Ghana

Malaria facts

Malaria is endemic and perennial in Ghana, with pronounced seasonal variations in the northern part of the country. The length of malaria transmission varies by geographic region, depending on the length of the dry season (December–March), during which there is little transmission.[1]

There are two major transmission patterns [1]

  • A 6–7-month transmission season in a larger part of the north of the country and a shorter 3–4-month transmission in the upper part of the north, with the highest number of cases occurring between July and November.
  • In the southern part of the country, the transmission season is 9 months or more, with a small peak from May to June and a larger peak from October to November.

With 2% of global malaria cases and 3% of deaths, Ghana is among the 15 highest burden malaria countries in the world.  Between 2016–2019, however, Ghana made significant progress in malaria control – cases decreased by 32% (from 237 cases per 1000 of the population at risk to 161 cases), and deaths decreased 7% (from 0.4 per 1000 of the population at risk to 0.37). [2]

To reduce the burden of malaria in the country, the high burden, high impact approach was introduced in Ghana in November 2019.[1]

Ghana has achieved the highest rate of two doses of intermittent preventive treatment in pregnancy (IPTp2) for pregnant women in sub-Saharan Africa – 78% in 2016 and 80.2% in 2019 [2,6].  The percentage of pregnant women receiving the third dose of IPTp (IPTp3) also increased from 39% to 60% between 2014 and 2016, and to 61% in 2019 [1]

As a result of improved access to testing, the reported rates of malaria cases in children under five has gradually risen from 12% in 2016 to 33% in 2017.[2] Although 73% of households owned at least one insecticide-treated net (ITN) in 2016, usage rates were noted to be lower. For instance, net use among pregnant women and children under five was 52% and 50%, respectively, in the same year.[1]

Following the positive impact of Seasonal Malaria Chemoprevention (SMC) on severe malaria (protective efficacy of 48% in the Upper West Region), the program was expanded to the Upper East region and was extended to a further 23 districts in the Northern region in 2019. [1] In 2021, the National Malaria Control Programme (NMCP) will expand SMC to Oti region to achieve coverage of all SMC-eligible regions in Ghana [3].

Facility-based case management

In 2019, Ghana’s National Malaria Control Program (NMCP) updated malaria treatment guidelines to better align with WHO malaria treatment recommendations. Severe malaria cases are referred from the community level to health centers and hospitals where patients receive injectable artesunate and supportive therapy. [1]

Integrated Community Case Management (iCCM) and Community Health Planning and Services (CHPS)

The iCCM strategy corresponds to the lowest level of health care delivery in the country and is implemented via community-based agents (CBAs) selected by the community.[4]

iCCM has been integrated into the Community Health Planning and Services (CHPS) strategy. The government plans to expand coverage from 4,400 functional CHPS zones to 6,548 by 2020 (DHIMS Analysis).[4]

A major component of the CHPS strategy is that traditional community leaders must accept the concept and commit to supporting it.[1] Malaria treatment is included in the Community Health Planning Services.[1] Services provided by accredited CHPS are free for those having an active national insurance card.[1]

Health funding

As of 2017, less than 25% of the country’s spending on health was from national resources.[5] In accordance with its vision of “Ghana Beyond Aid”, the government aims to procure all malaria commodities with local funding.[1] It also plans to procure all its ACTs without international funding (donor support), beginning in 2020.[1]

The government also made a commitment to universal health coverage when it passed the law to establish the National Health Insurance Scheme (NHIS) at the end of 2003.[5] As of 2017, the NHIS covered 45% of Ghana’s population. All necessary malaria services and medicines are covered at no cost to NHIS members.[1]

Severe malaria policy and practice

National treatment guidelines
Recommendation Treatment
Strong IV artesunate
Alternative IM artemether
Alternative IV quinine
Recommendation Pre-referral
Strong Rectal artesunate
Alternative IM artesunate
Alternative IM quinine
Alternative IM artemether
Malaria in pregnancy
Trimester Treatment
First IV or slow IM quinine
First alternative IV or IM artesunate
Second/third IV or IM artesunate

*First trimester: Avoid delay of treatment; if only one of the drugs artesunate, artemether or quinine is available, then it should be started immediately.

 

Severe malaria commodity needs

Total artesunate injection needs – forecasts

  • 2021 – 849,604 vials
  • 2022 – 859,715 vials

Artesunate rectal capsules (ARC) needs (100mg)

  • 2021 – 16,797
  • 2022 – 16,997