Presec Malaria Control in Ghana status 2
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MALARIA CONTROL IN GHANA
GROUND-BREAKING CEREMONY OF BIOLARVICIDE FACTORY
DR (MRS) CONSTANCE BART-PLANGE
PROGRAM MANAGER. 6TH AUGUST 2013
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OUTLINE OF PRESENTATION• INTRODUCTION/INTERVENTIONS
• PROGRESS MADE
• CHALLENGES AND LESSONS LEARNT
• CONCLUSION
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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: Efforts to reduce malaria with DDT begins
o Result: positive impact on malaria mortality and morbidity
o 1992: Dramatic increase led to the adoption of the Global Malaria Control Strategy
o 1998: Roll Back Malaria Partnership was launched to coordinate global efforts in combating malaria
• .
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Determinants of malaria
Environment Stagnant waters,
Agent=Anopheles mosquito which carries
The parasite
Host-manCattle, monkeys etc
Malaria Disease burden is the interaction of the three determinants
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• Diverse species-3500 different types of mosquitoes
• AGENTS FOR YELLOW FEVER, ELEPHANTIASIS, MALARIA, ENCEPHALITIS, WEST NILE FEVER, DENGUE
• About 40 species known to be vectors of malaria Globally
• IN GHANA: ONLY SIX (6) IDENTIFIED SO FAR
MOSQUITOES: AGENTS OF DIFFERENT DISEASES
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SIX ANOPHELES MOSQUITO TYPES SEEN IN
GHANA
• Anopheles gambiae complex:
o An gambiae ss-whole country-most imp
o Arabiensis-northern part
o Melas-swampy areas
• Anopheles funestus group• Anopheles hargreavesi• Anopheles coustani• Anopheles rufipes• Anopheles nili
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LIFE CYCLE OF MOSQUITO- FROM EGG-LARVAE-PUPAE-ADULT: 7 days at 31oC and 20 days at 20oC
Females lay eggs in batches of about 50 – 200 and they continue to lay eggs throughout
their life
LARVAE TO PUPA
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Adult Mosquito• Both male and female mosquitoes feed on nectar
• FEMALE MATES ONCE ONLY IN ITS ENTIRE LIFE
• After mating, the female mosquito searches for a blood meal for the development of her eggs
• TAKES BLOOD EVERY TWO-THREE DAYS TO LAY ITS EGGS
• WILL LAY EGGS UP TO 7 TIMES
• The average LIFE SPAN of female Anopheles under optimum conditions is 28 days
• Males live shorter than the females.( 14 days)
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Habitat preference of ANOPHELES• Anopheles gambiae prefer small water
collection that are open to sunlight
• Anopheles funestus prefer edges of streams, swamps and marshes
• Anopheles pharoensis prefer swamps and vegetated water bodies
• Anopheles culicifacies; adenesis prefer domestic breeding site such as barrels and water collections in domestic utensils
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Mosquito Larvae Habitats
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MALARIA PARASITES IN GHANA
oP. falciparum (About 90%)
oP. malariae (about 9%)
oP. ovale (about 1%)
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CHARACTERISTICS P. FALCIPARUM
P. MALARIAE
P.OVALE
PREPATENCY(INFECTION TO DETECTION IN BLOOD FILM)
5.5 DAYS 15 DAYS 9 DAYS
ASEXUAL CYCLE IN BLOOD
48 HOURS 72 HOURS 48 HOURS
NO OF MEROZOITES PER HEPATIC SCHIZONT
30, 000 15,000 15,000
DURATION OF UNTREATED INFECTION
1-2 YEARS UP TO 50 YEARS
1-5 YEARS
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Epidemiology of Malaria: IN GHANA
Malaria is endemic with slight seasonal variation:
oHypo-endemic in Greater Accra Region- 4% o hyper-endemic in the Upper West Region-51%
omeso-endemic in the rest of the country (18-22%)
• Overall parasite prevalence under 5 years is 27.5% (MICS 2011)
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Malaria within the Ghana health System
• Malaria is an important public health problem and considered high Priority in the country
• It is captured in MOH’s Medium Term Health Strategic Plan
• There exists a government policy which has exempted the payment of duty/taxes on ITNs; insecticides for IRS
• The National Malaria Strategic Plan 2008 -2015 INCLUDES LARVICIDING AS ONE OF THE KEY INTERVENTIONS
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IN LINE WITH Global Malaria Action
Plan Targets
GHANA MALARIA PROGRAM HAS SET THESE GOALS IN STRATEGIC PLAN 2008-2015
By 2015: Using the year 2000 as baseline:
oReduce Malaria cases by 75%
oReduce malaria attributable deaths by 75%
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GHANA-NMCP Targets on CURE- BY 2015
• All health facilities will provide prompt and effective treatment
• All communities will have access to community – based treatment for uncomplicated malaria;
• 90% of caretakers/parents will recognise early symptoms/signs of malaria and act correctly
• 90% of children under five years of age with fever will receive an appropriate ACT within 24hrs of onset;
• Reduce malaria cases in pregnant women from 16.1% to 8% and deaths from 9.0% to 4.5%
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GHANA-NMCP Targets ON PREVENTION- BY
2015 • ALL households will own at least one ITN
• 80% of the general population; 85% chn under-five years & pregnant women sleep under ITNs
• 90% of all structures in targeted districts protected thro Indoor Residual Spraying
• Limited Larviciding using chemicals and biological agents to be carried out coupled with focused spraying.
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SNAP-SHOT OF INTERVENTIONS PUT IN
PLACEA, PREVENTIVE INTERVENTIONS:
• ITNS FOR ALL ESP CHN, PREGNANT WOMEN• ADVOCATE FOR SCREENING OF DOORS, DINDOWS WITH
NETTING• PREGNANT WOMEN ON INTERMITTENT PREVENT
TREATMENT USING SULPHADOXINE-PYRIMETHAMINE (SP)• INDOOR RESIDUAL SPRAYING• TARGETED LARVICIDING• TARGETED SPACE SPRAYING• ADVOCATE FOR ENVIRONMENTAL MANAGEMENT
B. CURATIVE INTERVENTION• USE OF EFECTIVE, ANTIMALARIALS: ARTEMISING-BASED
COMBINATION FOR SIMPLE MALARIA; INJ ARTESUNATE; QUININE FOR SEVERE MALARIA
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Indoor Residual Spraying
• IRS remains a powerful vector control tool for reducing and interrupting malaria transmission. In 2011, 80 countries, including 38 in the African Region, recommended IRS for malaria control.
• In 2011, 153 million people were protected by IRS worldwide, or 5% of the global population at risk.
• In the African Region, the proportion of the at-risk population that was protected rose from less than 5% in 2005 to 11% in 2010 and remained at that level in 2011, with 77 million people benefiting from the intervention.
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WHY LARVICIDING??• Larviciding of temporary and permanent water bodies is an
integral component of malaria interventions
o Adult mosquitoes are highly mobile; & detect and avoid many interventions
o Mosquito eggs, larvae and pupae are however confined within relatively small aquatic habitats so cannot readily escape control measures
• This makes larval control a reliable and effective measure for reducing mosquito population.
• Larvicides affect all types of mosquito larvae: culex, aedes, anopheles,
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Different Mosquito Species• Females of the genus Anopheles, unlike all other genera of
mosquitoes, have palpi as long as the proboscis
Anopheles
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Progress Made in Ghana in Malaria
Control-1Indicators/years 2003
GDHS2008 GDHS
2011 MICS
2012 KAP BY SPH
TARGET 2015
Remarks
% Households with at least one insecticide treated net
3.2% 32.6% 48.9% 96.7% 100% 2012 TARGET ALMOST CLOSE TO 2015 SET TARGET
% children under 5 sleeping under insecticide treated net
4%53.9% 39% 77.6% 85% 2012 FIGURE
ALREADY CLOSE TO MDGs 2015
% Pregnant women sleeping under ITN
2.7% 50.4% 32.6% 59.7% 85% More than half of Pregnant Women Sleep under LLINs
25
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PROGRESS MADE IN MALARIA CONTROL-2
26
Indicators/years 2003 DHS
2008 GDHS
2011 MICS
2015 TARGET
Remarks
% Pregnant women receiving at least2 doses of SP (IpTp)
1.3% 43,7% 64.4% 100% Two third of all Pregnant women protected
Proportion of children under 5 with fever who are treated with appropriate anti malaria drugs (ACTs)
0% 23.7% 42% 90%) 2012 figure shows we have attained less than half of 2015 set target.
Parasite Prevalence (among 6 to 59months)
75.0% 27.5% 18.7% Parasite prevalence has dropped more than 50%.
ON COURSE TO ATTAIN MDGs
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National Urban Rural Male Female0.0
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
perc
enta
ge
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Trend: Health Insured Patients and non-Insured Malaria Cases Admitted: 2008-2012
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Progress Made in Ghana in Malaria
Control-3
Indicators/years 2000 2011
2012TARGET
FOR 201575%
REDUCED OF 2000
LEVELS
Remarks
Death associated with malaria
6108 3256 2815 1527 Reduced by 53.9%
Under 5 years Malaria Cases Fatality Rate (CFR)(Severe Malaria admission)
14.4%
1.2% 0.8% 1.0%Reduced by 95.8%
More admitted malaria cases survive now than in the past.
29
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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_DeathsNon mal death
Mal
aria
dea
ths
Non
-mal
aria
dea
ths
AMFm ACTs
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Trends in Malaria DEATHS versus NON-malaria
deaths in Ghana, 2005-2012; ABOVE-FIVE YEARS
2005 2006 2007 2008 2009 2010 2011 2012 -
500
1,000
1,500
2,000
2,500
3,000
-
2,000
4,000
6,000
8,000
10,000
12,000
14,000
Mal_Deaths Non mal death
Mal
aria
dea
ths
Non
-mal
aria
dea
ths
AMFm ACTs
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Challenges• Parasite resistance to Artemisinins
• Mosquito resistance to insecticides
• Poor Environmental management
• Threat of Galamsey/surface illegal mining to malaria vector control intervention
• Existence of sub-standard/counterfeit anti-malaria on the market
• Over-dependence on external funding esp. Global Fund/Sustainability of funding
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DOMESTIC: INCL GOV-ERNMENT
66%GLOBAL
FUND8%
EXTERNAL26%
Total Budget by Broad sources
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Illegal Mining Activities
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Progress Made, Ghana Should Move from Control Phase to Elimination
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WHAT WILL IT TAKE TO MOVE FROM
CONTROL TO ELIMINATION?ENSURING SUSTAINABLE RESOURCES
• TO SUSTAIN/ACCELERATE PROVEN INTERVENTIONS
MALARIA VACCINE• An effective vaccine against malaria has long been
envisaged as a potentially valuable addition to the available tools for malaria control. Ghana has 2 sites piloting vaccine….. Ready 2015??
BIOLARVICIDE: ..TO KILL THE LARVAE. KILL THEM YOUNG
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CONCLUSION• We are at a critical tipping point in the
fight against malaria. • Defeating malaria requires the
engagement of a number of sectors outside of health, including finance, education, defence, environment, mining, industry and tourism.
• IT IS POSSIBLE..OTHERS HAVE DONE IT, WEST AFRICA CAN DO IT TOO.
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