The Akan community of Ghana has a saying that if a child does not permit the mother to sleep, he or she will also not sleep. Guided perhaps by this saying, Ashaiman Municipal Health Directorate has declared war on malaria, which has been on the ascent in the densely populated urban community over the past decade.

Ashaiman municipality bursts at the seams with economic activity. The strategic location of the municipality to Ghana’s industrial centre gives it a special attraction to immigrants—and malaria.

Statistics from the health directorate indicates that between January and June this year,  43 percent of the 59,427 Out Patient Department attendance in the municipality, were down to malaria cases. “We have been recording increases in malaria cases in the municipality over the past decade,” says Patient Boni, the Principal Nursing Officer.

The number of malaria cases recorded at Ashaiman Health Centre rose from 9,123 between January and June last year to 9,174 in the same period this year, when they should have been reducing.  

Mrs Boni says the directorate is leaving nothing to chance to reduce the incidence of the disease in the area. Because of its location in the tropics, Sub-Saharan Africa hosts the deadly species of the plasmodium falciparum.

To check the spread of malaria in Ashaiman, the training co-ordinator of the health directorate says 120 categories of healthcare workers from both the private and public sectors are being re-trained and equipped with basic healthcare skills to effectively manage and control the disease from taking a further toll on the population. An estimated 217,717 people live in the area.

The municipality has been zoned into four sub-districts to ensure effective coverage. The dense nature of the population makes it easier for the health workers to gain access to the population. Under the home-based management of malaria programme, mothers are trained to identify the symptoms of illness for prompt treatment.

“Due to lack of education and ignorance, mothers are unable to identify signs and symptoms of disease and this takes a high toll of children,” says Mrs Boni. As part of the effort, insecticide treated bednets are made available at affordable prices.

The question is how effective this strategy will be in a multi-cultural society were the people are sharply split along social and cultural beliefs that underpin perceptions of how diseases occur.

According to Mrs Boni, some people believe the disease is caused by witchcraft while others feel that it is caused by too much exposure to the sun. “Because they associate the disease with witchcraft, they prefer to go to the prayer camp,” she says. “Only when the situation deteriorates and they experience a lot of complications do they come to the health institution.”

Ghana changed to amodiaquine for the treatment of uncomplicated malaria in 2005. This followed empirical evidence of resistance of mosquitos to the disease. Dr Constance Plange-Rhule, the Programme Manager of Ghana’s Malaria Control Programme, advises those suffering from malaria to complete the full dose to avoid resistance.

The Ashaiman Municipal Health Directorate has taken the first—and right—step to rid the people of malaria, considering the fact that the area is host to a huge labour force for Ghana’s industrial and economic development.

Malaria has become not only a health problem but a developmental one too. The disease is the leading cause of work days lost due to illness in Ghana, thereby contributing more to potential income loss than any other disease. One study found that economically active persons lost nine work days per episode with males losing more time off than females, according to the Ghana Malaria Advocacy Guide 2007.