Regional health threats

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The prevalence of malaria has escalated at an alarming rate in many parts of Africa during the last decade. Malaria is ranked the third most infectious disease threat after pneumococcal acute respiratory infections and tuberculosis. Of the 300 million people affected by malaria worldwide, there are between 1 million and 1.5 million deaths each year, with 85% of these being in Africa.

Those most seriously affected are children under the age of five and pregnant women. Inadequate health structures and poor socio-economic conditions are major factors contributing to the incidence of the disease, which is exacerbated by a growing resistance to drugs used to combat the parasites that cause the disease. Malaria, an infectious disease characterised by fever, shivering, joint pains and headaches, is caused by protozoan parasites of the genus Plasmodium (P.) and is transmitted to humans by the bite of an infected female anopheles mosquito. The P. falciparum parasite is the most widespread and dangerous of four parasite species, leading, as it can, to fatal cerebral malaria if untreated.

This type is prevalent in Ghana, where Bibiani mine is located. In an effort to reduce the incidence of malaria among its employees and their dependants, the mine embarked on an anti-malaria campaign two years ago. Measures implemented at the mine and at employee accommodation include:

• vector control: This comprises regular spraying of residential areas with insecticides; desilting of drains and water bodies; supplying insecticide-treated mosquito nets to employees and dependants at subsidised rates; and supplying mosquito repellents to night shift workers in exposed areas;
• education on malaria prevention: Education for employees takes place at regular ‘Tool Box Talk’ meetings and daily at the mine’s on-site clinic which is open to employees, dependants and private patients. Malaria prevention is also emphasised at the twice-weekly antenatal clinics held for expectant mothers; notable is the fact that in 2005 less than 5% of pregnant women reported to the clinic with malaria; and
• effective malaria management: All malaria cases are treated at the mine clinic. No malarial fatalities have been reported during the last three years at the clinic. Children under the age of five and pregnant women are prioritised. In line with the national treatment protocol, all pregnant women are placed on an anti-malaria prophylaxis.

Despite these efforts, however, the incidence of malaria has not declined, as one would have expected, but has conversely increased significantly. Between 2003 and 2005, the number of employees and contractors contracting malaria almost doubled, rising from 1,180 to 2,050; 522 work days were lost to malaria in 2005. Out of a total number of 11,506 cases presenting at the clinic in 2005, including employees, dependants and private patients, 4,430, or 38.5%, were diagnosed with malaria.

Bibiani mine is now undertaking a study to investigate why the incidence of malaria is on the increase. Headed by Dr Ernest Nagali from Bibiani mine clinic, the study team is attempting to find out how effective the vector control measures are at the mine and its residential areas, compared to the rest the town of Bibiani – the largest in the district with an estimated population of 45,000 – which was not included in the mine’s vector control programme.

The two-year long study, which commenced in June 2004, involves the collection of data from families living in certain areas of the town of Bibiani, where some employees reside, as well as employees and their families who live on mine premises, namely Old Administration Estates, Dan Owiredu Estates and Junior Village. At these venues, 131 housing units are available for families of employees, who have been allocated accommodation. When the study commenced, there was a total of 2,878 employees, dependants and contractors, but with downscaling of the operation, the current figure is 1,785 and it is expected to reduce further.

Because the housing address system in Bibiani is poor, the team has mapped out the area of study into 17 sections, and is cross-referencing malaria cases presenting at the clinic with the section from which each case originates. Once all the malaria cases and their corresponding sections have been ascertained, the team will then conduct interviews with affected families in an attempt to find out why some sections have a higher malaria incidence than others. Demographic data will be collected at this stage to ensure the study is as reliable as possible and also applicable in other regions where malaria is endemic.

Information being sought includes:

• the size of each respondent’s household; the number of times each was treated for malaria in the six months prior to the interview; and how many times each was infected;
• whether responders have acquired mosquito nets; if they have, and if they use them, how strict their adherence is; and
• what their basic knowledge of malaria prevention is – for example, whether they wear protective clothing in the evenings and whether they use mosquito repellents, like basic mosquito coils.

Expected to come out of the study is possible evidence that malaria prevention cannot be achieved with a homogenous ‘one size fits all’ approach but should perhaps rather be adapted to suit local conditions. The study’s findings and recommendations – which will look at practical solutions, taking into account prevailing socio-economic conditions and cultural practices – are anticipated to be released by August 2006 and will be presented to Bibiani mine, local health authorities and other interested parties. It is hoped the study will have relevance, not only for the Bibiani community but for the country at large, prompting a possible re-think on the way forward with regard to effective malaria control and prevention.