MALARIA CONTROL IN

GHANA
GROUND-BREAKING CEREMONY OF BIOLARVICIDE
FACTORY
DR (MRS) CONSTANCE BART-PLANGE
PROGRAM MANAGER. 6
TH AUGUST 2013
OUTLINE OF PRESENTATION

INTRODUCTIONINTERVENTIONS

PROGRESS MADE

CHALLENGES AND LESSONS

LEARNT

CONCLUSION
INTRODUCTION

MALARIA DATES BACK TO PREHISTORIC TIMES:

KILLED MORE PEOPLE THAN THE GUN IN WORLD WAR II

Mid-19th century: malaria endemic in most countries of

the world including the Arctic Circle

1945: Eforts to reduce malaria with DD !egins

o
"esult: #ositi$e im#act on malaria mortality and
mor!idity
o
199%: Dramatic increase led to the ado#tion of the
&lo!al Malaria Control 'trategy
o
199(: "oll )ac* Malaria +artnershi# was launched to
coordinate glo!al eforts in com!ating malaria
.
Determinants of malaria
Environment
Stagnant waters,
Agent
=Anopheles mosquito whih arries
The parasite
!ost"man
Cattle, mon#e$s et
%alaria Disease &ur'en is the interation o( the three
'eterminants

Di$erse s#ecies-3"00 diferent ty#es of

mos,uitoes

A&E-' ./" 0E11/2 .E3E"4 E1E+5A-6A'6'4

MA1A"6A4 E-CE+5A166'4 2E' -61E .E3E"4
DE-&7E

A!out 48 s#ecies *nown to !e $ectors of

malaria &lo!ally

6- &5A-A: /-10 '69 :;< 6DE-6.6ED '/ .A"

MOSQUITOES: AGENTS OF
DIFFERENT DISEASES
SIX ANOPHELES MOSQUITO TYPES SEEN IN GHANA

A#$%&'(') *+,-.+' /$,%('01

o
A# *+,-.+' ))-2&$(' /$3#456-,$)4 .,%
o
A5+-.'#).)-#$54&'5# %+54
o
M'(+)-)2+,%6 +5'+)

A#$%&'(') 73#')43) *5$3%

Ano#heles hargrea$esi

Ano#heles coustani

Ano#heles ru=#es

Ano#heles nili
LIFE CYCLE OF MOS8UITO- FROM EGG-LARVAE-PUPAE-ADULT1 7 days at 31
o
C and 20
days at 20
o
C
Females lay eggs in
batches of about 50
200 and they continue
to lay eggs throughout
their life
LARVAE TO PUPA
Adult Mosquito
Both male and emale mo!"#$toe! eed on ne%ta&
FMA! MA"# $%C $%!& '% '"# %"'( !'F
Ate& mat$n'( the female mosquito !ea&%he! o& a blood meal
o& the de)elo*ment o he& e''!
TAKES BLOOD )(& "*$+",( -A&# TO LA+ ITS
EGGS

WILL LA+ EGGS ./ "$ 7 "'M#

The a)e&a'e !'F #/A% o female Anopheles #nde&

o0timum conditions $! 21 days

Male! l$)e shorter than the emale!,- ./ da0!1

,abitat 0reference of A%$/,!#

Anopheles gambiae *&ee& small 2ater

collection that a&e o0en to sunlight

Anopheles funestus *&ee& ed'e! o streams3

s2am0s and marshes

Anopheles pharoensis *&ee& !2am*! and

)e'etated 2ate& 3od$e!

Anopheles culicifacies; adenesis *&ee& dome!t$%

3&eed$n' !$te !#%h as barrels and 2ater
collections in domestic utensils
Mo!"#$to La&)ae Ha3$tat!
MALARIA PARASITES
IN GHANA
o
P. falciparum
(About 90%)
o
P. malariae
(about 9%)
o
P. ovale (about
1%)
C!ARACTERISTICS
)* +A,CI)ARU% P. MALARIAE P.OVALE
)RE)ATENC-
.IN+ECTION TO DETECTION IN /,OOD
+I,%0
1*1 DA-S
15 DAYS 2 DA-S
ASE3UA, C-C,E IN /,OOD
45 !OURS
72 HOURS 45 !OURS
NO O+ %ERO6OITES )ER !E)ATIC
SC!I6ONT
78, 888
15,000 91,888
DURATION O+ UNTREATED
IN+ECTION
9": -EARS
UP TO 50 YEARS 9"1 -EARS
Epidemiology of Malaria: IN GHANA
Epidemiology of Malaria: IN GHANA
Malaria is endemic with slight seasonal
$ariation:
o
5y#o-endemic in &reater Accra "egion- 4>

o
hy#er-endemic in the 7##er 2est "egion-51>
o
meso-endemic in the rest of the country :1(-
%%><
/$erall #arasite #re$alence under 5 years is
%?@5> (MICS 2011)
Malaria within the Ghana health System
Malaria within the Ghana health System

Malaria is an .,%$54+#4 %3-(./ &'+(4& %5$-(',

and considered &.*& P5.$5.46 in the country

6t is ca#tured in M/5As Medium erm 5ealth

'trategic +lan

here eBists a *$9'5#,'#4 %$(./6 which has

'0',%4': 4&' %+6,'#4 $7 :3464+0') $#
ITN); .#)'/4./.:') 7$5 IRS

he -ational Malaria 'trategic +lan %88( -%815

INCLUDES LARVICIDING AS ONE OF THE KEY
INTERVENTIONS
IN LINE WITH Global Malaria Action Plan
Targets
IN LINE WITH Global Malaria Action Plan
Targets
GHANA MALARIA PROGRAM HAS SET
THESE GOALS IN STRATEGIC PLAN 200<-
201"
B6 201"1 U).#* 4&' 6'+5 2000 +)
-+)'(.#'1
o
"educe Malaria cases !y ?5>
o
"educe malaria attri!uta!le deaths !y ?5>
GHANA-NMCP Targets on CURE- BY 2015
GHANA-NMCP Targets on CURE- BY 2015

All health facilities will #ro$ide #rom#t and efecti$e

treatment

All communities will ha$e access to community C !ased

treatment for uncom#licated malariaD

98> of careta*ersE#arents will recognise early

sym#tomsEsigns of malaria and act correctly

98> of children under =$e years of age with fe$er will

recei$e an a##ro#riate AC within %4hrs of onsetD

"educe malaria cases in #regnant women from 1;@1> to

(> and deaths from 9@8> to 4@5>
GHANA-NMCP Targets ON PREVENTION- BY 2015
GHANA-NMCP Targets ON PREVENTION- BY 2015

A11 households will own at least $#' 6-

(8> of the general #o#ulationD (5> chn under-

=$e years F #regnant women slee# under 6-s

98> of all structures in targeted districts

#rotected thro 6ndoor "esidual '#raying

L.,.4': L+59./.:.#* using chemicals and

!iological agents to !e carried out cou#led
with focused s#raying@
SNAP-SHOT OF INTERVENTIONS PUT IN PLACE
A= PREVENTIVE INTERVENTIONS1
ITN' ./" A11 E'+ C5-4 +"E&-A- 2/ME-
AD3/CAE ./" SCREENING /. D//"'4 D6-D/2' 265
-E6-&
+"E&-A- 2/ME- ON INTERMITTENT PREVENT
TREATMENT 7'6-& '71+5AD/96-E-+0"6ME5AM6-E :'+<
INDOOR RESIDUAL SPRAYING
A"&EED LARVICIDING
A"&EED SPACE SPRAYING
AD3/CAE ./" ENVIRONMENTAL MANAGEMENT
B. CURATIVE INTERVENTION
7'E /. E.EC63E4 A-6MA1A"6A1': ARTEMISING-BASED
COMBINATION ./" '6M+1E MA1A"6AD IN> ARTESUNATE;
8UININE FOR SEVERE MALARIA
Indoor Residual Spraying
6"' remains a #owerful $ector
control tool for reducing and
interru#ting malaria transmission@
6n %8114 (8 countries4 including G(
in the African "egion4
recommended 6"' for malaria
control@
6n %8114 15G million #eo#le were
#rotected !y 6"' worldwide4 or 5>
of the glo!al #o#ulation at ris*@
I# 4&' A75./+# R'*.$#4 the
#ro#ortion of the at-ris*
#o#ulation that was #rotected rose
from less than 5> in %885 to 11>
in %818 and remained at that le$el
in %8114 with ?? million #eo#le
!ene=ting from the inter$ention@
WHY LARVICIDING??
1ar$iciding of tem#orary and #ermanent water !odies is an
integral com#onent of malaria inter$entions
o
A:3(4 ,$)?3.4$') +5' &.*&(6 ,$-.('; @ :'4'/4 +#:
+9$.: ,+#6 .#4'59'#4.$#)
o
M$)?3.4$ '**)= (+59+' +#: %3%+' +5' &$2'9'5
/$#A#': within relati$ely small a,uatic ha!itats so cannot
readily esca#e control measures
T&.) ,+B') (+59+( /$#45$( + 5'(.+-(' +#: 'C'/4.9' ,'+)35'
7$5 5':3/.#* ,$)?3.4$ %$%3(+4.$#.
L+59./.:') +C'/4 +(( 46%') $7 ,$)?3.4$ (+59+'1 /3('0=
+':')= +#$%&'(')=
Diferent Mosquito Species
.emales of the genus Anopheles4 unli*e all other genera of
mos,uitoes4 ha$e #al#i as long as the #ro!oscis
Ano#heles
Progress Made in Ghana in Malaria Control-1
I#:./+4$5)6'+5) 2003
GDHS
200<
GDH
S
2011
MICS
2012
KAP BY
SPH
TARGE
T 201"
R',+5B)
> 5ouseholds
with at least one
insecticide
treated net
3.2D G%@;
>
4(@9
>
E6.FD
100D
%81% A"&E
A1M/'
C1/'E /
201" SET
TARGET
> children under
5 slee#ing under
insecticide
treated net
GD 5G@9
>
G9> FF.6D
<"D
2012 FIGURE
ALREADY CLOSE TO
MDG) 201"
> +regnant
women slee#ing
under 6-
2.FD 58@4
>
G%@;
>
"E.FD
<"D
M$5' 4&+#
&+(7 $7
P5'*#+#4
H$,'#
S(''% 3#:'5
LLIN)
45
PROGRESS MADE IN MALARIA CONTROL-2
46
I#:./+4$5)6'+5
)
2003
DHS
200<
GDH
S
2011
MICS
201"
TARG
ET
R',+5B)
> +regnant women
recei$ing at least% doses of '+
:6##<
1.3D 4G4?
>
6G.GD
100
D
T2$ 4&.5: $7 +((
P5'*#+#4 2$,'#
%5$4'/4':
+ro#ortion of
children under 5
with fe$er who
are treated with
a##ro#riate anti
malaria drugs
(ACTs)
0D %G@?
>
G2D
E0D)
%81% =gure shows we ha$e +44+.#':
(')) 4&+# &+(7 $7 201" )'4 4+5*'4@
+arasite
+re$alence
:among ; to
59months<
F".0
D
2F."
D
1<.F
D
+arasite #re$alence has
dro##ed more than 58>@
ON COURSE TO ATTAIN MDG)
National Urban Rural Male Female
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Percentage of Children Under 5 Years who received ACTs within 2 weeks in Ghana MICS 2006 and MICS 2011 Compared
percentage
Trend: Health Insured Patients and non-Insured Malaria
Cases Admitted: 2008-2012
Progress Made in Ghana in Malaria Control-3
I#:./+4$5)6'+
5)
2000 2011
2012
TARGET
FOR
201"
F"D
REDUC
ED OF
2000
LEVELS
R',+5B)
Death
associated
with malaria
610
<
G%5; 2<1
"
1"2F
R':3/': -6
"3.ED
7nder 5 years
Malaria Cases
.atality "ate
:C."<
:'e$ere
Malaria
admission<
1G.
GD
1@%> 0.<
D
1.0D
R':3/': -6
E".<D
More admitted
malaria cases
sur$i$e now than
in the #ast@
47
Trends in Malaria DEATHS versus NON-malaria deaths in
Ghana, 2005-2012; UNDER-FIVE YEARS
2005 2006 2007 2008 2009 2010 2011 2012
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
-
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
Mal_Deaths
Non mal death
Malaria deaths Non-malaria deaths
AMF
m
ACTs
Trends in Malaria DEATHS versus NON-malaria deaths in
Ghana, 2005-2012; ABOVE-FIVE YEARS
Mal_Deaths Non mal death
Malaria deaths Non-malaria deaths
AMF
m
ACTs
Challenges
+arasite resistance to Artemisinins
Mos,uito resistance to insecticides
+oor En$ironmental management
hreat of &alamseyEsurface illegal mining to malaria
$ector control inter$ention
EBistence of su!-standardEcounterfeit anti-malaria on
the mar*et

/$er-de#endence on eBternal funding es#@ &lo!al

.undE'ustaina!ility of funding
Total DOMESTIC; 1
Total GLOBAL FUND; 0
Total EXTERNAL; 0
Total Budget by Broad sources
Illegal Mining Activities
Progress Made, Ghana Should Move from
Control Phase to Elimination
WHAT WILL IT TAKE TO MOVE FROM CONTROL TO
ELIMINATION?
ENSURING SUSTAINABLE RESOURCES

/ '7'A6-EACCE1E"AE +"/3E- 6-E"3E-6/-'

MALARIA VACCINE

An efecti$e $accine against malaria has long !een

en$isaged as a %$4'#4.+((6 9+(3+-(' +::.4.$# to the
a$aila!le tools for malaria control@ &hana has % sites
#iloting $accineH@. R'+:6 201"II
BIOLARVICIDE1 ..TO KILL THE LARVAE. KILL THEM
YOUNG
CONCLUSION

2e are at a critical ti##ing #oint in the

=ght against malaria@

Defeating malaria re,uires the

engagement of a num!er of sectors
outside of health4 including =nance4
education4 defence4 en$ironment4 mining4
industry and tourism@

6 6' +/''6)1E@@/5E"' 5A3E D/-E 64

2E' A."6CA CA- D/ 6 //@