BackgroundSince 2005, the Government of Ghana and its partners, in concerted efforts to control malaria, scaled up the use of artemisinin-based combination therapy (ACT) and insecticide-treated nets (ITNs). Beginning in 2011, a mass campaign of long-lasting insecticidal nets (LLINs) was implemented, targeting all the population. The impact of these interventions on malaria cases, admissions and deaths was assessed using data from district hospitals.MethodsRecords of malaria cases and deaths and availability of ACT in 88 hospitals, as well as at district level, ITN distribution, and indoor residual spraying were reviewed. Annual proportion of the population potentially protected by ITNs was estimated with the assumption that each LLIN covered 1.8 persons for 3 years. Changes in trends of cases and deaths in 2015 were estimated by segmented log-linear regression, comparing trends in post-scale-up (2011–2015) with that of pre-scale-up (2005–2010) period. Trends of mortality in children under 5 years old from population-based household surveys were also compared with the trends observed in hospitals for the same time period.ResultsAmong all ages, the number of outpatient malaria cases (confirmed and presumed) declined by 57% (95% confidence interval [CI], 47–66%) by first half of 2015 (during the post-scale-up) compared to the pre-scale-up (2005–2010) period. The number of microscopically confirmed cases decreased by 53% (28–69%) while microscopic testing was stable. Test positivity rate (TPR) decreased by 41% (19–57%). The change in malaria admissions was insignificant while malaria deaths fell significantly by 65% (52–75%). In children under 5 years old, total malaria outpatient cases, admissions and deaths decreased by 50% (32–63%), 46% (19–75%) and 70% (49–82%), respectively. The proportion of outpatient malaria cases, admissions and deaths of all-cause conditions in both all ages and children under five also fell significantly by >30%. Similar decreases in the main malaria indicators were observed in the three epidemiological strata (coastal, forest, savannah). All-cause admissions increased significantly in patients covered by the National Health Insurance Scheme (NHIS) compared to the non-insured. The non-malaria cases and non-malaria deaths increased or remained unchanged during the same period. All-cause mortality for children under 5 years old in household surveys, similar to those observed in the hospitals, declined by 43% between 2008 and 2014.ConclusionsThe data provide compelling evidence of impact following LLIN mass campaigns targeting all ages since 2011, while maintaining other anti-malarial interventions. Malaria cases and deaths decreased by over 50 and 65%, respectively. The declines were stronger in children under five. Test positivity rate in all ages decreased by >40%. The decrease in malaria deaths was against a backdrop of increased admissions owing to free access to hospitalization through the NHIS. The study demonstrated that retrospective health facility-based data minimize reporting bias...
Background Ghana has made impressive progress against malaria, decreasing mortality and morbidity by over 50% between 2005 and 2015. These gains have been facilitated in part, due to increased financial commitment from government and donors. Total resources for malaria increased from less than USD 25 million in 2006 to over USD 100 million in 2011. However, the country still faces a high burden of disease and is at risk of declining external financing due to its strong economic growth and the consequential donor requirements for increased government contributions. The resulting financial gap will need to be met domestically. The purpose of this study was to provide economic evidence of the potential risks of withdrawing financing to shape an advocacy strategy for resource mobilization. Methods A compartmental transmission model was developed to estimate the impact of a range of malaria interventions on the transmission of Plasmodium falciparum malaria between 2018 and 2030. The model projected scenarios of common interventions that allowed the attainment of elimination and those that predicted transmission if interventions were withheld. The outputs of this model were used to generate costs and economic benefits of each option. Results Elimination was predicted using the package of interventions outlined in the national strategy, particularly increased net usage and improved case management. Malaria elimination in Ghana is predicted to cost USD 961 million between 2020 and 2029. Compared to the baseline, elimination is estimated to prevent 85.5 million cases, save 4468 lives, and avert USD 2.2 billion in health system expenditures. The economic gain was estimated at USD 32 billion in reduced health system expenditure, increased household prosperity and productivity gains. Through malaria elimination, Ghana can expect to see a 32-fold return on their investment. Reducing interventions, predicted an additional 38.2 clinical cases, 2500 deaths and additional economic losses of USD 14.1 billion. Conclusions Malaria elimination provides robust epidemiological and economic benefits, however, sustained financing is need to accelerate the gains in Ghana. Although government financing has increased in the past decade, the amount is less than 25% of the total malaria financing. The evidence generated by this study can be used to develop a robust domestic strategy to overcome the financial barriers to achieving malaria elimination in Ghana.
Background Malaria in pregnancy control interventions have been implemented through antenatal care services for more than 2 decades in Ghana. The uptake of these interventions has seen steady improvement over the years. This has occurred within the context of decreasing global trends of malaria infection confirmed by decreasing malaria in pregnancy prevalence in Ghana. However, not much is known about how these improvements in interventions uptake and reduction in malaria infection prevalence have impacted pregnancy outcomes in the country. This study aimed at describing trends of maternal anaemia and low birth weight prevalence and uptake of malaria in pregnancy control interventions over the last decade using data from Ghana’s District Health Information Management System (DHIMS II). Methods Data from Ghana’s DHIMS II on variables of interest covering the period 2012 to 2021 was analysed descriptively using Microsoft Excel 365. Results were computed as averages and percentages and presented in tables and graphs. Results The prevalence of maternal anaemia at booking and at term and low birth weight increased marginally from 31.0%, 25.5% and 8.5% in 2012 to 36.6%, 31.9% and 9.5% in 2021 respectively. Severe anaemia prevalence at booking and at term remained under 2% over the study period. Women making at least 4 ANC visits, receiving at least 3 doses of intermittent preventive treatment of malaria and an insecticide-treated net increased from 77.0%, 41.4% and 4.1% in 2012 to 82%, 55.0% and 93.3% in 2021, respectively. Malaria test positivity rate reduced from 54.0% to 34.3% between 2014 and 2021 while women receiving iron and folate supplementation for 3 and 6 months rose from 43.0% and 25.5% to 89.7% and 61.8%, respectively between 2017 and 2021. Conclusion Maternal anaemia and low birth weight prevalence showed marginal upward trends over the last decade despite reduced malaria infection rate and improved uptake of malaria in pregnancy control interventions. There is room for improvement in current intervention implementation levels but the complex and multi-factorial aetiologies of maternal anaemia and low birth weight need urgent investigation and quantification to inform policy and practice.
Background: Ghana has made impressive progress against malaria, decreasing mortality and morbidity by over 50% between 2005-2015. These gains have been facilitated in part, due to increased financial commitment from both government and donors. Between 2006 and 2011, total resources for malaria increased from less than USD 25 million in 2006 to over USD 100 million. However, the country still faces a high burden of disease and is at risk of declining external financing due to its strong economic growth and the consequential increased donor requirements for domestic contributions. The resulting financial gap will need to be met domestically to accelerate progress. The purpose of this study was to provide evidence of the economic impact of malaria elimination and the potential risks of withdrawing financing to shape an advocacy strategy for resource mobilization.Methods: A compartmental transmission model was developed to estimate the impact of a range of malaria interventions on the transmission of Plasmodium falciparum malaria between 2018 and 2030. The model projected scenarios that allowed the attainment of elimination using a package of common interventions and scenarios that predicted transmission if interventions were withheld. The outputs of this model were used to generate costs and economic benefits of each option.Results: Elimination was predicted using the interventions outlined in the national strategy, particularly increased net usage and improved case management. Malaria elimination in Ghana was predicted cost USD 961 million between 2020 and 2029. Compared to the baseline, elimination is estimated to prevent 85.5 million cases, save 4,468 lives, and avert USD 2.2 billion in health system expenditures. The economic gain was estimated at USD 32 billion in reduced expenditure, increased household prosperity and productivity gains. Through malaria elimination, Ghana can expect to see a 32-fold return on their investment. Withdrawing interventions, predicted an additional 38.2 clinical cases, 2,500 deaths and additional economic losses of USD 14.1 billion.Conclusions: Although government financing has increased in the past decade, the amount is less than 25% of total malaria financing. The study findings can be used to develop a robust strategy to overcome financial barriers for malaria elimination in Ghana.
Background Multiple interventions have been implemented over the years to decrease malaria morbidity and mortality in Ghana. After years of rolling out these interventions, assessing its effect on the trends for decision making is key. The objective of this study was to understand the trends of malaria related deaths in the country from 2005 to 2014.Methods Between September 2016 and June 2017, abstraction of retrospective data covering January 1st 2005 to December 31st, 2014 was conducted in 93 sampled health facilities providing AIDs/HIV, Tuberculosis and Malaria (ATM) services in Ghana. This paper is written out of a bigger study which looked at the mortality of ATM in Ghana. Abstraction form was used to retrieve socio-demographic and admission outcome of patients from facility registers, death certificates and inpatients registers. Data was entered using EpiData 3.1 statistical software package then exported to STATA 11 version for analysis. Bivariate analysis with Chi-square test and multiple logistic regression were done to assess factors associated with malaria related mortality at a 5% level of significance.Results A total of 667,186 admissions records related to malaria were retrieved in 93 hospitals from 2005 to 2014 with majority of the admissions being females (53.9%) and children under 5 years (47.8%). A total of 10,433(1.6%) of the admitted malaria cases were reported to have died with males and children under five years accounting for 51.0% and 26.6% respectively. Malaria case fatality rate showed an increasing trend from 2.2% in 2005 to 3.0% in 2007 and decreased to 1.1% in 2014. Malaria mortality declined by approximately 59% over the ten-year period with an average annual decline of 7%. Year of admissions, age, sex, insurance status and ownership of facility was significantly associated with mortality (p < 0.001). Sub-regional level hospitals have a decreased likelihood of malaria related mortality. A non-insured client increases the likelihood of mortality by 2.4 times (Odds Ratio = 2.4 p < 0.001).Conclusion Malaria mortality declined over the ten-year period with an average annual decline of 7%. An increase in age and not having health insurance among malaria-related admissions increases the likelihood of mortality.
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