INVEST IN THE FUTURE: DEFEAT MALARIARevisiting our roles and responsibilities and accelerating our efforts

Introduction

Progress to Date

World Malaria Day is commemorated every year on April 25th and recognizes global efforts to control malaria.

The theme for this year's World Malaria Day, Invest in the future: Defeat malaria, reminds us that important work still remains to eliminate the disease. Seewww.worldmalariaday.org/about/world-malaria-day/.

Undisputed progress is being made in reducing malaria cases and deaths where the disease is endemic. The Roll Back Malaria Partnership proclaims a shrinking malaria map, showing that 55 countries are on track to reduce their malaria burden by 75%. A record 214 million insecticide-treated nets (ITNs) have been distributed in Africa. Thanks to this and other interventions, the World Malaria Report 2014 paints a brighter picture with 54% fewer deaths due to malaria between 2000 and 2013.

Progress in Ghana is equally remarkable. Access to critical preventive interventions and their use have increased dramatically. Comparing 2008 and 2014 Ghana Demographic Health Survey (DHS) data reveals that the proportion of households who owned at least one ITN increased from 33% to 68%; the proportion of children under five who slept under an ITN the previous night rose from 28% to almost 47%; and the proportion of pregnant women who slept under an ITN the previous night rose from almost 20% to 43%. Between 2008 and 2014, the proportion of pregnant women in Ghana receiving at least two doses of intermittent preventive therapy in pregnancy (IPTp) rose from 58% to 68%.

The proportion of malaria cases treated with artemisinin-based combination therapy (ACT) rose from 39% in 2011 to 82.5% in 2014. As a result, the malaria case fatality rate in children younger than five years dropped from 14.4% in 2001 to 0.51% in 2014.

According to the 2014 NMCP Annual Report, Ghana achieved a 50% reduction in parasite prevalence between 2002 and 2014, dropping from a national average of >50% to 26.7%. Real progress indeed.

These achievements are the results of better tools and greater commitment from Ghana and other countries where malaria is endemic, and support from the donor community. This level of success would not have been possible without the longstanding commitments of the Global Fund to Fight AIDS, Tuberculosis and

Vol. 1 Issue 1, April 2015

Malaria; U.S. President's Malaria Initiative (PMI), World Health Organization (WHO), U.K. Department for International Development (DfID), Bill and Melinda Gates Foundation, United Nations International Children's Emergency Fund (UNICEF), and other partners from the global health community.

We can all be proud to have recorded successes, but we cannot rest as we have more work to do to defeat malaria in Ghana.

Complacency will be the most serious enemy to further progress in the march toward defeating malaria. In the midst of persistent global and Ghanaian challenges, the fight against malaria must not fall off the stakeholders and partners' radar screens. The most important issues to keep in focus are as follows:

The Road to Further Progress-Important Issues

World Malaria Day 2015 Edition

Ghana NMCP worked in partnership with the PMI-funded NetWorks Project to ensure more ITNs reach homes through schools. Photo: Alexis Ayelepuni

Let's come together and work towards a malaria-free Ghana!

· Gaps in funding. Available funding is less than what is required to protect everyone at risk. An estimated 278 million people in Africa still live in a household without a single ITN. In Ghana, more than 6.5 million ITNs are required to meet the needs for 2015 and 2016. Furthermore, having in place an efficient supply chain management system to ensure regular supply and distribution of malaria rapid diagnostic tests (RDTs) and ACTs is crucial.

· Child deaths. Though progress has been made, malaria remains a danger to our children's survival. The 2014 Ghana DHS estimates mortality per year as 60 per 1,000 for children under 5, with 11% of those deaths attributable to malaria.

· Women's health. About 15 million pregnant women in Africa have no access to IPTp with sulfadoxine-pyrimethamine (SP) to prevent malaria during pregnancy. In Ghana, 32% of pregnant women do not receive the

Ghana Health ServiceBe a part of the continuing action to sustain

and improve upon Ghana's efforts to control malaria.

Ensure your family sleeps in a treated mosquito net

tonight and all through the night for a Good Life.

This Ghana Malaria Action Alert is produced by the National Malaria Control Program of the Ghana Health Service and the USAID-PMI VectorWorks Project

Call to Action—Accelerating Our Efforts

Everyone has an important role to play to defeat malaria.

· Sustain public and private sector support.

Health, education, agricultural, and industry leaders must

continue to insist on malaria prevention and treatment as

major development activities. All public institutions and

private companies must support effective mobilization and

proper management of resources, especially funds and

essential malaria control commodities such as ITNs,

insecticides, malaria medicines, and RDTs.

· Sustain donor commitment and support.

Commitment and support from the global health

community, donor organizations, funding agencies, and

private companies have been tremendously important in

generating the success achieved thus far. We all need to

encourage these institutions by demonstrating effective

management and proper use of all resources meant for

malaria.

· Maintain health facility standards.

Regional and district health management teams, malaria focal

persons, health care providers, school health coordinators,

and even our community leaders should band together to

ensure procedures for implementing the continuous

distribution program are followed. ITNs must be given to

pregnant women during their first visit to ANC. Mothers

who bring their children for Measles II vaccine should also

be given an ITN for their child. Records must be kept

properly and stocks must be stored safely.

· Ensure families regularly use nets.

Any family that has an ITN should ensure that every net

within the household is used properly every night and all

through the night. Community leaders, chiefs, and queen

mothers should aim to make their communities a “Net-use-

by-all” community and feel proud for doing so.

Let's all remember the RBM 2015 World Malaria Day Message:

“Winning the fight against malaria means that families,

communities, and all countries will thrive as never before.”

Let's come together and work towards a malaria-free

Ghana!

recommended two or more doses of IPTp.· Emerging drug and insecticide resistance. In the long run,

insecticide resistance may reduce the effectiveness of ITNs. This development could pose a major threat to malaria control and, if not checked, could trigger an upsurge in deaths due to malaria.

Remaining Focused on Critical Interventions

Ghana's Journey to Universal ITN Coverage

Malaria can be prevented and cured via cost-effective interventions. Vector control is one of these interventions because it reduces the transmission of the malaria parasite from humans to Anopheles mosquitoes and then back to humans. The use of ITNs stands out as a key vector control measure, in line with the WHO assertion that ITNs can reduce malaria mortality rates by 55% in children under 5 in sub-Saharan Africa, including Ghana.

By the end of 2012, the Ghana NMCP, with support from its key partners, succeeded in distributing more than 12 million ITNs to Ghanaian households through a door-to-door hang-up campaign.

Ghana's national strategy includes four key channels for continuous distribution (CD) of ITNs: antenatal clinics (ANC), child welfare clinics (CWC), primary schools, and subsidized sales of ITNs through the private sector. These channels ensure that gaps are filled and high coverage levels are sustained. In 2013 and 2014, Ghana distributed 4,342,100 ITNs through CD in ANC, CWC and primary schools.

During 2015, point distribution of ITNs is being carried out. It started in the Volta and Eastern regions in the latter part of 2014 and continues during the first half of 2015 in Western and Brong Ahafo regions. The other regions will be covered starting in September 2015.

Even though the proportion of Ghanaians with access to an ITN and those sleeping under one has increased since 2008, there is still more work to do. We need to continue to distribute large numbers of ITNs, responsibly store them, and ensure fair and equitable distribution by following approved protocols. Of course, it is vital to ensure that families who have ITNs properly use and care for them. A study conducted in the

Northern and Upper West regions in 2014 suggests that even

A healthy, happy morning after a mosquito-free night for mum, daughter and the unborn child. Photo: Prince Owusu

those with access to an ITN do not always use it throughout the entire night, year round. The importance of sleeping under an ITN every night and all through the night must be emphasized.

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