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Issue 6: January - June 2016 National Malaria Control Programme (NMCP) Box KB 493│Korle - Bu│Accra│Ghana

Editorial

This is the 6th issue of the Ghana Malaria Control Programme Periodic Bulletin.

The aim of this bulletin is to inform all stakeholders on progress achieved and challenges encountered in malaria control in Ghana. Most importantly, it is to encourage use of this information at all levels in order to foster improvement of our efforts and to highlight achievements and create awareness for increased resource mobilization & allocation in order to maintain the gains we have achieved.

In this issue, we present HMIS data, representing malaria burden, case management and coverage of malaria interventions for the first half of 2016.

We would be pleased to receive comments from you regarding this publication, and we welcome

your contributions to subsequent issues.

Thank you. We hope this will inform decision making at all levels.

ACKNOWLEDGEMENT

Programme Manager and staff of NMCP

PPMED

GHS, Regional and District Directors of Health Services

Partners (WHO, Global Fund, USAID/PMI, DFID, CDC and Noguchi etc.)

Contents Page

Editorial and Report Highlights Page 1

Malaria Burden Page 2

Key Activities undertaken in the first half year 2016 Page 2

Malaria Statistics Page 6

Indicator Definition Page 12 References Page 13

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Malaria Burden

In the first half of the year 2016, the country recorded 4,940,270 suspected cases of malaria.

Thus on the average, approximately 26,922 suspected cases of malaria were recorded daily in the

country’s health facilities during the period. During the semester under review, deaths attributed

to malaria by clinicians in the health facilities were 685. Out of these malaria attributable deaths,

290 occurred among children under-5 years in 2016 compared to 385 in 2015.There is therefore

a steady significant reduction in deaths attributable to malaria in the country.

Even though, suspected malaria cases increased by 6.9% as compared with the previous year,

admission and deaths attributed to malaria however decreased by 6.3% and 24.6% respectively.

Malaria under five case fatality rate also dropped from 0.44 in the first half of 2015 to 0.35 at the

end of the semester in 2016.

Key Activities undertaken in the First Half year 2016

In the first half of 2016, NMCP undertook the following activities to help achieve the targets set

for the year, with the ultimate aim of reducing malaria morbidity and mortality by 75% (using

2012 as baseline) by the year 2020.

Case Management

Case management training and clinical outreach training and supportive supervision OTSS were

conducted in five regions (Ashanti, Brong Ahafo, Eastern, Upper East and Upper West region)

with a total of 11,083 health staff trained. Trainer of Trainers (TOT) was conducted for eighteen

regional coordinators of Ghana Registered Midwives Association (GRMA). Case management

refresher training was carried out for 5,781 health workers in Greater Accra, Northern, Volta and

Western region in collaboration with Systems for Health, a USAID supported project. The

NMCP coordinated case management training for health staff and Pharmacy Auxiliary staff,

during sentinel site review meetings and Strengthening Health Outcome through the Private

Sector (SHOPs) training.

Malaria In pregnancy

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The Malaria in pregnancy (MIP) working group meetings held two within the period and carried

out monitoring and supportive supervisory visits to 307 facilities implementing IPTp but are not

reporting in DHIMS. Desk review on barriers and determinants of IPTp uptake in Ghana was

done and issues of concurrent administration of 5mg folic acid and SP was tackled. Integrated

Community Case Management has been integrated into Community Health Planning Services

(CHPS) system. At the end of the period 538,311 home visits have conducted across the country.

Plans were put in place to ensure availability of SP which was out of stock during the first

quarter of the year.

Malaria Diagnostics

In the first half of 2016, the National Guidelines for Laboratory Diagnosis (NGLD) on Malaria

was finalised. Also during the same period NMCP and partners develop a Malaria Diagnostic

Quality Assurance (MDQA) manual for stakeholders’ review.

The Program trained 410 Laboratory scientists from public, private and quasi health facilities on

malaria diagnostics. NMCP also monitored the supply and use of RDT in 106 private facilities;

24 Pharmacies, 57 Over the Counter Medicine Sellers (OTCMS) and 25 Private Clinics /

hospitals. The programme also trained 342 Pharmacy Auxiliary staff in Eastern, Volta, Central,

Brong Ahafo, Ashanti, Greater Accra regions on malaria diagnostic.

Integrated Vector Control

Under vector control, NMCP continued the distribution of LLIN in the country using multiple

channels. Point mass distribution of LLIN was conducted in Upper East and Northern Regions.

A total number of 695,061 out of 712,300 LLINs allocated and 1,762,811 out of 1,814,467

LLINs allocated were distributed in the two (2) regions respectively. This represents 98% and

97% coverage of LLINs distributed in the two regions respectively. A total of 936,357 out of the

targeted 1,014,300 LLINs were distributed to children in public and private basic schools in 6

regions; Ashanti, Brong Ahafo, Central, Western, Eastern and Volta regions representing 92.3%

of the target group covered. A total number of 337,207 LLINs were also distributed through

Continuous Distribution (CD) at health facilities for pregnant women and children under five

years.

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Advocacy, Communication and Social Mobilization (ACSM)

NMCP staffs were involved in 41 Radio and Television discussions programme on selected

stations to sensitize the public on malaria control interventions in the first half of 2016. These

discussion programmes included news interviews and health programmes in both English and

local languages. Two press briefings were held to update the media on Malaria Control

interventions. We launched the LLIN point mass distribution campaign in Greater Accra during

the period.

The developed television and radio adverts on test, treat and track: compliance, use and improve

provider confidence in the use of RDTs and SP (TV adverts) have been translated into seven

local (Akan, Dagbani, Dagaare, Ewe, Ga, Gurini and Hausa) languages. On April 25th, people

across the country took part in different activities to mark the World Malaria Day.

The theme for 2016 World Malaria Day was ‘Invest in Malaria: End malaria for good’.

Research, Surveillance, Monitoring and Evaluation

The Surveillance, Monitoring and Evaluation Technical Working Group (SM&E TWG) held one

meeting during the period to discuss pertinent issues bothering data quality in the country. Public

and private supervisory visits were conducted in selected districts across the country. The

districts were selected based on their performance on IPT 3 coverage. A total of 380 facilities in

178 districts were visited. Activities for the first data quality assessment commenced towards the

end of the half year. Monthly validation of routine data reported through DHMIS was carried out

within the period. All 10 regions were also supported to conduct quarterly data reviews with the

focus on completion of consulting room register and timely reporting of monthly data. Sentinel

site visits were also conducted in all 30 sites. As part of the visits, on the job coaching was

provided for lab personnel as well as data management staff in the facilities. Reported malaria

deaths were verified and those found not to be due to malaria were changed and reports updated

accordingly. Other research activities and finalization of the report on the impact of seasonal

malaria chemo-prevention were some of the key activities under Research, Surveillance,

Monitoring and Evaluation for the first half of 2016.

Procurement Supply Chain Management (PSM)

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The NMCP received anecdotal reports on decreasing demand for ACTs and the growing

preference for Artemether Lumefantrine (AL) to Artesunate Amodiaquine (ASAQ). These were

also observed in the monthly stock reports from the regions. Based on these observations, the

programme revised the respective proportions of ASAQ to AL for both adults and children and

subsequently revised the shipment plan for 2016.Some shipments originally scheduled to be

delivered in 2016 were reschedule to 2017 to avoid overstocking.

In the period under review, the following commodities were received in country, the USAID

RDTs were received at the end of March and was not captured in the first quarter report, it has

been captured in the current report,

Table 1: Malaria Drugs and commodities stock level, Jan – Jun 2016

DESCRIPTION QUANTITY DATE RECEIVED

SOURCE OF FUNDING

mRDTs 3,093,450 11/2/2016 DFID 2,096,925 31/03/2016 USAID/PSM

Injection Artesunate 60 mg/vial 248, 014 21/04/2016 The Global Fund 524,415 13/05/2016 USAID/PSM

Artemether Lumefantrine 20/120 mg 24’s 1,520,640 3/5/2016 The Global Fund

AL 24’s 747720 27/05/2016 USAID/PSM 949,800 17/04/2016 USAID/PSM

Rectal Artesunate 50mg 3,612 12/1/2016 USAID/PMI/Deliver

Sulpadoxine Pyrimethamine 25/500 mg 9,000,000 tablets

3/6/2016 USAID/PSM

Artemether lumefantrine 20/120 mg 24s (adults) 223,020 25/01/2016 USAID/PMI/Deliver

Artemether Lumefantrine 20/120 mg 6’s 199,800 17/04/2016 USAID/PSM

LLINs 2,124,210 4/02-11/03/2016

The Global Fund

Source: NMCP PSM, August, 2016

Resource Mobilization/Private Sector Partnership (RM)

As part of efforts to generate domestic funds for malaria control, the NMCP Resource

Mobilization Working Group under the Malaria Inter-Agency Coordinating Committee (MICC)

in collaboration with Stakeholders has developed a Resource Mobilization Plan to guide the

generation of domestic resources. As part of the plan, Ghana malaria foundation has been

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registered to drive domestic financing to support Malaria control interventions. A private sector

board of trustees has been identified and would be inaugurated in October, 2016.

Finance and Administration

As at the end of June 2016, the programme has absorbed 71% of total funds released. A huge

proportion of this disbursement was for procurement of commodities (RDTs and ACTs including

private sector co - payment).

MALARIA STATISTICS FOR JANUARY – JUNE 2016

Reporting Rates

Generally, reporting rates on the DHIMS 2 platform has improved. OPD Morbidity’s reporting

form recorded an increase in data completeness from 86.8% in the first half of 2015 to 97.9% in

2016; whilst the Monthly Anti-malaria reporting form also increased from 84.1% in the first half

of 2015 to 97.3% in 2016.

Table 2: Number and Proportion of Malaria OPD Cases, Admissions and Deaths in Ghana, Jan – Jun 2016

INDICATOR NUMBER REPORTED

PROPORTION CASES ATTRIBUTABLE TO MALARIA

Out Patient Department (OPD)

Total OPD Cases 13,373,577 Suspected Malaria Cases 4,940,270 36.9%

Confirmed Malaria Cases 2,029,162 41.1%

ADMISSION

Total Admissions (All Facilities)

748,218

Malaria admissions 175,304 23.4%

Under 5 malaria admissions 81,962 46.8%

DEATHS

Total deaths (All ages) 15,792 Total malaria deaths (All ages)

685 4.3%

Under 5 malaria deaths 290 42.3% UNDER 5 MALARIA CASE FATALITY RATE

0.35

Source: DHIMS, 22nd August 2016

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MALARIA MORBIDITY AND MORTALITY

The country recorded a reduction in under-five malaria deaths from 385 in the first half of 2015

to 290 in 2016, representing a case fatality rate of 0.35. In 2016, Northern region recorded the

highest case fatality rate of 0.57%, even though it recorded an 8% reduction in malaria deaths

from 108 malaria deaths in the first half of 2015 to 94 in 2016. Upper West Region also had a

case fatality rate of 0.51% which is the second highest in the country within the same reporting

period whilst Ashanti Region recorded the lowest case fatality rate of 0.16% with 30 malaria

deaths (Figure 1).

Figure 1: Under-five Malaria Deaths, by Region, Jan - Jun 2016

As shown in Figure 2, the country recorded a decrease in malaria case fatality rate amongst

persons above five years from 523 malaria deaths in the first half of 2015 to 395 representing a

case fatality rate of 0.54 and 0.42 respectively. In 2016, Upper East and Upper West regions

recorded the highest above five malaria case fatality rates of 0.95% and 0.94 respectively.

Comparatively, there has been an improvement in case management in Upper East and Central

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region in the first half of 2016. Eastern Region recorded the lowest malaria under-five case

fatality rate of 0.21 with 20 malaria deaths out of 9,593 malaria admissions.

Figure 2: Number of Malaria deaths for above five years by Region, Jan - Jun 2016

Table 3: Malaria Slide and Test Positivity Rates, All 30 Sentinel Sites, Jan - Jun

2015 - 2016

Type of Test (All Ages) Number Period

Slide/Test Positivity Rate

2015 2016 2015 2016

Microscopy

Tested 45,029 67,338

30.2 21.4

Positive 13,588 14,386

RDT

Tested 89,499 90,460

27.0 25.3

Positive 24,126 22,926

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The malaria slide positivity rate (percentage of positive malaria cases using microscopy),

decreased from 30.2% in the first half of 2015 to 21.4% in 2016. Test positivity rate using RDTs

also decreased from 27.0% in the first half of 2015 to 25.3% in 2016.

For the period under review, the number of suspected malaria cases put on ACTs reduced from

2,760,652 in the first half of 2015 to 2,651,216 in 2016. This could be attributed to the

improvement in adherence to test result. Despite this reduction, malaria cases treated with ACTs

were more than confirmed malaria cases. (Figure 3).

Figure 3: Number of Malaria Suspected Cases, Malaria Cases Tested, Test Positive and Cases Put On Acts in Ghana, Jan - Jun 2015 - 2016

The country recorded an increase in malaria testing rate from 70.7% in the first half of 2015 to

77.2% in 2016. All the regions with the exception of Upper East and Upper West Regions

recorded an increase in testing rate. (Figure 4).

4,620,574

4,940,270

3,268,448

3,812,692

1,814,440

2,029,162

2760652

2,651,216

0 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 6,000,000

Suspected malaria cases 2015

Suspected malaria cases 2016

Malaria cases tested  2015

Malaria cases tested  2016

Malaria cases test Positive 2015

Malaria cases test Positive 2016

OPD attendants treated with ACTs  2015

OPD attendants treated with ACTs  2016

OPD Attendants

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Figure 4: Testing Rate of all Health Facilities by Region, Jan - Jun 2015 - 2016

INTERMITTENT PREVENTIVE TREATMENT IN PREGNANCY (IPTp)

In the first quarter of the period under review, there was a massive stock-out of Sulfadoxine

Pyrimethamine (SP) for IPTp throughout the country. This affected the uptake of IPTp

tremendously. There was a decrease in the proportion of ANC registrants that took IPTp 1 from

71.0% in the half of 2015 to 59.7% in 2016. IPTp 3 uptake also decreased from 41.7% in 2015 to

35.7% in 2016. However there was a slight increase in IPTp 5 uptake from 4.9% in the half year

of 2015 to 6.5% in 2016 (Figure 5). This is probably due to the increasing acceptance of the

change in policy from 3 doses to 5 doses by pregnant women.

70.7

77.2

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Ashanti Brong Ahafo Central Eastern GreaterAccra

Northern Upper East Upper West Volta Western Ghana

Testing Rates

Region

Testing Rate 2015 Testing Rate 2016

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Figure 5: Proportion of Pregnant Women Taking IPT 1-5, Ghana, Jan - Jun 2015 - 2016

LONG LASTING INSECTICIDAL NETS (LLIN)

The Distribution of LLIN through the continuous distribution model in health facilities continued

within the period under review. LLIN coverage for pregnant women decreased from 29.1% in

the first half of 2015 to 27.5% in 2016. Upper East Region had the highest coverage 69.7% of

LLIN given to pregnant women; whilst Central Region recorded the lowest coverage of 7.0%

(Figure 6).

Figure 6: LLIN coverage for Pregnant Women through ANC by Region, Jan - Jun

2015 - 2016

IPT  1 2015  IPT 1 2016  IPT 2 2015  IPT 2 2016  IPT 3 2015  IPT 3  2016  IPT 4 2015  IPT 4 2016  IPT 5 2015  IPT 5 2016

Proportion 71.0 59.7 59.5 49.3 41.7 35.7 14.3 16.1 4.9 6.5

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

AshantiBrongAhafo

Central EasternGreaterAccra

Northern Upper EastUpperWest

Volta Western Ghana

2015 42.7 36.9 26.3 20.0 10.9 47.1 55.9 56.5 13.4 8.4 29.1

2016 11.9 46.8 7.0 31.6 14.9 41.7 69.7 20.4 35.2 34.2 27.5

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

LLIN coverage

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LLIN coverage for children due for measles 2 distributed through CWC also decreased from

53.1% in the first half of 2015 to 45.7% in 2016. In the first half of 2016, Upper East Region had

the highest coverage of 82.3%; whilst Central Region recorded the lowest coverage of 10.3%

(Figure 7).

Figure 7: LLIN coverage for Children under five years through CWC by Region, Jan - Jun

2015 - 2016

Source of data: DHIMS 2, 22nd August 2016

INDICATOR DEFINITIONS

Reporting completeness: Percentage of monthly reports received from health facilities in

relation to the number of monthly reports expected .

Malaria Case Fatality Rate: Proportion of deaths attributable to malaria out of all malaria

admissions.

Malaria slide positivity rate: percentage of total malaria microscopy positive test out of all

malaria microscopy test conducted.

Malaria Test positivity rate: percentage of total malaria RDT positive test out of all

malaria RDT test done.

Testing Rate: Proportion of suspected malaria cases that received a parasitological test at a

facility (RDT and microscopy).

IPTp1 – 5 coverage: Percentage of pregnant mothers who received appropriate dose of SP

AshantiBrongAhafo

Central EasternGreaterAccra

Northern Upper EastUpperWest

Volta Western Ghana

2015 74.2 52.6 55.0 35.0 38.3 68.3 77.5 79.8 38.8 29.9 53.1

2016 18.2 65.0 10.3 41.6 55.5 61.5 82.3 29.6 56.7 56.0 45.7

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

LLIN coverage

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REFERENCES

GHS. District Health Information Management System II . Ghana Health Service, Ghana, Half Year ,2016.

GHS.NMCP - PSM Malaria Drugs and commodities stock level, Ghana, Half Year, 2016