Francisca Masawi
PhD student
Walden University
PUBH: 8165-1 Environmental Health
Instructor: Dr. Robert Marino
Spring, 2011
1
At 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
2
1.
2.
Malaria - one of the infectious diseases of
major public health concern Globally (WHO,
2005)
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)
References
World 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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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)
References
World 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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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.php
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 Diseases Control and Prevention, United States Aid For International
Development, (CDC-USAID, 2010). Sustaining Momentum Against Malaria: Saving Lives
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1.
Etiology of Malaria :
o Cause –protozoan parasite genus Plasmodium
o Vector –female Anopheles mosquito (at least 60
species)
o Host - humans
o 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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1.
2.
3.
Major cause of illness, death and poverty in
Ghana
At risk population: Entire population ( CDCUSAID,2010)
However Mortality is high:
o
o
o
Among children < 5 yrs
Expectant mothers
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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1. Malaria - major cause of illness and death in Ghana:
o 38.6% of all outpatient illness
o 36.9% of all admissions
o 171 – Malaria Prevalence per 1000 population
o 2,835 deaths caused by Malaria - for all ages
o 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.mohghana.org/UploadFiles/Policies_Programs/Nationalhealthpolicy090817040222.pdf
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1. Malaria infection – a major cause of illness in expectant
mothers:
o Maternal Anaemia
o 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.mohghana.org/UploadFiles/Policies_Programs/Nationalhealthpolicy090817040222.pdf
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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 reportGhana. 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 of
pregnancy. American Journal of Epidemiology, 162:709-716.
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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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1. 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.mohghana.org/UploadFiles/Policies_Programs/Nationalhealthpolicy090817040222.pdf
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1. Treatment of Malaria: Mainly by antimalarial drugs:
Chloroquine
Mefloquine (Lariam® and generic brands)
Doxycycline
Atovaquone-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.mohghana.org/UploadFiles/Policies_Programs/Nationalhealthpolicy090817040222.pdf
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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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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
15
1. Malaria - although this research focused on
Ghana
2. Malaria – A Global public health issue
3. Effective Policies – At Global and also at local
levels are needed.
4. Challenges to be addressed:
1.
2.
Malaria Drug resistance
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.mohghana.org/UploadFiles/Policies_Programs/Nationalhealthpolicy090817040222.pdf
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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/010310.pdf
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Cohen, L., Chavez, V. & Chehimi. S. (Eds.). (2010). Prevention is Primary:
Strategies for community well-being. San Francisco, California: JosseyBass.
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/Nationalhealthpolicy0908170
40222.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 DDT
and pregnancy loss: a prospective study using a biomarker of
pregnancy. American Journal of Epidemiology, 162:709-716.
Salazar-García, F., Gallardo-Díaz, E., Cerón-Mireles, P., Loomis, D. and
Borja-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): 236240.
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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.h
tml
World 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/sha
lala.htm
Websites:
◦ www.imaginenomalaria.org
◦ Christian Health Association of Ghana (CHAG):
www.chagghana.org
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