The prevailing public health threats of malaria in Ghana

Malaria is a life-threatening vector-borne disease spread by bites from infected female Anopheles mosquitoes.

The disease is predominant in tropical and sub-tropical developing countries, significantly affecting countries in sub-Saharan Africa. The earliest common symptoms of malaria are fever, headache, aching, chills, joint pains, vomiting and anemia. In severe cases especially when left untreated, malaria causes convulsions, coma, morbidity and death.

The disease has over the years remained an endemic public health issue faced by the global community with grave reported cases and fatalities strikingly in children.

This article for the case of Ghana succinctly brings to mind some causes of malaria, its health hazards to the public and populace, and the measures being taken to mitigate the threats to public health. This feature recommends further actions to be prioritized as a country to more fully reduce malaria impacts into the future.

Africa continues to record disproportionately highest cases of malaria worldwide with Ghana being among the most malaria prevalent and endemic countries. According to the World Health Organization (WHO), in 2022 for example, the African Region reported 94% and 95% of worldwide malaria cases and deaths respectively.

In the case of Ghana, malaria is perennial with regional and seasonal variations but worrisome infection levels with the entire population being socially at risk. About 5.3 million cases were confirmed for the year 2022.

Consequently, the country is at present in the group of the 11 malaria high burden to high impact (HBHI) countries in the world; accounting for 4% of Africa’s malaria cases, about 2.2% of global malaria cases and 2% of global malaria deaths.

Indeed, the country has over the past decade made momentous progress in controlling the disease burden, reducing confirmed deaths from 2799 in 2012 to 151 in 2022, and 27.6% prevalence in 2011 to about 8% in 2022. In spite of the headway, malaria poses a far-reaching health snag and challenge for the people and the country, more so when viewed as a vector-borne biological hazard that is targeted for eventual elimination.

Distinctively, the direct cause of malaria is bites from the female Anopheles mosquitoes that carry the parasites. However, the high incidence rate in Ghana is also influenced by distal and intermediate social factors and health determinants, inter alia, environmental suitability for the vectors, climate conditions, poverty, culture, population risk and lifestyles. On the other hand, malaria infections have also triggered a number of deaths, hospitalizations, economic burden, inequality gaps and social inconvenience, evidentially perpetuating a cycle of cause-effect conundrum for social and health outcomes.

Although everyone could be exposed to mosquito bites and the parasite, as earlier alluded to, children, particularly aged under-5 years, are significantly impacted by the malaria hazard. Of all deaths, children reportedly account for about 80% and are those mostly affected by severe disease and hospitalizations. This is reflective of the case in the African region where in 2021, 80% and 2022, 78.1% of all malaria deaths were reported in children within that age group.

Pregnant women are also severely impacted by malaria infections with implications for the mother’s health, fetus and the born babies, engendering stillbirth, low birth weight and impairment of the child’s cognitive and corporeal growth.

As a country, Ghana has over the years engaged in proactive steps to minimize the impacts of mosquito bites and malaria cases. First, insecticide-treated nets (ITNs) are distributed regularly through mass campaigns, community outreach and school-based distributions. For example, access to ITNs increased from 30% in 2008 to 67% in 2019 with usage increasing from 21% to 43% within the same period.

Similarly, Ghana is implementing drug-based prevention strategies including nationwide intermittent preventive treatment in pregnancy (IPTp) and Seasonal Malaria Chemoprevention (SMC) targeting treatment of children aged under 5 years with SPAQ.

In other respects, control measures being undertaken to minimize the impacts are improvement in case management, door-to-door campaigns, community sensitization programs, health funding, medical screening and mosquito-free environment initiatives involving communal cleaning and household sanitation.

Policy-wise, a plan of action such as the recent National Malaria Strategic Plan 2021–2025 seeks to harmonize interventions to effectively prevent at least 80% of the population from malaria.

Above and beyond the actions already being implemented, certain measures are herein recommended to help drastically reduce the burden and impact of malaria disease and its implications for public health. First, access to quality but regulated preventive chemotherapy ought to be improved and expanded to augment the existing preventive programs and treatment options.

Second, complementarily, the recently developed R21/Matrix-M (R21) malaria vaccine, which has far higher efficacy than the first RTS,S/AS01 (RTS,S) vaccine, and first approved by Ghana are both yet to draw extensive coverage for eligible children. Therefore, the country’s efforts against malaria must urgently address logistics, and financial and social constraints that could potentially affect the vaccines’ mass rollout and acceptability.

As well, the country should intensify public awareness campaigns in a well-coordinated shape to expand the knowledge base about new trends of the disease, effective observance of public health protocols like sanitation and increased acceptability of ITNs especially for vulnerable people in highly prevalent areas and seek early medical care for suspected cases of malaria.

Last, advancements in Ghana’s health system and practice must sufficiently tackle the malaria affliction by prioritizing equitable and highest possible standard of health care to all people with special attention to higher risk persons of malaria infection. This stands to be best achieved through plausible primary health care and universal health care delivery is fundamental to the health targets for the Sustainable Development Goals (SDGs).

Although the data shows commendable achievements, malaria remains a public health issue for Ghana and could receive even more attention than it currently does when viewed from the nature of the disease and its implications. Collectively, regular expert and academic opinions, measures demonstrated being already implemented and recommendations like those postulated in this article could expedite actions to further ameliorate malaria prevalence in Ghana for possible elimination.

All in all, confronting malaria is crucial for Ghana as a major contributing factor to attaining most of the SDGs, particularly the SDG 3: Good Health and Well-Being. By doing so, the country’s health metrics as in Life Expectancy at Birth, Infant Mortality, Under-Five Mortality and Maternal Mortality would also show better rates of improvements.