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A Global Health Issue – Malaria in Ghana

Francisca MasawiPhD student

Walden UniversityPUBH: 8165-1 Environmental Health

Instructor: Dr. Robert MarinoSpring, 2011

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Expected Learning OutcomesAt the end of this presentation, the target audience will be able to:1. Describe the etiology of Malaria 2. Identify the transmission routes of Malaria.3. Describe the main preventive and control measures of

Malaria in Ghana. 4. Describe the importance and role of Community Health

Officers (CHO) in Ghana towards prevention of Malaria.5. Describe significance of Malaria as a Public Health

issue

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Background

1. Malaria - one of the infectious diseases of major public health concern Globally (WHO, 2005)

2. Eradicated in some countries - But still a major health issue:• tropical and subtropical countries (WHO, 2005 &

CDC, 2010).

• Sub-Saharan African Countries – mainly affected (CDC-2010)

ReferencesWorld Health Organization, WHO, (2005). World Malaria Report: Roll back Malaria, UNICEF. Retrieved from http://whqlibdoc.who.int/publications/2005/9241593199_eng.pdf

Centers for Diseases Control and Prevention, (CDC, 2010). The History of Malaria: An ancient disease. Retrieved from http://www.cdc.gov/malaria

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Background (Cont’d)

1. Malaria – A Global Public Health Issue ( WHO, 2005):

o Incidence increased over 40 years

o 300-500 million infected annually ( at least 90% in Sub-Saharan Africa)

o More than 1 million deaths reported annually (mostly infants and children) (WHO, 2005)

ReferencesWorld Health Organization, WHO, (2005). World Malaria Report: Roll back Malaria, UNICEF. Retrieved from http://whqlibdoc.who.int/publications/2005/9241593199_eng.pdf

Centers for Diseases Control and Prevention, (CDC, 2010). The History of Malaria: An ancient disease. Retrieved from http://www.cdc.gov/malaria

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Significance of Malaria as a Public Health Issue

1. Etiology of Malaria - Mosquito Life cycle

References: Ministry of Health- Ghana Health Services, (2008). National Malaria Control program report-Ghana. Retrieved from http://www.ghanahealthservice.org/malaria_control.phpCenters for Diseases Control and Prevention, (CDC,2009). Malaria: Mosquito Biology. Retrieved from http://www.cdc.gov/malaria/about/biology/mosquitoes/index.html

Centers for Diseases Control and Prevention, United States Aid For International Development, (CDC-USAID, 2010). Sustaining Momentum Against Malaria: Saving Lives in Africa. Retrieved from http://www.pmi.gov/countries/profiles/ghana_profile.pdf

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Significance of Malaria as a Public Health Issue -

1. Etiology of Malaria :

o Cause –protozoan parasite genus Plasmodiumo Vector –female Anopheles mosquito (at least 60

species)o Host - humanso Species of malaria parasite -

•P. falciparum; P.vivax, P. ovale and P. malariae (CDC-2010 & CDC, 2008)

Centers for Diseases Control and Prevention, United States Aid For International Development, (CDC-USAID, 2010). Sustaining Momentum Against Malaria: Saving Lives in Africa. Retrieved from http://www.pmi.gov/countries/profiles/ghana_profile.pdf

Centers for Diseases Control and Prevention, (CDC,2009). Malaria: Mosquito Biology. Retrieved from http://www.cdc.gov/malaria/about/biology/mosquitoes/index.html

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Significance of Malaria as a Public Health Issue

1. Major cause of illness, death and poverty in Ghana

2. At risk population: Entire population ( CDC-USAID,2010)

3. However Mortality is high:o Among children < 5 yrso Expectant motherso The poor (MOH-GHS,2008)

References: Ministry of Health- Ghana Health Services, (2008). National Malaria Control program report-Ghana. Retrieved from http://www.ghanahealthservice.org/malaria_control.php

Centers for Diseases Control and Prevention, United States Aid For International Development, (CDC-USAID, 2010). Sustaining Momentum Against Malaria: Saving Lives in Africa. Retrieved from http://www.pmi.gov/countries/profiles/ghana_profile.pdf

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Significance of Malaria as a Public Health Issue

(cont’d)1. Malaria - major cause of illness and death in Ghana:

o 38.6% of all outpatient illnesso 36.9% of all admissionso 171 – Malaria Prevalence per 1000 populationo 2,835 deaths caused by Malaria - for all ageso As stated earlier – Infection rates high in children:

> than 80% in children between 5-9 ( MOH-G., 2009)

References: Ministry of Health- Ghana Health Services, (2008). National Malaria Control program report-Ghana. Retrieved from http://www.ghanahealthservice.org/malaria_control.php

Ministry of Health, Ghana (MOH-G, 2009). Anti-Malaria Drug Policy for Ghana. Retrieved from http://www.moh-ghana.org/UploadFiles/Policies_Programs/Nationalhealthpolicy090817040222.pdf 

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Significance of Malaria as a Public Health Issue

(cont’d)1. Malaria infection – a major cause of illness in

expectant mothers:o Maternal Anaemiao Placental parasitemia

Consequently this causes: High rate of loss of pregnancy or Babies born with low birth-weight (MOH-G.,

2008).

References: Ministry of Health- Ghana Health Services, (2008). National Malaria Control program report-Ghana. Retrieved from http://www.ghanahealthservice.org/malaria_control.php

Ministry of Health, Ghana (MOH-G, 2009). Anti-Malaria Drug Policy for Ghana. Retrieved from http://www.moh-ghana.org/UploadFiles/Policies_Programs/Nationalhealthpolicy090817040222.pdf 

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Significance of Malaria as a Public Health Issue

(cont’d)1. Malaria infection – a major cause of illness in

expectant mothers:o Leading to death as well ( MOH – G. (2008).

2. Elsewhere ( Venners, et al.2005) – Malaria studies have been linked to premature loss of pregnancy – but due to DDT exposure ( used to treat Malaria).

References: Ministry of Health- Ghana Health Services, (2008). National Malaria Control program report- Ghana. Retrieved from http://www.ghanahealthservice.org/malaria_control.php Venners, S. A, Korrick S, Xu X, et al. (2005). Preconception serum DDT

and pregnancy loss: a prospective study using a biomarker ofpregnancy. American Journal of Epidemiology, 162:709-716.

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Prevention and Control: First a closer look at Global Distribution of Malaria – Ghana is one of the countries at Risk with Malaria.

References:Centers for Diseases Control and Prevention, (CDC, 2010). The History of Malaria: An ancient disease. Retrieved from http://www.cdc.gov/malaria

World Health Organization, WHO, (2005). World Malaria Report: Roll back Malaria, UNICEF. Retrieved from http://whqlibdoc.who.int/publications/2005/9241593199_eng.pdf

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Prevention and Control1. Intervention programs aiming at:

o Primary – Preventing mosquito bites by use of mosquito nets, education, etc.

o Secondary – Controlling the disease in the infected patient and preventing spread of disease

o Tertiary – Taking care of the infected

References: Ministry of Health- Ghana Health Services, (2008). National Malaria Control program report-Ghana. Retrieved from http://www.ghanahealthservice.org/malaria_control.php

Ministry of Health, Ghana (MOH-G, 2009). Anti-Malaria Drug Policy for Ghana. Retrieved from http://www.moh-ghana.org/UploadFiles/Policies_Programs/Nationalhealthpolicy090817040222.pdf 

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Prevention and Control (cont’d)

1. Treatment of Malaria: Mainly by antimalarial drugs:

ChloroquineMefloquine (Lariam® and generic brands)DoxycyclineAtovaquone-proguanil (Malarone®)Primaquine

References: Ministry of Health- Ghana Health Services, (2008). National Malaria Control program report-Ghana. Retrieved from http://www.ghanahealthservice.org/malaria_control.php

Ministry of Health, Ghana (MOH-G, 2009). Anti-Malaria Drug Policy for Ghana. Retrieved from http://www.moh-ghana.org/UploadFiles/Policies_Programs/Nationalhealthpolicy090817040222.pdf 

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Prevention and Control (cont’d)

1. Ghana Community-Based Health Planning and Services(CHPS) Program: An Innovative way for scaling up service delivery

2. Why great success with program in Ghana: • Bridges gap between main-stream

health programs and the community

Nyonator, F.K., Awoonor-Williams, J.K., Phillips, J.F., Jones, T.C. and Miller, R.A. (2005). The Ghana Community-Based Health Planning Services Initative for Scalling up service delivery innovation. Health Policy and Plannning; 20(1): 25-34

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Prevention and Control – Community Health Planning and

Services:

1. Why great success with program in Ghana: • Bridges gap between main-stream

health programs and the community• CHPS program – works with community

leaders before implementation• Community health Officers (CHO) – for

the program are familiar members of the community

Nyonator, F.K., Awoonor-Williams, J.K., Phillips, J.F., Jones, T.C. and Miller, R.A. (2005). The Ghana Community-Based Health Planning Services Initative for Scalling up service delivery innovation. Health Policy and Plannning; 20(1): 25-34

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Public Health Policy Implications

1. Malaria - although this research focused on Ghana

2. Malaria – A Global public health issue3. Effective Policies – At Global and also at local

levels are needed.4. Challenges to be addressed:

1. Malaria Drug resistance2. Eradication of Malaria in Ghana and

worldwide

References: Ministry of Health- Ghana Health Services, (2008). National Malaria Control program report-Ghana. Retrieved from http://www.ghanahealthservice.org/malaria_control.php

Ministry of Health, Ghana (MOH-G, 2009). Anti-Malaria Drug Policy for Ghana. Retrieved from http://www.moh-ghana.org/UploadFiles/Policies_Programs/Nationalhealthpolicy090817040222.pdf 

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Public Health Policy Implications (cont’d)o Effective Global policy against Malaria is needed

because, due to Globalization everyone could be easily be at risk of Malaria.

o Malaria is a preventable environmental disease – eradication of this deadly infectious disease is imperative.

o Community Health Officers – research results are showing they are important towards Malaria eradication in Ghana

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References:

Abuaku, B.K., Koram, K.A and Binka, F.N. ( 2005). Antimalarial Prescribing Practices:A Challenge to Malaria Control in Ghana. Journal of Medical Principles and Practice, 14:332–337.

 Binka, F.N., Kubaje, A., Adjuik, M., Williams, L.A., Lengeler, C., Maude, G.H., G. E. Armah, G. E., Kajihara, B., Adiamah, J.H., and Smith, P.G. (1996). Impact of permethrin impregnated bednets on child mortality in Kassena-Nankana district, Ghana: a randomized controlled trial. Journal of Tropical Medicine and Intenational Health. (I): 2: 147-154.

  ATSDR (2002). Toxicological profile of DDT. Retrieved from http://www.atsdr.cdc.gov/toxprofiles/tp35.pdf

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 Bate, R., (2007). USAID’s health Challenge: Improving US foreign Assistance. Journal of Royal Medicine, 100: 11-15 Centers for Diseases Control and Prevention, (CDC, 2010). The History of Malaria: An ancient disease. Retrieved from http://www.cdc.gov/malaria Centers for Diseases Control and Prevention, (CDC,2009). Malaria: Mosquito Biology. Retrieved from http://www.cdc.gov/malaria/about/biology/mosquitoes/index.html Centers for Diseseases Control and Prevention, United States For International Development, (CDC-USAID, 2010). Sustaining Momentum Against Malaria: Saving Lives in Africa. Retrieved from http://www.pmi.gov/countries/profiles/ghana_profile.pdf Centers for Disease Control and Prevention, Emerging Infectious Diseases, (2002). Defining and Detecting Malaria Epidemics in the Highlands of Western Kenya. Retrieved from http://www.cdc.gov/ncidod/eid/vol8no6/pdf/01-0310.pdf  

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 Cohen, L., Chavez, V. & Chehimi. S. (Eds.). (2010). Prevention is Primary: Strategies for community well-being. San Francisco, California: Jossey-Bass.  Ghana Health Service, (GHS, 2010). National Malaria Control Programme: Programme Background. Retrieved from http://www.ghanahealthservice.org/malaria_control.php Ministry of Health, Ghana (MOH-G, 2009). Anti-Malaria Drug Policy for Ghana. Retrieved from http://www.moh ghana.org/UploadFiles/Policies_Programs/Nationalhealthpolicy090817040222.pdf

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Moeller, W.D., (2005). Environmental Health. Cambridge, Ma: Harvard University Press.

Nyonator, F.K., Awoonor-Williams, J.K., Phillips, J.F., Jones, T.C. and Miller, R.A. (2005). The Ghana Community-Based Health Planning Services Initative for Scalling up service delivery innovation. Health Policy and Plannning; 20(1): 25-34 Venners, S. A, Korrick S, Xu X, et al. (2005). Preconception serum DDTand pregnancy loss: a prospective study using a biomarker ofpregnancy. American Journal of Epidemiology, 162:709-716. Salazar-García, F., Gallardo-Díaz, E., Cerón-Mireles, P., Loomis, D. andBorja-Aburto, V. H (2004). Reproductive effects of Occupational DDT Exposure among Male Malaria Control Workers. Environmental Health Perspectives, (112) (5): 542-547. Trape, J, F., aand Rogier, C., (1996). Combating Malaria Morbidity and Mortality by Reducing Transmission. Parasitology Today, 6(12): 236-240.

 

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United States Environmental Protection Agency, (US, EPA 2002). The Foundation for Global Action on Persistant Organic Pollutants. Retrieved from http://www.epa.gov/ncea/pdfs/pops/POPsa.pdf World Health Organization, WHO, (2005). World Malaria Report: Roll back Malaria, UNICEF. Retrieved from http://whqlibdoc.who.int/publications/2005/9241593199_eng.pdf World Health Organisation, (WHO, 2008). Malaria – A Global Public Health Problem. Retrieved from http://www.who.int/mediacentre/news/releases/2008/pr32/en/index.htmlWorld Health Organization, (WHO, 2009). Roll Back Malaria Global Malaria Action Plan Report. Retrieved from http://www.rbm.who.int/gmap/gmap.pdf  

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Center for Diseases Control and Prevention, CDC (2010a): Collaboration in the fight against infectious diseases. Emerging infectious diseases, 4(3): 1-4. Retrieved from http://www.cdc.gov/ncidod/EID/vol4no3/shalala.htm

Websites:◦ www.imaginenomalaria.org◦ Christian Health Association of Ghana (CHAG):

www.chagghana.org

Additional Resources: