In the year 2018, “malaria afflicted 228 million people and killed an estimated 405 000, mostly in sub-Saharan Africa.” (WHO, 2019). In 2021, three years later, “there was an estimated 247 million cases of malaria worldwide. The estimated number of malaria deaths stood at 619 000 in 2021.” (WHO, 2022). “In 2021, WHO estimated that there were an estimated 5.3 million malaria cases with 12,500 estimated deaths recorded (Target Malaria, 2023). It is worrying to know that, worldwide, the COVID-19 pandemic has threatened the fight against malaria. Since its onset, the COVID-19 pandemic has successfully stolen all the attention and derailed efforts geared at preventing other diseases of public health importance.
The Mosquitoes of Ghana and their Impact.
There are three main types of mosquitoes found in Ghana. These are the Anopheles, Aedes and Culex mosquitoes. various species from these genera are spread around the country. Some of them transmit diseases of humans and animals. In recent times, cases of Yellow Fever have been recorded in Ghana. According to the WHO (2021), “From 15 October to 27 November 2021, 202 suspected cases of Yellow Fever (YF) including 70 confirmed cases and 35 deaths [Case Fatality Ratio (CFR): 17%] have been reported in four regions in Ghana (Savannah, Upper West, Bono and Oti regions).” The Yellow Fever Virus is transmitted by the Yellow Fever mosquitoes of the Aedes species (Aedes albopictus and Aedes aegypti).
Malaria, which is a very common disease in our part of the world, is transmitted in Ghana by mosquitoes of the Anopheles genus, including members of the Anopheles gambiae complex and the Anopheles funestus complex. The Anopheles coluzzii and Anopheles gambiae species are more common and they are very efficient transmitters of the malaria parasites.
The behaviour of the Anopheles mosquitoes makes them very fast spreaders of malaria. Firstly, they usually like biting people at night, when people are tired from work and about to sleep. When you switch off your light and you want to rest, that is when they start work, looking for who they can get to bite and suck some blood. It will interest you to know that it is only the female Anopheles mosquitoes that bite. Also, they do not bite to feed on your flesh but they pierce your skin with their modified proboscis and draw blood from your blood vessels. This bloodmeal assists the eggs of the mosquito to develop well. Two to three days after the blood meal, a female mosquito will usually look for a safe water body to lay its eggs. A single healthy female Anopheles mosquito can lay up to 200 eggs. Eggs hatch into larvae in a few days in the water and the larvae develop into pupae which then develop into adults and the cycle repeats itself.
Please let us do a little mathematics here: if a single female could lay up to 200 eggs, what happens if there are just 20 females in your locality who have been able to bite and take a bloodmeal, how many mosquitoes will you get in your neighbourhood within a month? Inestimable! That is one of the reasons the fight against malaria and mosquitoes has become so difficult. We literally breed mosquitoes through our daily activities without even knowing. The Anopheles mosquitoes in Ghana can breed in hoofprints of cattle, empty tins and cans, car tyre impressions made in the ground, rice farms, potholes and anywhere that water collects and stays.
Bad News? Discovery of Anopheles stephensi in Accra, Ghana
A few days ago, it was reported by the Ghana Health Service that a new mosquito species has been found in Ghana. The name of this mosquito is Anopheles stephensi and its discovery has sent panic waves across the country. This is a species that used to be found mainly in Asia and has started spreading around the world. It is known to spread very fast, relatively faster than the existing Anopheles mosquitoes that we have had in Ghana before now. However, the situation is not as hopeless as some think it is. Yes, it can transmit malaria parasites and will make our fight against malaria even harder. Yet, there is still hope.
Some of the challenges hindering our fight against mosquitoes and malaria in Ghana include, our attitude towards our environment. Environmental management of mosquitoes through habitat destruction and environmental cleanliness is effective to some extent. Wrongful use of insecticides has caused resistance in mosquitoes. That is why in recent times, even when you spray your room or sleep under treated mosquito nets, mosquitoes can still come and bite you.
In addition to the problem with mosquito control, we also have a problem with antimalarial drug resistance in the Plasmodium parasites. When we fail to follow the treatment prescribed by help care providers, or when we abuse antimalarial drugs by buying and taking them without a malaria test, we are only increasing resistance in the malaria parasites to the drugs. Resistance is the reason Chloroquine became ineffective and inefficacious against malaria.
Good news: Introduction of vaccines in Ghana
Fortunately, after many years of research, there has been the invention of a malaria vaccine that has been accepted for use in Ghana. “Ghana is the first country to approve a new malaria vaccine that has been described as a "world-changer" by the scientists who developed it. The vaccine called R21 - appears to be hugely effective, in stark contrast to previous ventures in the same field.” Gallagher (2023). “Ghana’s Food and Drugs Authority (FDA) has approved a malaria vaccine developed by the University of Oxford for use in children aged 5 months to 3 years.” (Mahase, 2023). In line with the observance of the World Malaria Day 2023 (celebrated on 25th April, 2023), "the Programme Manager of the National Malaria Elimination Programme, Dr Keziah Malm, said as of December 2022, a total of 1.4 million doses of the vaccine had been administered to eligible children with 459,446 children receiving at least one dose and 184,418 children completing all the four doses."This means children can get prophylaxis treatment against malaria.
The other good news is that, in addition to the introduction of vaccines, several interventions are being investigated and existing ones are being reinforced. New insecticides that comprise more than one class of insecticide are being introduced for use. In addition, malaria treatment is being done in recent times with combination therapies. Several research activities are ongoing in Ghana and around the world to find new ways of controlling mosquitoes including biological control techniques and genetic technologies.
Personal responsibility in preventing malaria
In addition, each of us has a personal responsibility to keep our environment clean, devoid of stagnant water bodies. We also have to observe and adhere to the instruction we receive during malaria treatment. Also, we should endeavour to raise barriers to prevent mosquitoes from having access to our rooms. The commonest barriers include trap doors and nets in windows, as well as insecticide-treated mosquito nets. It will also be very helpful for us to stay indoors at dusk and in the night. We can also kill mosquitoes one by one, especially when they land on our walls. We could use insect repellents every evening-they help. There are insecticidal paints on the Ghanaian market, we could add them to our control techniques by painting our walls with these paints. Finally, we should wear protective clothing and be intentional about protecting ourselves against mosquito bites.
The fight against mosquitoes and malaria calls for our collective efforts. Let us do our personal best.
The writer is a Biological Scientist (Entomologist) who lives in Accra.
References
Gallagher, J. (2023). Ghana first to approve 'world-changer' malaria vaccine. https://www.bbc.com/news/health-65252511
https://outbreaknewstoday.com/ghana-records-5-7-million-malaria-cases-in-2021/
https://www.who.int/emergencies/disease-outbreak-news/item/yellow-fever---ghana.
https://www.who.int/news-room/fact-sheets/detail/malaria
Mahase, E. (2021). Ghana approves Oxford’s malaria vaccine for children aged 5 to 36 months BMJ 381: p850 doi:10.1136/bmj.p850
WHO (2019). World malaria report 2019.
https://www.graphic.com.gh/news/health/world-malaria-day-ghana-on-course-to-achieving-elimination.html
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