1999). This burdens the health system in general. It is estimated that malaria accounts for an average of 3% of the total global disease burden as a single disease in 1990. In Sub-Saharan Africa (SSA), 10.8% of all Disability The effect of malaria on people of all ages is quite immense. It is however very serious among pregnant women and children because they have less immunity. When malaria infection is not properly treated in pregnant women, it can cause anemia and also lead to miscarriages, stillbirths, underweight babies and maternal deaths. Also, frequent cerebral malaria can lead to disabling neurological sequelae. The malaria burden is a challenge to human development. It is both a cause and consequence of under-development. In Ghana, malaria is the number one cause of morbidity accounting for 40-60% of out patient. It is also the leading cause of mortality in children under five years, a significant cause of adult morbidity, and the leading cause of workdays lost due to illness. EXTENT OF MALARIA IN GHANA Malaria presents a serious health problem in Ghana. Malaria is hyper endemic in Ghana, with a crude parasite rate ranging from 10 – 70% with Plasmodium falciparum dominating. It is the number one cause of morbidity accounting for over 40 % of out- patient attendance in public health facilities with annual reported cases of about 2.2 million between 1995 and 2001, with over 10 % ending up on admission. Source of Data: Centre for Health Information Management, Ghana Health Service, 2003. Malaria is a major killer in Ghana and also the leading cause of mortality among children The disease is also the leading cause of workdays lost due to illness in Ghana and thereby contributing more to potential income lost than any other disease. Ghana can broadly be divided into three agro-ecological zones namely, the Coastal, the Forest and the Savannah. According to the Ministry of Health (MoH), each of these zones exhibits different characteristics in relation to the vector and the parasite. Differences in temperature, rainfall and humidity patterns as well as the ecology account for these variations. Several species of the Anopheles mosquito carry the four species parasites namely, Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale and Plasmodium malariae, which cause malaria in humans. Epidemiological analysis in Ghana has revealed that only three species of the Plasmodium are present; Plasmodium falciparum (80%-90%), Plasmodium malariae (20%-36%) and Plasmodium ovale (0.15%). The Plasmodium falciparum is thus the predominant parasite species carried by a combination of vectors. The principal vectors are the Anopheles gambiae complex, which is most widespread and difficult to control, and the Anopheles funestus accounting for 95% of all catches (MOH, 1991). Malaria transmission is intense and perennial in the rain forest zone with slight fluctuations but the peak transmission occurs shortly after the major rainy season. Ghana is stable and the level of endemicity in the forest zone is high since favourable environment exist throughout the year for disease transmission. The principal vector is the Anopheles gambiae complex while the predominant parasite species is the Plasmodium falciparum, which is quite fatal. The Coastal zone falls into two eco-epidemiological areas. Just along the coast is the coastal lagoons and mangrove swamps. The principal vector is the Anopheles melas, which breeds in the lagoons and swamps. The zone also lies in the Coastal Savannah which stretches from the lower Volta Region through the Accra Plains to the lower Central Region. Malaria transmission is intense and perennial but markedly reduced during the dry season especially in the coastal savannah. The Northern Savannah zone covers the three Northern Regions of Ghana. Unlike the forest zone, the rainfall pattern there could be described as erratic. The principal vector is the Anopheles arabiensis while the predominant parasite is the Plasmodium falciparum. Though transmission is intense and perennial, it reduces during the long dry season (October to April). It has however been observed that this situation is changing since a favourable micro-climate exist in certain parts of the zone for all year round transmission. Though malaria can strike several times in a year to an individual, it is a curable disease if promptly diagnosed and adequately treated. This rather poses a serious problem in Ghana like in many other African countries. This is because effective treatment and prevention of the disease is now expensive and at times remote from victims especially to those in the rural areas. The malaria parasite is also becoming resistant to the commonly used first and second line anti-malarial drugs and also takes long to be cured. Self prescription or medication is a widespread phenomenon in Ghana. Majority of the malaria victims only seek medical examination and treatment from health facilities when the initial attempts have failed resulting in late presentation The location and severity of malaria are mostly determined by climate and ecology (Gallup and Sachs, 2001). The area of potential transmission is controlled by climatic factors such as temperature, humidity and rainfall as well as the socio-economic conditions of the population. These factors influence the development of both the vector and the parasite. Cost of malaria prevention to households. The household survey revealed that prevention cost is relatively significant for households. The total monetary expenses incurred on prevention per month are estimated at US$ 521.05 which translated to a per capita cost of prevention of $1.40. Households on the average spend US$ 1.40 a month on products such as aerosol sprays, mosquito coils and bednets to protect themselves against mosquito bites. Seventy percent of the households’ total expenditure per month is on preventive measures, mosquito coils. Institutional Cost of Malaria in Ghana Malaria imposes a heavy burden on health institutions in Ghana especially those at the Primary Health Care level. Though the treatment of malaria is not free in Ghana except in cases of exemptions, health sector resources are stretched in the course of providing preventive and treatment services. The cost imposed on health institutions by malaria is assumed to contribute substantially to their annual recurrent expenditures. The cost of malaria prevention and treatment involves direct and indirectly in the fight against the disease in various ways. The likely costs of malaria prevention in Ghana includes expenditures on personnel, supplies, administration, maintenance, accommodation, allowances and general services such as sanitation and utility among others. COST & BEDNETS With regards to bednets, the household survey revealed that 18% had at least one bednet. While almost 43% of the users preferred the bednets as a protective measure because it was effective, the availability of the nets was confirmed by only 14% of the respondents. It was also observed that only 17.9% of the bednet users had Insecticide Treated Nets (ITNs) which cost on the average US$15 per net in the Ghanaian local market. Majority of the bednet users (82.1%) had ordinary bednets which also on the average cost US$ 10 per net. MOSQUITO BITES The exposure of people to the bites of the Anopheles mosquito results in sickness and if not promptly and efficiently addressed may result in the death of the victim. The process of seeking treatment involves cost to the individual and his household. The fear of contracting malaria also urges people to protect themselves by using available resources to prevent the mosquito bites. The best approach is to prevent the malaria “mosquito bites” disease. Another concern also is how to value the death of those who are outside the labour force (e.g. children and the unemployed). The cost of illness due to malaria constitutes the resources that are spent on treatment, control and prevention of malaria by households, health institutions, with the assistance from your international organization is the best approach to this pandemic. We therefore wish to appeal to you or your institution for financial support. Regards Kofi Oppong CEO – Ghana Compafricare Foundation