Fighting malaria in Ghana
IPN Critical Opinion articles
Here in Ghana, the authorities are failing to deal with the worsening malaria problem that is crippling our country and killing our people. After years of failure, it is time for a re-think.
More than 17 million of Ghana's 20 million people are infected by malaria every year, costing the nation a colossal 850 million cedis (US$94 million) for treatment alone. These figures are probably an underestimate of the real burden, as many cases go unreported.
Malaria also has a huge indirect cost on Ghana's economy due to lost productivity. Those infected by malaria are in and out of hospital and unable to work. Malaria takes an especially heavy toll on farmers. Swarms of mosquitoes make it impossible for farmers and their families to sleep indoors, especially during the rainy seasons when they are forced to sleep outdoors around bonfires.
Malaria makes it difficult for our fledgling industries to get off the ground because it scares away tourists and investors, both major potential sources of income and jobs. A country where 85 percent of the population falls sick every year is not likely to attract investors, in search of a robust and healthy workforce, or tourists, looking for amusement and leisure.
The productivity of future generations is also being undermined by this epidemic. Pregnant women and children under five are a significant proportion of those infected each year. Even if children survive the infection, serious illness at such an early age stunts development, with lifelong repercussions. This loss of potential is unnecessary and unacceptable.
Our health system is utterly ill-equipped to deal with the malaria crisis, even with the government's recent introduction of a national system of socialised healthcare.
Some of the blame of Ghana's failure to tackle malaria must fall on the World Health Organisation whose recommendations have led to rising infection levels. Until recently, the WHO advocated the use of insecticide-treated bednets in vector control, almost to the exclusion of other proven measures. While bed-nets have their uses, they are not a panacea.
For bednets to be effective, they must first be distributed among the population, and second, be used correctly. Poor roads, isolated communities and a fragmented healthcare system make distribution very difficult. To remain effective, bednets also need to be dipped in toxic pesticide every three months. And people often find them too hot to sleep in, or use them for fishing nets or even wedding dresses!
This all means that the number of people contracting malaria is on the rise, but the recommended treatment - Artemisinin Combination Therapy (ACT) - is beyond the financial reach of most Ghanaians. Our national health system is not able to shoulder the spiraling cost of treatment, either.
We need to consider different approaches if we are to free Ghana from the economic and social destruction malaria brings.
One such alternative is Indoor Residual Spraying, which involves spraying the interior walls of dwellings with a small amount of DDT. This acts as an irritant to the mosquitoes, which prevents them from coming in the house in the first place. Those that do make it inside are quickly repelled outside. This can effectively stop the transmission of malaria.
DDT is a low-cost and long lasting insecticide that only requires reapplication once a year. South Africa has run a successful 50-year DDT-based IRS program using DDT in preventing malaria.
In 2003, the South African Minister of health urged other African countries to use DDT in malaria prevention. Now, many African countries including Swaziland, Namibia, Zimbabwe, Madagascar and Botswana are all using DDT in malaria prevention with positive results. Isn't it time Ghana joined these countries?
Effective and wide-scale prevention stops infection in the first place and removes much of the need for medication, saving both lives and money. The good news is that after years of providing only lukewarm support for IRS, the WHO has now changed its strategy to advocate more strongly for DDT.
Ghana must therefore make good use of the WHO's recent decision to re-introduce DDT in malaria control and start using the insecticide as a cornerstone of its control program. Despite limited resources, the cost-effectiveness and reliability of DDT will mean that many Ghanaians will be protected and able to live productive lives. Only then will it be possible to build a wealthy nation of healthy people.