I would like to share here the findings of the Ghana Urban Malaria study presented last week at the National Malaria Program Review in Accra, which showed that there is a wide difference in the prevalence in malaria between urban and rural areas, and even among neighborhoods within cities. This research was critical because it helps us to dedicate scarce resources in the most effective way to address malaria, which is the leading cause of morbidity and mortality in Ghana today, and especially affects children under five.
The meeting was well attended by senior government health officials including the Minister of Health, the Director General of the Ghana Health Service and the Coordinator of the National Malaria Control Program.
Malaria policy in Ghana has long been shaped by routine health service data and national surveys that tend to show that malaria occurs evenly throughout the country. But public health experts had their doubts. So the U.S. President’s Malaria Initiative called for a study to determine the true burden of malaria in urban areas, and commissioned a JSI-led study.
One thing we knew was that malaria cases in Ghana are often diagnosed presumptively, based on the presence of fever. But this study has shown us that few of the children in Accra and Kumasi with fever tested positively for malaria. However, in some areas within the cities – those areas near urban agriculture and bodies of water where mosquitoes breed – the incidence of malaria was much higher. Also, poorer households were more likely to see malarial infection, possibly due to less frequent use of nets and other preventive measures.
We have learned from this research that malaria data reported by health facilities are not providing a reliable indicator of the burden of malaria. Resources to fight malaria are not necessarily going to the right places, while urban children with fever may not be getting proper treatment.
It was important to quickly explore this question and then share the results so that current programs could be modified, so we used triangulation methodology. Triangulation methodology is key to the success of this research because it is relatively easy to do quickly and will address questions that probably would take a longer time if another process was followed. The method involves reviewing, analyzing and synthesizing secondary data from a variety of sources. The wide range of sources helps validate results, increase credibility, and reduce bias. In this way, we were able to get more knowledge to the stakeholders so we could modify programs according to what the data shows.
We have made many recommendations as a result of this research and it is our genuine hope that these findings will be put into broad practice within the health care community, and that we can continue to educate both health care professionals and households in Accra and Kumasi.
Here are some of the critical recommendations that I would like to highlight:
- Educate health care professionals to perform malaria tests on all suspected cases, and modify current practices for diagnosis and treatment of fever to reflect the low prevalence of malaria in most city neighborhoods.
- Promote the use of insecticidal-treated nets by children and pregnant women.
- Ensure that community-based malaria control interventions are targeted to the poorest urban neighborhoods and to urban neighborhoods proven to have a higher burden of malaria.
- For health facilities in Ghana’s cities, records of malaria tests should capture information about the residence of the patient in order for us to expand our ability to identify neighborhoods with a higher than average malaria burden.