Reductions in malaria cases have stalled after several years of decline globally, according to the new World malaria report 2018.
To get the reduction in malaria deaths and disease back on track, World Health Organisation, WHO and partners are joining a new country-led response, launched today, to scale up prevention and treatment, and increased investment, to protect vulnerable people from the deadly disease.
For the second consecutive year, the annual report produced by WHO reveals a plateauing in numbers of people affected by malaria: in 2017, there were an estimated 219 million cases of malaria, compared to 217 million the year before. But in the years prior, the number of people contracting malaria globally had been steadily falling, from 239 million in 2010 to 214 million in 2015.
“Nobody should die from malaria. But the world faces a new reality: as progress stagnates, we are at risk of squandering years of toil, investment and success in reducing the number of people suffering from the disease,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
“We recognise we have to do something different – now. So today we are launching a country-focused and -led plan to take comprehensive action against malaria by making our work more effective where it counts most – at local level.”
In 2017, approximately 70% of all malaria cases (151 million) and deaths (274 000) were concentrated in 11 countries: 10 in Africa (Burkina Faso, Cameroon, Democratic Republic of the Congo, Ghana, Mali, Mozambique, Niger, Nigeria, Uganda and United Republic of Tanzania) and India. There were 3.5 million more malaria cases reported in these 10 African countries in 2017 compared to the previous year, while India, however, showed progress in reducing its disease burden.
Despite marginal increases in recent years in the distribution and use of insecticide-treated bed nets in sub-Saharan Africa – the primary tool for preventing malaria – the report highlights major coverage gaps. In 2017, an estimated half of at-risk people in Africa did not sleep under a treated net. Also, fewer homes are being protected by indoor residual spraying than before, and access to preventive therapies that protect pregnant women and children from malaria remains too low.
In line with WHO’s strategic vision to scale up activities to protect people’s health, the new country-driven “High burden to high impact” response plan has been launched to support nations with most malaria cases and deaths. The response follows a call made by Dr Tedros at the World Health Assembly in May 2018 for an aggressive new approach to jump-start progress against malaria. It is based on four pillars:
Catalyzed by WHO and the RBM Partnership to End Malaria, “High burden to high impact” builds on the principle that no one should die from a disease that can be easily prevented and diagnosed, and that is entirely curable with available treatments.
“There is no standing still with malaria. The latest World malaria report shows that further progress is not inevitable and that business as usual is no longer an option,” said Dr Kesete Admasu, CEO of the RBM Partnership. “The new country-led response will jumpstart aggressive new malaria control efforts in the highest burden countries and will be crucial to get back on track with fighting one of the most pressing health challenges we face.”
Targets set by the WHO Global technical strategy for malaria 2016–2030 to reduce malaria case incidence and death rates by at least 40% by 2020 are not on track to being met.
The report highlights some positive progress. The number of countries nearing elimination continues to grow (46 in 2017 compared to 37 in 2010). Meanwhile in China and El Salvador, where malaria had long been endemic, no local transmission of malaria was reported in 2017, proof that intensive, country-led control efforts can succeed in reducing the risk people face from the disease.
In 2018, WHO certified Paraguay as malaria free, the first country in the Americas to receive this status in 45 years. Three other countries – Algeria, Argentina and Uzbekistan – have requested official malaria-free certification from WHO.
India – a country that represents 4% of the global malaria burden – recorded a 24% reduction in cases in 2017 compared to 2016. Also in Rwanda, 436 000 fewer cases were recorded in 2017 compared to 2016. Ethiopia and Pakistan both reported marked decreases of more than
240 000 in the same period.
“When countries prioritize action on malaria, we see the results in lives saved and cases reduced,” says Dr Matshidiso Moeti, WHO Regional Director for Africa. “WHO and global malaria control partners will continue striving to help governments, especially those with the highest burden, scale up the response to malaria.”
As reductions in malaria cases and deaths slow, funding for the global response has also shown a levelling off, with US$ 3.1 billion made available for control and elimination programmes in 2017 including US$ 900 million (28%) from governments of malaria endemic countries. The United States of America remains the largest single international donor, contributing US$ 1.2 billion (39%) in 2017.
To meet the 2030 targets of the global malaria strategy, malaria investments should reach at least US$6.6 billion annually by 2020 – more than double the amount available today.
Ghanaian entrepreneurs are making fortunes, selling sachet soup, known as “Shito’’ at the ongoing Lagos International Trade Fair.
A News correspondent at the fair reports that many women were seen on Wednesday besieging the Ghana stand at the fair, to buy Shito, packaged in 500 grammes and selling for N1, 000 per sachet.
Queuing to buy the soup, a banker, Mrs Tessy Imagoro, said the already made soup had saved her from having to be making soup after her daily office work on the Lagos Island.
“The soup in sachet saves time for me from going to the kitchen to make soup after my busy schedule daily. I like this innovation,’’ she said.
Her colleague, Mrs Taiye Odu, described the soup as creative, saying that she had never seen that kind of innovation before.
“I am buying the soup because I see others buying it. Since it can be kept in freezer and microwaved later, I think it can save a lot time.
A business woman, Mrs Nneka Williams, said she bought the soup out of curiosity and that she planned to start making a similar delicacy to deliver to Nigerians, who might be interested in such delicacies.
“The idea looks good. I want to look at the possibility of introducing it to a larger segment of the Nigerian consumer market,’’ she said.
The Ghanaian maker of the soup, Mr David Amoah, said that the soup was patronized mostly by corporate women, whom she said, hardly found time to go to the kitchen after their daily chores.
“The sachet soup is moving more than I anticipated. I never knew that Nigerian women would be so interested in Ghana soup.
“The soup is already cooked with ingredients and there is no need to cook it any longer. It can be eaten hot or cold,’’ Amoah said.
The soup is packaged in red sachets with description of its contents as pepper, tomato, onion, fish, crayfish and sauce.
Source: Premium Times
Student protests in Ghana resulted in the temporary closure of the Kwame Nkrumah University of Science and Technology. The cause: police use of force in the arrest of students following a vigil to protest the possibility of all-male halls becoming mixed.
The Conversation Africa’s Moina Spooner spoke to Justice Tankebe about Ghana’s police service, and their use of force.
Does Ghana have a professional police force? What is their reputation? Is it justified?
To say a police service is professional is to claim that there’s a code of ethics that governs them, there are credible structures of accountability and that these ensure their integrity in delivering a certain quality of service to the public. These features remain undeveloped in Ghana’s police force.
The police’s reputation is it intimidates, is violent, corrupt and that it treats civilians unfairly. Earlier this year there were reports of police officers brutalising citizens without provocation. This included a video of a woman and her toddler being beaten in Accra. Police are also accused of being trigger-happy. In one incident police killed seven young men that they claimed were robbers.
This type of violence happens for a couple of reasons. I conducted two studies of Ghanaian police officers. The first showed that most police officers supported the use of force for a range of reasons. Including; they didn’t have strong bonds with the service and the rules about when and how to use force don’t have legitimacy in their eyes, so they disregard them. This lack of legitimacy was put down to the fact that there are high levels of corruption in the police force.
My second study revealed that officers were treated badly by their supervisors. The result is that officers take their frustrations out on civilians and that the supervisors lose credibility in encouraging good behaviour. Improving police treatment of civilians therefore requires paying attention to the moral climate within police departments in Ghana.
To address the problems there needs to be a proper diagnosis. This isn’t being done. Ghana’s police managers believe the issues can be traced to problems with individual rogue officers. For example, the national police chief, Asante Appeatu, said that:
we must fire the bad apples because they are dangerous.
But the problems facing Ghana’s police are systemic. There are conditions within the police service – like poor supervision, poor training, and unfair treatment of lower-ranked officers – that make misconduct more likely to happen. Focusing on individual officers diverts attention from these conditions and it also means police managers can avoid responsibility for the problems.
How does it compare to other countries in the region?
There’s no systematic tracking of police violence in the region which makes country comparisons impossible. My own work has focused on Ghana and, as Director of the African Institute of Crime, Policy and Governance Research, I have started to collate cases of police violence in Ghana. With time this will be extended to other countries so that a solid basis for comparison can be made.
Is the government taking steps to address police violence?
Rhetoric about curbing police violence haven’t been matched by concrete action or strategy. The government’s approach is reactive, responding to public pressure to investigate instances of police violence. There are no efforts to delve into the broader issues and to develop national standards.
If this type of impunity persists, the rule of law loses credibility and police become part of the problem rather than the solution. Unless government takes steps to address police violence, the situation is bound to worsen.
There are a few things that can be done.
Firstly, there needs to be independent and credible oversight institutions that can investigate serious cases of police violence and other forms of misconduct. For instance in England and Wales, the independent office for police conduct investigates misconduct by individual officers while the inspectorates of criminal justice regularly inspects police forces with the aim of improving policing and ensuring public safety. Ghana needs similar institutional arrangements.
Ghana’s police also need to develop a strategy for dealing with public disorder. This should guide the training of officers on how best to handle public order so that they can manage situations, like the one at the Kwame Nkrumah University of Science and Technology campus, discretely. It was clear from the way the police behaved that they reacted impulsively, escalating tensions. Policy direction and regular training will help avert unnecessary violence.
Thirdly, part of the problem with the police in Ghana is that they confuse legality with legitimacy. They believe that just because their orders are lawful, they are legitimate and deserve public compliance. This mindset means they pay only lip-service to the hard work of understanding and engaging with local communities, taking complaints seriously, improving treatment of civilians, and holding officers to account.
Finally, police legitimacy needs to be part of a strategy. Unless police officers command legitimacy –- that is, they are perceived to be effective, to act lawfully, and to treat civilians fairly –- violence will remain a stable feature of their interactions with civilians. The strategy should involve training which puts more emphasis on building better relationships with civilians through fair treatment – explaining decisions, listening to civilians, being respectful, trustworthy, and being impartial. It could also involve investing in equipment – like body-worn cameras by officers – to track and capture data on interactions with civilians. These significantly reduce the use of force by police.
Ghana has a serious flood problem. Over about 50 years, 4 million people have been affected by floods, resulting in economic damage exceeding USD$780 million. At least one major flood disaster has occurred every year over the past 10 years.
Floods are not uncommon in West Africa. Rainfall variability and land use changes have made them increasingly common throughout the region.
In Ghana’s urban areas, like Accra and Kumasi, floods are mostly triggered by seasonal rainfall combined with poor drainage, the dumping of waste into waterways and the low elevation of settlements. In northern Ghana, some floods are caused by spillage from a dam in Burkina Faso.
The problem is Ghana’s government currently reacts to the floods using coping strategies. These don’t deal with the underlying risks, are expensive and don’t consider that floods will get worse. The government must take steps towards more proactive flood risk management.
After every flood, the country’s national disaster management organisation – along with the military, police, and other emergency personnel – is deployed for rescue and emergency relief.
The government then repairs damaged infrastructure, clears waterways and demolishes properties built close to drainage channels.
These coping strategies will get more costly because the flood risk is set to get worse. The amount of rainfall classified as “heavy” is projected to increase between 2010 and 2050, with the wet seasons projected to get wetter and the dry seasons drier.
This will be felt intensely in the urban areas as populations continue to grow. Already, about 40% of Accra is classified as “highly prone” to flooding. This will increase as, due to more building, less water will drain into the soil.
The case for flood risk adaptation
The government needs to make the country more resilient and able to withstand the challenges posed by intense and frequent floods.
The government has also taken on projects to protect against floods, but these are focused on the coastal areas. For example the Keta sea defence project.
The current greater Accra Metropolitan Area sanitation and water project is constructing drains and culverts in Accra. But this isn’t a major part of the project.
Much more needs to be done. Ghana must fully transition from coping strategies, to proactive, long-term measures. These include:
Structural flood protection measures – like storm drains or levees. These need to be constructed to protect all at risk areas, and not just the coastal areas
Improve early warning systems to ensure timely flood risk alerts. This should include; a 24 hour monitoring and warning service during peak rain seasons and an education program to help communities understand the risk, respect the warnings and know how to respond
Social protection – like affordable social housing – which will move more people out of informal settlements built in flood prone zones
Encourage households to adapt and advise on actions they can take, like using more water resistant building materials
Restore lagoons and rivers
Proper waste management. Ghana has a huge solid waste problem. Poor disposal of solid waste often leads to the blocking of drains and drainage systems, preventing flood waters from flowing through
Moving homes and businesses out of flood prone locations. They can choose to do this, or the government can facilitate it by buying out at-risk properties
Build new homes on elevated ground or foundations
Strict planning to avoid construction in flood-prone areas
Deal with spillage from dams by building canals that channel the water. These can be dammed and the water used for irrigation.
The initial cost of adaptation measures will be expensive, but it will pay off. Research shows that for every US$1 spent on flood risk reduction, it saves at least US$4 to US$9 otherwise spent in an emergency response when disaster occurs. The Netherlands is a classic example of a country that has taken flood risk adaptation seriously. A quarter of the country is below sea level and 60% of its people in flood-risk areas but the measures it has taken have reduced the likelihood of major flooding.
Ghana can take advantage of predictions and past experiences of floods to aggressively pursue flood risk adaptation. Failure to do this will increase flood disasters, and social and economic disruptions.
Jerry Chati Tasantab, PhD Candidate, School of Architecture and Built Environment, University of Newcastle; Jason von Meding, Senior Lecturer in Disaster Risk Reduction, University of Newcastle; Kim Maund, Head of Discipline-Construction Management, University of Newcastle, and Thayaparan Gajendran, Associate professor, University of Newcastle
The use of non-biomedical methods to treat mental disorders in developing countries, like Ghana, has long been acknowledged. The World Health Organisation (WHO) estimates that about 80% of people who need mental health care in developing countries go to indigenous or faith healers for care.
Some studies have been done to explain the popular use of non-biomedical health care alternatives, and various reasons have been suggested. These include an alignment of the illness beliefs of patients and healers, easier or more flexible accessibility, and cost.
But many of these studies of non-biomedical health care systems in Africa tend to assess the healers as one homogeneous group of practitioners. In our study, we argued that different types of healers may hold different worldviews. These in turn influence how they conceptualise or think about different disorders.
We conducted interviews with 36 participants from four different categories of non-biomedical healers in Ghana’s capital Accra. The categories of healers were herbalists, Pentecostal Christian faith healers, traditional medicine men (also called shrine priests) and Muslim clerics/healers.
Using case vignettes, we examined the healers’ notions about three different types of mental disorders – schizophrenia, depression and post-traumatic stress disorder (PTSD). We examined their ideas about the nature and perceived effects of the different disorders, as well as their thoughts on the causes.
Understanding the different beliefs about different disorders is important in efforts to improve mental health care in developing countries. In particular, with increased calls for collaboration between biomedical and non-biomedical health care systems, it’s important to understand how the different groups of healers think about different conditions.
Different views on different conditions
Our data suggest that indigenous and faith healers’ views on psychotic illness were similar to biomedical notions. But they held different views on depression and PTSD. These views were fluid, and obviously influenced the choice of treatments they offered patients.
All the healers readily identified the case vignette of schizophrenia as an example of mental disorder. This was often described as “madness” by the healers. Some local names that the healers used included “abɔdam”, “εdam” and “sεkε”. These names are often used to describe people whose behaviour is perceived as disruptive, disorganised or overtly dysfunctional.
Although the participants believed spiritual factors like witchcraft and curses could cause such a condition, they were also aware that certain physiological processes (such as traumatic brain injury) as well as abuse of drugs and alcohol could account for it. They all considered it to be a severe condition which required urgent intervention.
So for this psychotic disorder there weren’t major differences in the views of the various categories of healers, and their views were similar to biomedical understanding of psychotic disorders.
But this wasn’t the case for all the disorders.
For example, most of the healers were quite firm in their views that post-traumatic stress disorder was not a mental disorder. Rather, they considered it to be a normal reaction to a traumatic experience. The healers thus endorsed more psychosocial explanations for PTSD.
Depending on their orientation, they described different causes for the symptoms of PTSD. For example, pastors, described PTSD as being due to the presence of a “spirit of fear”. Some herbalists also believed the symptoms were physiological manifestations of “thinking too much”.
Given these different notions of cause, their recommended treatments also varied. However, all the participants emphasised the need for some form of counselling. In most cases, the healers believed that PTSD could develop into full-blown “madness” (ie disruptive/psychotic behaviours) if left untreated.
There was a great deal of difference between the healers when it came to depression. Most of the herbalists had physiological explanations for the symptoms and did not consider depression to be a mental disorder. For their part, the traditional medicine men viewed depression as a milder form of mental illness. Some pastors did identify the condition as depression, while the Muslim clerics saw it as potentially resulting from Jinn possession.
As expected, the recommended treatments were based on the identified cause. For instance, the herbalists mostly recommended treating the underlying physiological condition through herbal remedies. The pastors advocated biomedical care as well as spiritual interventions like prayer and fasting.
In many African countries traditional and faith healers are viewed as community leaders and their views are likely to reflect those of their patients. Consequently, biomedical professionals who treat patients who are also seeking help from indigenous and faith healers, would benefit from understanding the different beliefs about different disorders. This can then form an important part of clinical training and practice.
In addition to this, the healers’ positions of influence within their communities is a unique opportunity to enhance the reintegration and monitoring of patients once they return to their communities. Their influence can also play a key role in fostering patient behaviour change and treatment compliance, as well as eliminating stigma.
But this can be done only through appropriate collaboration with community-based healers. It can only work effectively if there’s an appreciation of the different views of different healers. Understanding this diversity of approach may be crucial in developing a framework for collaboration amongst different types of healers (including biomedical practitioners) to improve mental health care.