Ghanaian Chronicle (Accra)

Ghana: World Malaria Day - The Experts View Point

Naa Norley

25 April 2008


Every year, malaria kills 1-2 million people, and infects 300-500 million, with 90% of deaths occuring in sub-Saharan Africa. The disease is present in over 100 countries, threatening 40% of the world's population.

Experts say, the disease remains the single largest cause of death, for children under five in Africa - it kills one child every thirty seconds worldwide, which has a serious effect on their future. Affected children may suffer neurological aftereffects, and impaired learning abilities.

Dr. Mrs. Constance Bart Plange, Manager of the National Malaria Control Program (NMCP), defines malaria as an infectious disease of the blood, caused by a parasite called the plasmodium, a small parasite that cannot be seen with the naked eye, but only with microscope. She said mainly, mosquitoes of the Genus Anopheles transmit this small parasite into the human blood.

She said there are four human malaria parasites namely, Plasmodium falciparum, Plasmodium malariae, Plasmodium ovale and Plasmodium vivax.

Epidemiological analysis in Ghana has revealed that only three species of the plasmodium are present: Plasmodium falciparum, Plasmodium malariae and Plasmodium ovale.

Dr. Bart Plange noted that the most common and dangerous is Plasmodium falciparum, which causes about 95% of all malaria cases, seen in the most of the nation's health facilities.

What you need to know

Most Anopheles mosquitoes bite mainly at night, and some bite at dusk, while others bite late or early morning, and have site preferences.

Endophagic mosquitoes enter homes to bite, while the ones that bite outside are called exophagic.

There are favorable breeding grounds for anopheles, and these flying insects prefer relatively clean water, collecting in flowerpots, ponds, potholes, dugout pits, hoof prints puddles, rice fields and streams.

The Anopheles mosquitoes (those carrying the malaria parasite) in Ghana, breed throughout the year, and rest mainly indoors (endophilic); others, however, rest outdoors after feeding on blood (exophilic).

Plasmodium falciparum invades all the red blood cells of both the young and old, distorts, and weakens the red blood cells (RBC), ruptures the cells and release some toxins.

The toxins cause fever, tissue damage (cerebral malaria).

Destruction of the RBC results in the eyes turning yellow, cola like coloured urine and anemia.

Why pregnant women are a priority

Mrs. Aba Baffoe-Wilmot, a Medical Entomologist with the Ghana Health Service (GHS), said pregnant women are at high risk of getting malaria, and women in their first pregnancy are at high risk, because they lack the special antibodies, which protect women who have had at least one pregnancy, against malaria.

She said that the effects of malaria on the pregnant woman can be catastrophic, because research has shown that blood smears, taken from the pregnant woman for laboratory tests, can prove negative, but the parasite may be hiding in the placenta.

According to her, the parasite will be interfering with supply of oxygen and nutrients to the unborn baby, causing a lot of problems, which can lead to natural anemia, spontaneous abortion, stillbirths, pre-term labour and maternal mortality, from severe malaria.

Mrs. Baffoe-Wilmot noted that the effects of malaria on the foetus, can be disastrous, and these may include intrauterine growth retardation (IUGR), intrauterine foetal death (IFD), low birth weight, high perinatal mortality, and rarely, neonatal malaria/ anemia.

Remember, malaria is preventable and curable. Artemisinin-based combination drugs are now the recommended treatment for malaria. Treating malaria in Ghana with Chloroquine, will not clear the parasites. It may reduce the fever (just like paracetamol does), but the parasites will be in the blood causing harm.

Treat malaria promptly, fully and correctly, for malaria in children can lead to death within 48 hours!

The effect of malaria on people of all ages is quite immense. It is however very serious among pregnant women and children, because they have less immunity. When malaria infection is not properly treated in pregnant women, it can cause anaemia and also lead to miscarriages, stillbirths, underweight babies and maternal deaths. Cerebral malaria can cause disabling neurological damage, including mental disability and epilepsy.

Further, malaria in school children is a major cause of absenteeism, in endemic countries. It is estimated that about 2% of children, who recover from cerebral malaria, suffer brain damage, including epilepsy (WHO/UNICEF, 2003). Hence, among young children, frequent episodes of severe malaria may negatively impact on their learning abilities, and educational attainment. This is a threat to human capital accumulation, which constitutes a key factor in economic development.

The disease also has debilitating effects on adults. In addition to time and money spent on preventing and treating malaria, it causes considerable pain, and weakness among its sufferers. This can reduce peoples working abilities. The adverse impact of the disease, on household production, and gross domestic product, can be substantial.

Malaria, therefore, is not only a public health problem, but also a developmental problem for most of sub-Saharan Africa. At the national level, apart from the negative effects of lost productivity, on the major sectors of the economy, malaria has negative effects on the growth of tourism, investments and trade, especially in endemic regions. Malaria presents a major socio-economic challenge to African countries. This challenge cannot be allowed to go unnoticed, since good health is not only a basic human need, but also a fundamental human right, and a pre-requisite for economic growth (Streeten, 1981)

Lost work days

The disease is also the leading cause of work days lost, due to illness in Ghana, and thereby contributing more to potential income loss, than any other disease. One study found that economically active persons, who suffer from malaria, lose 9 workdays per episode, with males losing more time off, than females. In addition, caretakers sacrifice more than five work days, on average, to care for the sick, who were mostly children. The value of this productive time lost to the household, was estimated at US$8.92, representing 56% of the total cost of illness, per episode to the household (WHO, 2004). School children also lose about four school days, on the average, due to the malaria illness.

From the macroeconomic perspective, an econometric model found malaria to have negative effect on real GDP growth. It was estimated that for every one per cent increase in the malaria morbidity rate, real GDP growth will slow by 0.41%.

Therefore, reducing/eradicating malaria will surely lead to wealth creation.

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