Malaria has declined clinically, says NMCP-Balla Kandeh

By Sarjo Camara-Singateh

Mr. Balla Kandeh, Programme Manager,NMCP

The Programme Manager of National Malaria Control Programme Mr. Balla Kandeh has given a situational analysis about the Gambia’s Malaria control strategy and effective indicators that reduce Gambia’s malaria burden.

In an interview with Mr. Kandeh in his office yesterday he indicated that The Gambia Malaria Indicator Survey (MIS), 2014 is  the  second  nationally  representative survey, which covered 5,200 households in 7 Health Regions of the country and  the main objective of The Gambia MIS 2014 was to measure progress towards achieving the goals and targets set in The Gambia National Malaria Control Strategic Plan (NMCSP) 2008-2015. “The specific objectives were to measure the coverage of household possession of nets (treated and LLINs), use of ITNs among under-five children and pregnant women, the prompt provision of anti-­ malarial treatment in the past two weeks among children age 6-59 months, the use of SP for IPT among pregnant women, in-door residual spraying, malaria and anaemia prevalence among children age 6-59 months, 5-14 years and pregnant women as well as to assess the knowledge and practice on malaria prevention and treatment at community level”.

He said it is noteworthy that both the MIS 2010/11 and 2014 were conducted in the peak malaria season (November to December) with huge sample sizes.  Thus, the results are comparable in time and space.

Mr. Kandeh noted that the MIS 2014 results compared to the MIS 2010/11showed significantly higher ITN usage among under-five children (24.2%), women aged 15-49 years (33.2%) and pregnant women aged 15-49 years (35.9%). However, net usage in the general population increased by only 3.6% whilst household possession of ITNs between MIS 2010/11 and MIS 2014 also increased by 6.2%.

He states that the overall malaria parasite prevalence declined from 4.0% in 2010/11 to 0.2% in 2014. He also cited the drop of Malaria and its related complications, that Malaria parasite prevalence in 2014 also declined significantly (> 90 %) in all the health regions. Anaemia prevalence (< 8g/dl) among children aged 6-59 months and among children aged 5-14 years declined by 58.5% and 79.8% respectively. Percentage of pregnant women aged 15-49 years who took 2+ doses of SP/Fansidar with at least one during an ANC visit increased by 17.9%.

Mr Kandeh remarked, “As was the case in the MIS 2010/11, knowledge on malaria among women aged 15-49 years is extremely high. About 98.9% heard of malaria. Seventy per cent got their source of information about malaria from the radio.  Other important sources of information about malaria were family and friends (49.2%) and health workers (46.3%). On the method of malaria prevention, 89% of women reported sleeping under a net (i.e.  any net) compared to 19.3% who mentioned sleeping under an ITN. Over 50% of women reported that the surroundings of the house should be clean to prevent malaria”

He said The Gambia is situated on the West Coast of Africa, almost surrounded by Senegal. It has a population of 1.9 million people, with women constituting 50.5% of the population (Provisional Census Report, 2013-Annex 1), he noted.  Gambia’s Human Development Index (HDI) value for 2012 was 0.439 and classified in the low human development category and occupies position 165 out of 187 countries and territories. Mr. Kandeh noted that the HDI value is below the average of 0.466 for countries in the low human development group and below the average of 0.475 for countries in Sub-Saharan Africa (Gambia HDR Report, 2013- Annex,2).

The NMCP programme manager said malaria is an important public health problem in The Gambia.  It is meso-endemic, with the whole population at risk of infection, he added. According to him, transmission is perennial but with marked seasonal variation and most cases (about 90%) occurring   in the later stages of the rainy season from September to December.  He noted, “The 2010 Malaria Indicator Survey (MIS) conducted in the peak malaria season showed that malaria prevalence   by microscopy among children less than five years was 4% across the country”.

He noted that however prevalence varies widely across regions of the country, with the Central River Region having the highest rates (about 10%), moderate prevalence rates of 4% occur in the Upper River Region, and the North Bank East Region having the lowest prevalence rates of only 0.5%.

“A nationwide community cross-sectional survey conducted during the peak malaria season in 2012 and using molecular methods found overall prevalence of P. falciparum infection was 16.0% with marked heterogeneity   between regions (4.3 to 36.8%)  and also between villages (1.6% to 49.1%).” However, a more recent MIS, 2014 shows an overall malaria parasite prevalence rate of 0.1% among under five year children across the country during the peak malaria season compared to 4% in 2010. (MIS 2014 Preliminary Report)”. He said Primary Health Care (PHC)’approach has made it possible for at least 85% of communities to be within 5kilometre radius within reach of a health care service provider (primary, secondary or tertiary).

He stated that the intervention has a wide approach “Physically challenged and destitute persons and children in orphanages are specifically targeted with various interventions including malaria services from the existing Global Fund Malaria grant, with additional support from the Department of Social Welfare and the SOS Children villages.  In the past, there were about 11,439 refugees (UNHCR 2015) 4 2015), mainly farmers, who have migrated from the Cassamance region of Senegal due the separatist war”.He remarked, “As part of the NFM process we have consulted UNHCR and representatives of these refugees who informed us that the refugees have been integrated into Gambian communities.  These refugees now have access to all health care services including malaria just like other members of the community.   Therefore, there is no segment of the population that has any physical barriers to accessing services from the minimum basic health care package (which includes malaria services) and these services are offered at no cost to the population”.