Malaria in Ghana
Ghana represents one of the most intense transmission countries in Africa.
2010 transmission data
- 0% of population lived in areas classified as low-stable endemicity (PfPR2-10 <1%)
- 13.3% of population lived in areas of traditional hypoendemic conditions (PfPR2-10 <10%)
- 40% of population lived in areas of mesoendemic transmission (PfPR2-10 10-49%)
- 30% of population lived in areas of hyperendemic transmission (PfPR2-10 50-74%)
- 16.6% of population lived in areas that continue to be classified as holoendemic transmission (PfPR2-10 ≥ 75%).
Making data available
During phase 1 , data was systematically collated and compiled from online electronic databases and unpublished archived survey reports. National scientists and international collaborators were approached and provided unpublished data.
The final database contained 368 temporally unique data points at 342 survey locations between 1982 and 2011. Of the 368 unique time-space survey locations identified through the data search, 300 (82%) were identified from unpublished sources including the 185 survey locations from the Malaria Indicator Cluster 2011 Survey; three (0.8%) were sourced from other unpublished reports and 65 (17%) were directly abstracted from journals.
Estimating malaria risk over space
Ghana is a country that supports intense Plasmodium falciparum transmission. In 2010, we predicted that 11.3 million people, 47% of the population, were living in areas where the parasite rate in children PfPR2-10 ≥50% , including four million people (17%) who lived in areas where PfPR2-10 >75%. These intense transmission conditions were most prevalent in the most northerly two-thirds of the country.
There are important transmission intensity differentials within the country. The 110 urban extents of Accra and neighbouring municipalities have considerably lower transmission compared to the rest of the country. The risks of infection are lower in Ghanaian cities compared to neighbouring rural areas [Pond et al., 2013]. The unique ecologies of urban extents for transmission offer opportunities for different vector control strategies and areas where parasitological diagnosis would be more cost-effective for case-management strategies. Just 10 large municipalities account for 6.4 million people who, while at much lower incident risks of malaria, will account for a significant number of infections.
There is an "island" of lower intensity parasite transmission, surrounded by a sea of intense transmission, at Kassena Nankana district in the Upper East Region, where sustained surveillance and intervention has been maintained over many years [Bawah & Binka, 2007].
A similar "island" of lower transmission is observed around Obuasi, where Indoor residual House Spraying (IRS) has been sustained since 2005. In both areas it is likely that an epidemiological transition is beginning to emerge. Other parts of Ghana are best described as mesoendemic (PfPR2-10 10-49%), affecting 9.6 million people, largely located in the east and south of the country. The 58 districts that supported mesoendemic transmission in 2010 are likely to experience a larger reduction in transmission intensity following scaled single approaches to vector control, such as insecticide-treated nets (ITNs), compared to higher transmission northern districts over the next five years. These spatial heterogeneities are important to recognise in the future design of control.
Engagement with decision-makers
In 2014 during Phase 1, an epidemiology and control profile of malaria was produced by a collaboration between KEMRI-Wellcome Research team, Ghana National Malaria Control Programme (NMCP) and regional and national academic/technical partners including: the University of Health and Allied Sciences, AngloGold Ashanti Malaria Control Program and the World Health Organization, country office.
As part of Phase 2, LINK has collated evidence from 553 published articles or MSc/PhD theses and eight implementation reports/policies.