“Sustain Gains, Safe Lives and Invest in Malaria”

Malaria is one of the dangerous diseases which kills almost one million people every year and afflict about half a billion people globally. Africa accounts for about 90% of this. Children under five years are most vulnerable as 85% of malaria death occurs amongst them. Every 30 seconds a child dies from malaria. Malaria has been estimated to cost Africa more that 12 billion dollars every year.

Malaria is one of the leading causes of illness in Ghana and the primary cause of morbidity and mortality, accounting for over three (3) million outpatient visits to public health facilities annually. It occurs all year round and affects a large proportion of the population. In 2009 reported cases attributed to malaria among children under five years were 48.9%. Among pregnant women the proportion was 11.5%.

  • Malaria remains a major cause of poverty and low productivity in Ghana.
  • Malaria is caused by plasmodium parasites. The parasites are spread to people through the bites if infected Anopheles mosquitoes called malaria vectors, which bite mainly between dusk and dawn.
  • Malaria is hyper endemic, accounting for 44.5% of all outpatient attendances and 12 % of under-five mortality in Ghana.
  • Malaria is a major cause of absenteeism from schools and from work.
  • Malaria causes high rates of miscarriage (up to 60% in P falciparum) and maternal death rates of 10-50%.
  • The best available treatment for malaria is artemisinin-based combination therapy (ACT).
  • Insecticide treated nets (ITNs) use and indoor residual spraying, are the best forms of controlling and preventing malaria.
  • Malaria kills nearly one million children yearly.
  • Pregnant women most receive IPT and sleep in Insecticide treated nets (ITN’s) to prevent malaria infection of their unborn babies.

Malaria is a major cause of illness and death in Ghana, particularly among children and pregnant women in Ghana. In 2006 , malaria accounted for 38.6% of all outpatient illness and 36.9% of all admissions. Malaria prevalence per thousand population was 171 and 2,835 malaria –attributable death (all ages) representing 19% of all deaths were recorded. Infection rates are high in children peaking at more than 80% in those aged 5-9 years and falling to low levels in adults. Malaria infection during pregnancy causes maternal anaemia and placental parasitemia both of which are responsible for miscarriages and low birth weight babies among pregnant women. As many as 13.7% of all admissions of pregnant women in 2006 was as a result of malaria whilst, 9.0% of them died from the disease.

 What is malaria?

Malaria is a disease which is caused by a parasite called Plasmodium passed from one human being to another by the female Anopheles mosquito. These parasites are so small that they can only be seen with a microscope. The most common form of the malaria parasite found in Ghana is called the Plasmodium Falciparum. There are other forms of malaria parasites but the Plasmodium Falciparum is the most dangerous and causes about 95% of all malaria cases in Ghana. Malaria can be classified as either uncomplicated to complicated (severe).

 How it is transmitted

Malaria is transmitted by female Anopheles mosquitoes. Many species of Anopheles mosquitoes can be found in Sub-Saharan Africa. Human being serves as hosts to the malaria parasite in that the parasites live, grow and multiply in the liver and bloodstream of man. The disease –carrying mosquitoes are also known as vectors. This means that they carry the parasite from one person to another person. Malaria transmission is a cycle. When the mosquito bites a person with malaria, it sucks up a mixture of blood and malaria parasites into its stomach. The parasite takes several days to develop inside the stomach of the mosquito. The mosquito then bites another person and passes the parasite through its saliva into the next person thus infecting the new person. The parasite then live ,grow and multiply in the person’s blood destroying the red blood cells and make the person very ill, causing the fever and weakness people experience when they get malaria.

 Life of the Anopheles Mosquito

Mosquitoes have 4 different stages in their life cycle; Egg. Larva, Pupae and adult.

• Egg ( first hatch within 2-3 days)

• Larva ( larval development takes 8-10 days but temperature dependent)

• Pupa ( Pupal stage takes 2-4 days but temperature dependent)

• Average life span 3-4 weeks , most lay up to 3 batches(100-150/batch) Rarely up to 7 batches have different breeding habitat preferences

The overall objective of Malaria Prevention is to:

• Promote use of Long lasting Insecticide-Treated Materials and Nets(LLINs)

• Encourage Intermittent Preventive Treatment (IPT) of malaria in pregnancy

• Undertake indoor residual spraying(IRS)

 Insecticide Treated materials (ITMs)

Insecticide –treated materials are materials impregnated with insecticides (usually a pyrethroid) which have residual effects to repel or kill insects on contact. ITMs include long lasting insecticide treated nets (LLINs), treated door and window curtains and treated clothes in some cases. Promoting the idea of people sleeping under insecticide treated nets is key intervention strategy for malaria control. Insecticide treated nets decrease both the number of malaria cases and malaria death rates in pregnant women and children. Using insecticide treated nets every night provides a constant physical barrier between man (host) and the mosquito (the vector) and thereby reduces exposure to malaria infections.

 Intermittent preventive treatment (IPT)

During pregnancy, the woman’s protection against diseases is weakened. Immunity to malaria is altered especially during the first and second pregnancies. Sometimes, the blood smear/ laboratory test may be negative but the parasites may be hiding in the placenta interfering with oxygen and nutrient supply to unborn babies causing a lot of problems which can lead to one or more of the following.

• Spontaneous abortion

• Stillbirth(child may die in the womb)

• Pre-term birth/ miscarriages(birth occurring before due date)

• Low birth weight-small babies weighing less than 2.5kg(malaria contributes about 35%

• Maternal anaemia (malaria contributes about 15%)

• Anemia in newborn or neonates

Intermittent preventive treatment (IPT) of malaria during pregnancy is based on the assumption that every pregnant woman living in areas of high malaria transmission has malaria parasite in her blood or placenta eventhough they may not present with signs and symptoms of malaria. In Ghana, sulphadoxine-Pyrimethamine (SP) is the recommended drug for IPT. IPT involves the administration of full. Curative treatment doses of an effective anti malaria at predefined intervals during pregnancy, beginning at week 16 or after quickening in doses of 3 tablets one month apart and under direct observation(DOT) by a qualified midwife during antenatal visits. The last doses should be given after week 36.

Indoor Residual Spraying (IRS)

The female Anopheles mosquito which transmits malaria usually rests indoors on walls. Indoor residual spraying is a vector control intervention which involves the spraying of insecticides on the interior walls of buildings with the aim of destroying the vector that transmits malaria.IRS can be done once or twice a year depending on the type of chemical being used. This is different from the use of the common mosquito spray available on the market.