Malaria

Ghana sees falling malaria burden, targets elimination

One of three countries that began rolling out the world’s first malaria vaccine in 2019, Ghana aims to eliminate the parasitic scourge. Francis Kokutse spoke to health leaders to establish exactly what that means.

22 March 2024
5 min read
by Francis Kokutse
Republish this article

Disclaimer

If you would like to republish this article, please follow these steps: use the HTML below; do not edit the text; include the author’s byline; credit VaccinesWork as the original source; and include the page view counter script.
<article> <h1> <span>Ghana sees falling malaria burden, targets elimination</span> </h1> <div><p>One of three countries that began rolling out the world’s first malaria vaccine in 2019, Ghana aims to eliminate the parasitic scourge. Francis Kokutse spoke to health leaders to establish exactly what that means.</p></div> <ul> <li> <b>22 March 2024</b> </li> <li> <b class="me-2">by</b> <span> <a href="https://www.gavi.org/vaccineswork/authors/francis-kokutse" hreflang="en">Francis Kokutse</a> </span> </li> </ul> <div> <div> <div> <div> <div> <p> </p><p>When Eugene Andoh was told that the National Malaria Elimination Programme (NMEP) had set in motion a plan to eliminate malaria in the country, he beamed, made the sign of the cross and declared, "This must be a big news to me. It is something that I have always prayed for.</p><p>"I lost my twin brother to malaria when we were just over a year old. I have seen pictures of the two of us and there are times I missed him a lot," Andoh explained.</p><blockquote><h2>Confirmed malaria cases per 1,000 people dropped from 192 in 2019 – the year Ghana began rolling out the world’s first malaria vaccine as part of the three-country pilot programme – to 159 just a year later.</h2></blockquote><p>Growing up, malaria made him "paranoid" he said, and throughout his life he has taken every available precaution to avoid it. "But growing up at Takoradi, there was no way that I could avoid it." Takoradi, a harbour city in Ghana's Western Region, is malaria-endemic. "I can only be thankful to God that something is being done about it," he added.</p><h3>Setting high targets for success</h3><p>In 2022, Ghana recorded over 5.2 million confirmed cases of malaria, with 151 malaria-associated deaths, according to the NMEP's <a href="https://mesamalaria.org/resource-hub/national-malaria-elimination-strategic-plan-nmesp-of-ghana-2024-2028/">strategic plan</a> document.</p><p>That's already a staggering improvement from 2012, when Ghana recorded 2,799 malaria deaths. There are other signs that Ghana is on the right track: the countrywide prevalence rate – which measures the total number of cases divided by the total population – declined from 27.5% in 2011, to 8.6% in 2022.</p><p>Confirmed malaria cases per 1,000 people dropped from 192 in 2019 – the year Ghana began rolling out the <a href="https://www.gavi.org/vaccineswork/malaria-vaccine-vaccineswork-guide">world's first malaria vaccine</a> as part of the three-country pilot programme – to 159 just a year later.</p><p>But under the new strategic plan, the NMEP is aiming high, targeting a reduction in malaria mortality of 90% by the year 2028, using 2022 as the baseline. They also plan to reduce malaria case incidence by 50% by 2028 and eliminate malaria in the 21 districts considered to have a very low malaria burden by 2028.</p><p>However, Dr Keziah Malm, Programme Manager of the NMEP, told <em>VaccinesWork</em> that the strategy's target does not amount to "a full-nationwide elimination. Rather, we have zoned the country into areas with very low, and low and high malaria [rates]. We are doing this in stages, and so we call it a sub-national elimination," she explained.</p><p>"We will continue to do all we have been doing as a country to fight malaria. In addition, for the areas that we have marked as 'very low' and 'low', we will carry out surveillance on the parasite," Dr Malm said, adding that the organisation has added two districts with very high malaria burdens to surveillance plans for 2024.</p><p>The NMEP also intends to put in place seasonal malaria screening in areas including Upper East, Upper West, Northern Savana, and Oti. The screening activities were intended to be carried out for a period of four months in the high transmission season, but due to extended rains, the screening has been extended by a further month.</p><h3>Rolling out the elimination programme</h3><p>The elimination programme is being implemented side by side with the introduction of malaria vaccination for children. Ghana, along with Malawi and Kenya, is part of the <a href="https://www.gavi.org/vaccineswork/mvip-update-1-million-doses-administered-kenya-1st-anniversary-cooperation-vaccine">Malaria Vaccine Implementation Programme</a> (MVIP), which kicked off here in May 2019.</p><div><h4>Have you read?</h4><ul><li><a href="https://www.gavi.org/vaccineswork/malaria-vaccine-reduces-under-five-mortality-severe-disease-episodes-malawi" hreflang="en">Malawi health workers report drop in malaria cases following vaccine intro</a></li><li><a href="https://www.gavi.org/vaccineswork/five-innovations-could-help-eliminate-malaria" hreflang="en">Five innovations that could help to eliminate malaria</a></li><li><a href="https://www.gavi.org/vaccineswork/two-vaccines-one-target-how-rtss-and-r21-malaria-vaccines-work" hreflang="en">Two vaccines, one target: How the RTS,S and R21 malaria vaccines work</a></li></ul></div><p>John Bawa, Chief of Party of the global health organisation PATH, which is working with the NMEP, said, "The malaria vaccine is currently deployed in seven out of the 16 regions, covering all 93 districts located in these regions. The regions are Central, Volta, Oti, Upper East, Ahafo, Bono and Bono East regions."</p><p>Bawa said Ghana started has rolled out the revolutionary jab, commonly known as <a href="https://www.malariavaccine.org/malaria-and-vaccines/rtss">RTS,S</a>, in a phased manner, and has, to date, deployed over 1 million doses. Each child receives four doses of the vaccine, beginning at six months of age.</p><p>Dr Kwame Amponsa-Achiano, Programme Manager of the <a href="https://ghs.gov.gh/expanded-programme-on-immunization-epi/">Expanded Programme on Immunization</a>, part of the Ghana Health Service (GHS), said that in 2023, "We were able to reach a lot of children with malaria vaccines in regions such as Central and Bono East, with RTS,S-1 coverage rate of 101,029 children, representing 87%, and 44,663 children representing 92% respectively. At the district level reach, majority of the children were vaccinated in Awutu Senya East – 11,293 children, representing 98%. [In] Gomoa East, 10,684 children, representing 87%, and Atebubu-Amanten, 5,622 children representing 95%."</p><blockquote><h2>"In Ghana, under five-mortality due to malaria is generally on a decreasing trend across the vaccinating districts since 2019. Similarly, under-five malaria admissions have seen reductions in the [vaccine] implementing regions, especially in Bono and Central regions. This is within the context of other malaria elimination interventions that are concurrently being deployed such as bed-net use, and seasonal malaria chemoprevention."</h2><h6>– Dr Kwame Amponsa-Achiano, Programme Manager of the Expanded Programme on Immunization</h6></blockquote><p>Dr Amponsa-Achiano confirmed that the vaccination is showing impact already. "The vaccination has contributed towards the reduction of all-cause mortality among eligible children by 13%, [with a] 22% reduction in hospitalised severe malaria cases, and 17% reduction in hospitalisation with positive malaria test in the pilot countries (Ghana, Malawi, and Kenya).</p><p>"In Ghana, under five-mortality due to malaria is generally on a decreasing trend across the vaccinating districts since 2019. Similarly, under-five malaria admissions have seen reductions in the [vaccine] implementing regions, especially in Bono and Central regions. This is within the context of other malaria elimination interventions that are concurrently being deployed such as bed-net use, and seasonal malaria chemoprevention," he added.</p><p>As all these efforts continue, basic issues threaten to hobble transformative progress. Professor Tsiri Agbenyega, head of the Malaria Research Group of the Kwame Nkrumah University of Science and Technology (KNUST), said, "We are not going to eradicate malaria unless we solve our water and sanitation problems."</p><p>Meanwhile, the elimination strategy itself depends on available resources, according to Dr Malm. The NMEP will be asking their partners including USAID for support, she said. They will also be appealing to the private sector to help the programme.</p> </div> </div> </div> </div> </div> <p> <a target="_blank" rel="noopener noreferrer" href="https://www.gavi.org/vaccineswork/ghana-sees-falling-malaria-burden-targets-elimination">Original article</a> </p><p>This article was originally published on <a target="_blank" rel="noopener noreferrer" href="https://www.gavi.org/vaccineswork">VaccinesWork</a> </p><script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-M7H54VD');</script><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-M7H54VD" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript></article>

Malaria vaccination and control exercises in Buduburam in the Gomoa East District of Ghana. Credit: The Global Fund/Nana Kofi Acquah

When Eugene Andoh was told that the National Malaria Elimination Programme (NMEP) had set in motion a plan to eliminate malaria in the country, he beamed, made the sign of the cross and declared, "This must be a big news to me. It is something that I have always prayed for.

"I lost my twin brother to malaria when we were just over a year old. I have seen pictures of the two of us and there are times I missed him a lot," Andoh explained.

Confirmed malaria cases per 1,000 people dropped from 192 in 2019 – the year Ghana began rolling out the world’s first malaria vaccine as part of the three-country pilot programme – to 159 just a year later.

Growing up, malaria made him "paranoid" he said, and throughout his life he has taken every available precaution to avoid it. "But growing up at Takoradi, there was no way that I could avoid it." Takoradi, a harbour city in Ghana's Western Region, is malaria-endemic. "I can only be thankful to God that something is being done about it," he added.

Setting high targets for success

In 2022, Ghana recorded over 5.2 million confirmed cases of malaria, with 151 malaria-associated deaths, according to the NMEP's strategic plan document.

That's already a staggering improvement from 2012, when Ghana recorded 2,799 malaria deaths. There are other signs that Ghana is on the right track: the countrywide prevalence rate – which measures the total number of cases divided by the total population – declined from 27.5% in 2011, to 8.6% in 2022.

Confirmed malaria cases per 1,000 people dropped from 192 in 2019 – the year Ghana began rolling out the world's first malaria vaccine as part of the three-country pilot programme – to 159 just a year later.

But under the new strategic plan, the NMEP is aiming high, targeting a reduction in malaria mortality of 90% by the year 2028, using 2022 as the baseline. They also plan to reduce malaria case incidence by 50% by 2028 and eliminate malaria in the 21 districts considered to have a very low malaria burden by 2028.

However, Dr Keziah Malm, Programme Manager of the NMEP, told VaccinesWork that the strategy's target does not amount to "a full-nationwide elimination. Rather, we have zoned the country into areas with very low, and low and high malaria [rates]. We are doing this in stages, and so we call it a sub-national elimination," she explained.

"We will continue to do all we have been doing as a country to fight malaria. In addition, for the areas that we have marked as 'very low' and 'low', we will carry out surveillance on the parasite," Dr Malm said, adding that the organisation has added two districts with very high malaria burdens to surveillance plans for 2024.

The NMEP also intends to put in place seasonal malaria screening in areas including Upper East, Upper West, Northern Savana, and Oti. The screening activities were intended to be carried out for a period of four months in the high transmission season, but due to extended rains, the screening has been extended by a further month.

Rolling out the elimination programme

The elimination programme is being implemented side by side with the introduction of malaria vaccination for children. Ghana, along with Malawi and Kenya, is part of the Malaria Vaccine Implementation Programme (MVIP), which kicked off here in May 2019.

Have you read?

John Bawa, Chief of Party of the global health organisation PATH, which is working with the NMEP, said, "The malaria vaccine is currently deployed in seven out of the 16 regions, covering all 93 districts located in these regions. The regions are Central, Volta, Oti, Upper East, Ahafo, Bono and Bono East regions."

Bawa said Ghana started has rolled out the revolutionary jab, commonly known as RTS,S, in a phased manner, and has, to date, deployed over 1 million doses. Each child receives four doses of the vaccine, beginning at six months of age.

Dr Kwame Amponsa-Achiano, Programme Manager of the Expanded Programme on Immunization, part of the Ghana Health Service (GHS), said that in 2023, "We were able to reach a lot of children with malaria vaccines in regions such as Central and Bono East, with RTS,S-1 coverage rate of 101,029 children, representing 87%, and 44,663 children representing 92% respectively. At the district level reach, majority of the children were vaccinated in Awutu Senya East – 11,293 children, representing 98%. [In] Gomoa East, 10,684 children, representing 87%, and Atebubu-Amanten, 5,622 children representing 95%."

"In Ghana, under five-mortality due to malaria is generally on a decreasing trend across the vaccinating districts since 2019. Similarly, under-five malaria admissions have seen reductions in the [vaccine] implementing regions, especially in Bono and Central regions. This is within the context of other malaria elimination interventions that are concurrently being deployed such as bed-net use, and seasonal malaria chemoprevention."
– Dr Kwame Amponsa-Achiano, Programme Manager of the Expanded Programme on Immunization

Dr Amponsa-Achiano confirmed that the vaccination is showing impact already. "The vaccination has contributed towards the reduction of all-cause mortality among eligible children by 13%, [with a] 22% reduction in hospitalised severe malaria cases, and 17% reduction in hospitalisation with positive malaria test in the pilot countries (Ghana, Malawi, and Kenya).

"In Ghana, under five-mortality due to malaria is generally on a decreasing trend across the vaccinating districts since 2019. Similarly, under-five malaria admissions have seen reductions in the [vaccine] implementing regions, especially in Bono and Central regions. This is within the context of other malaria elimination interventions that are concurrently being deployed such as bed-net use, and seasonal malaria chemoprevention," he added.

As all these efforts continue, basic issues threaten to hobble transformative progress. Professor Tsiri Agbenyega, head of the Malaria Research Group of the Kwame Nkrumah University of Science and Technology (KNUST), said, "We are not going to eradicate malaria unless we solve our water and sanitation problems."

Meanwhile, the elimination strategy itself depends on available resources, according to Dr Malm. The NMEP will be asking their partners including USAID for support, she said. They will also be appealing to the private sector to help the programme.