Issue 9: January March, 2017 National Malaria Control Programme (NMCP) Box KB 493 Korle - Bu Accra Ghana Contents Page Editorial and Report Highlights 1 Malaria Burden 2 Key activities undertaken in First Quarter of 2017 2 Malaria Statistics 4 Indicator Definition 11 References 11 Editorial This is the 9th 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, highlight achievements and create awareness for increased resource mobilization and allocation in order to maintain the gains we have achieved. In this issue, we present DHIMS data, representing malaria burden, case management and coverage of malaria interventions for first quarter 2017. 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 GHS: Regional and District Directors of Health Services Policy Planning Monitoring and Evaluation Division (PPMED) 1 P a g e
Regional Malaria Focal Persons Partners (WHO, Global Fund, USAID/PMI, DFID, CDC, and Noguchi etc.) Malaria Burden In the quarter under review, the country recorded 2.3 million suspected malaria cases at the OPD. This represents a 1.18% increase over cases reported during the same period in 2016. Averagely, 24,885 suspected malaria cases were recorded daily. The number of malaria admissions reduced from 79,822 in 2016 to 69,467. The number of deaths also reduced from 379 to 143 in 2017. This represents a percentage decrease of 22.86% and 165.03% in admissions and deaths respectively. Out of the 143 malaria deaths recorded in 2017, 74 deaths occurred among children under5 years compared to 152 in2016. Malaria under five Case Fatality Rate (CFR) also decreased from 0.39 in 2016 to 0.22 in 2017. Key Activities Undertaken in the First Quarter of 2017 NMCP undertook the following activities in 2017 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 The unit participated in the Malaria Operational Plan (MOP) for the 2018 financial year. NMCP conducted 510,484home visits through CHPs within the period under review. SHOPS USAID in collaboration with NMCP coached 720 Over the Counter Medicine Sellers (OTCMS) attendance who purchased malaria RDTs from SHOPs on practical RDT principles and testing. The programme in collaboration with Institutional Care Division (ICD) oriented 30 Regional Malaria Lab OTSS Supervisors on proficiency Testing Scheme. Proficiency testing of medical laboratory scientists was conducted for 40 facilities nationwide. A survey on the availability and pricing of co-paid or green leaf ACTs was conducted in all the 10 regions. Integrated Vector Control Activities of the vector control unit within the period under review were mainly on planning for 2 P a g e
the 2017 Schools LLIN distribution campaign. The first ITN sub-committee meeting for the year was held in February 2017.Continuous distribution of LLINs in health facilities for Antenatal clinics (ANC) registrants and children 18 months and above due for measles 2 (two) continued in all regions. DHIMs data for the period under review showed that 128,540 LLINs were distributed in health facilities to ANC registrants and children 18 months and above given measles 2. Social and Behaviours Change Communication (SBCC) The Programme used mass media campaigns to advocate and intensify education on test, treat and track (T3); compliance, use and improve provider confidence in RDT, Intermittent preventive treatment in pregnancy (IPTp) and proper care and use of LLIN. A total number of 54 TV and 1,817 radio adverts were aired across the country in the quarter under review. In addition, 33 NGOs were funded to implement community sensitization in 9 regions, except Ashanti. Surveillance, Monitoring and Evaluation (SM&E) In the quarter under review, the SM&E unit organized three monthly data verification and validation exercise of routine data in all the 10 Regions. The programme populated a Principal Recipient (PR) dashboard for submission to Country Coordination Mechanism (CCM). Other activities undertaken include; preparation of annual statistics for the 2016 malaria report, participation in the Malaria Operational Plan (MOP) for the 2018 financial year, classification of DHIMS indicators, preparation of 2016 progress update and disbursement to The Global Fund (TGF), production of quarterly malaria bulletin (annual bulletin), participation in Malaria/RSSH Global Fund grant application, planning for Outreach Training and Supportive Supervision (OTSS) and Participated in the harmonization of DHIMS indicators organized by PPMED. Research The following research has either being conducted or is still ongoing; Malaria Indicator Survey, ATM Mortality Trend Analysis, Durability and viability studies on LifeNets (LLIN), Impact evaluation of BCC interventions among others. Finance and Administration 3 P a g e
As at the end of first quarter 2017, the programme had absorbed 91% 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 MARCH, 2017 Reporting Rates DHIMS2 reporting rate completeness on the monthly OPD morbidity form increased from 70.8% in the first quarter of 2016 to 80.5% in 2017.The Monthly Anti-Malaria reporting form also increased from 86.6% in2016 to 97.5% in 2017. Table 4: Number and Proportion of Malaria OPD Cases, Admissions and Deaths in Ghana, Jan Mar 2017 Indicator Number Reported Proportion Of Cases Attributable To Malaria OUT PATIENT DEPARTMENT (OPD) ADMISSION DEATHS Total OPD Cases 6,066,431 Suspected Malaria Cases 2,270,774 37.4 Tested Malaria Cases 1,904,183 83.9 Confirmed Malaria Cases 956,123 42.1 Pregnant Women 28,793 0.5 Total Admissions (All ages) 349,949 Malaria admissions (All ages) 69,467 19.9 Under 5 malaria admissions 33,402 48.1 Total deaths (All ages) 7,966 Total malaria deaths (All ages) 143 1.8 Under 5 malaria deaths 74 51.7 Under 5 Malaria CFR 0.22 MALARIA MORBIDITY AND MORTALITY 4 P a g e
Case Fatality Rate The country recorded a reduction in under-five CFR from 152 (0.39%) in the first quarter of 2016 to 74(0.22%) in 2017. This represents 105.4% reduction in malaria deaths. In the period under review, Brong Ahafo and East Regions recorded the highest under 5 malaria CFR of 0.41% and 0.54%respectively whilst Eastern Region had the lowest CFR of (0.04%). Figure 1. Figure 1: Malaria Case Fatality Rate for children under 5 years by Region, Jan - Mar 2016 &2017 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 Ashanti Brong Ahafo Central Eastern Greater Accra Northern East West Volta Western Ghana Jan - Mar 2016 0.16 0.21 0.47 0.26 0.32 0.68 0.12 0.69 0.52 0.32 0.39 Jan - Mar 2017 0.05 0.41 0.14 0.04 0.08 0.32 0.54 0.39 0.27 0.25 0.22 The country recorded a decrease in malaria CFR amongst persons above five years from 227 (0.55%) in the first quarter of 2016 to 69 (0.19%) in 2017.This represents a 228.9% reduction in malaria deaths. Northern Regions recorded the highest above five malaria CFR of 21(0.67%). Comparatively, there has been an improvement in case management in all the 10 Regions. East Region recorded the lowest malaria above five CFR of 0.06 with one (1) malaria deaths out of 1,787 malaria admissions. (Figure 2). 5 P a g e
Case Fatality Rate Figure 2: Malaria Case Fatality Rate for persons above five years by Region, Jan - Mar 2016 & 2017 1.20 1.00 0.80 0.60 0.40 0.20 0.00 Ashanti Brong Ahafo Central Eastern Greater Accra Northern East West Volta Western Ghana Jan - Mar 2016 0.35 0.76 0.73 0.21 0.30 0.74 0.93 0.93 1.12 0.21 0.55 Jan - Mar 2017 0.13 0.47 0.11 0.16 0.08 0.67 0.06 0.21 0.13 0.09 0.19 Table 2: Malaria Slide and Test Positivity Rates, All 30 Sentinel Sites, Jan - Mar 2016 &2017 Type of Test (All Ages) Number Period Slide & Test Positivity Rate Jan Mar 2016 Jan Mar 2017 Jan Mar 2016 Jan Mar 2017 Microscopy Tested 37,497 24,533 Positive 8,121 5,262 21.7 21.4 RDT Tested 35,804 61,968 Positive 7,365 13,305 20.6 21.5 The malaria slide positivity rate (percentage of positive malaria cases using microscopy), reduced from 21.7% in the first quarter of 2016 to21.4% in 2017. Test positivity rate using RDTs also increased from 20.6% in the first quarter of 2016 to 21.5% in2017. 6 P a g e
Number of cases For the period under review, the number of suspected malaria cases put on ACTs reduced from 1,206,237 in the first quarter of 2016 to 1,145,062 in 2017. This could be attributed to the improvement in adherence to the T3 policy. (Table 2) Figure 3: Number of Malaria Suspected Cases, Malaria Cases Tested, Malaria Cases Test Positive and Cases Put On ACTs in Ghana, Jan - Mar 2016 &2017 2,500,000 Jan - Mar 2016 Jan - Mar 2017 2,000,000 1,500,000 1,000,000 500,000 0 Uncomplicated Suspected malaria cases Tested Malaria cases Confirmed Malaria Cases Malaria cases treated with ACTs Jan - Mar 2016 2,243,950 1,689,532 853,031 1,206,237 Jan - Mar 2017 2,270,774 1,904,183 956,123 1,145,062 The country recorded an increase in malaria testing rate from 75.3% in the first quarter of 2016 to 83.9% in 2017. All the ten (10) Regions recorded an increase in testing compared to that of 2016. Brong Ahafo Region recorded the highest testing rate of 91.6% whilst Northern Region recorded the lowest rate of 64.7%. Refer to Figure 4. 7 P a g e
Proportion Figure 4: Testing Rate of all Health Facilities by Region, Jan - Mar 2016 &2017 100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Ashanti Brong Ahafo Central Eastern Greater Accra Northern East West Volta Western Ghana Jan - Mar 2016 68.6 77.9 78.6 79.0 76.8 57.1 84.3 54.8 78.1 81.7 75.3 Jan - Mar 2017 77.4 91.6 87.6 87.6 82.9 64.7 89.4 90.2 81.5 83.9 83.9 INTERMITTENT PREVENTIVE TREATMENT IN PREGNANCY (IPTp) There was a steady supply of Sulphadoxine Pyrimethamine (SP) for IPTp throughout the country in the first quarter of 2017. This had a positive impact on the uptake of IPTp. The proportion of IPTp 1 uptake increased from 62.1% to 66.5% in 2017.The country recorded an increase in all the stages of IPTp uptake (IPT 1 5) compared to that of last year. Refer to Figure 5. 8 P a g e
Proportion Figure 5: Proportion of Pregnant Women Taking IPT 1-5, Ghana, Jan - Mar 2016-2017 70.0 60.0 62.1 66.6 52.3 Jan - Mar 2016 Jan - Mar 2017 57.3 50.0 40.0 36.6 41.3 30.0 20.0 15.6 19.5 10.0 5.6 7.2 0.0 % IPTp 1 % IPTp 2 % IPTp 3 % IPTp 4 % IPTp 5 Period LONG LASTING INSECTICIDAL NETS (LLINs) Continuous distribution of LLINs for ANC registrants was carried out in all the 10 Regions. The coverage of LLIN given to pregnant women increased from 22.9% in the first quarter of 2016 to 74.3% in 2017. Brong Ahafo Region had the highest coverage; 94.0% whiles Central Region recorded the lowest coverage of 51.1% (Figure 6). Figure 6: Proportion of ANC Registrants given LLIN by Region, Jan - Mar 2016 &2017 9 P a g e
Proportion Proportion 100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Ashanti Brong Ahafo Central Eastern Greater Accra Norther n East West Volta Western Ghana Jan - Mar 2016 14.0 35.2 7.5 12.9 15.1 41.7 80.7 28.2 24.8 15.2 22.9 Jan - Mar 2017 56.7 94.6 51.7 85.1 73.6 74.4 88.2 79.8 85.4 83.4 74.3 LLIN coverage for children due for measles 2 Child Welfare Clinic (CWC) increased from 36.8% in 2016 to 80.2% in 2017. In the quarter under review, all the 10 Regions recorded an increase over that of 2016. West Region had the highest coverage with94.2% whilst Ashanti Region recorded the least coverage; 61.5% (Figure 7). Figure 7: Proportion of under five children given LLIN through CWC by Region, Jan - Mar 2016 &2017 100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 Ashanti Brong Ahafo Central Eastern Greater Accra Norther n East West Volta Wester n Jan - Mar 2016 20.9 47.8 12.0 19.6 47.2 58.9 90.3 39.7 43.0 31.0 36.8 Jan - Mar 2017 61.5 90.4 66.7 92.8 86.1 68.2 91.3 94.2 90.9 86.7 80.2 Ghana 10 P a g e
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 tests 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 REFERENCES GHS. District Health Information Management System II. Ghana Health Service, Ghana, Jan Mar, 2017. GHS.NMCP NMCP Surveillance data, Ghana, Jan Mar, 2017. GHS.NMCP - PSM Malaria drugs and commodities stock level, Ghana, Jan Mar, 2017. 11 P a g e
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