Rachel Kakraba
Residents of Tuba in the Ga South Municipality and Dansoman within the Ablekuma West Municipal Assembly, in the Greater Accra Region, are calling for massive sensitization on the new mosquito vector Anopheles Stephensi, recently confirmed in the two communities.
This they said is to prevent a surge in malaria cases in the area and the country at large. The Ghana Health Service on April 15 confirmed the presence of the Anopheles Stephensi in Tuba and Dansoman, after Routine Malaria Surveillance System and Vector Control Monitoring at designated sentinel sites.
GBC news visited the two communities to find out the awareness level of residents and efforts at ensuring their safety. The residents appealed to the Ghana Health Service and the National Malaria Elimination Programme as well as other stakeholders in health to prioritize malaria interventions which focus on the two communities. This they said is to ensure the presence of the Anopheles Stephensi does not derail Ghana’s efforts at malaria elimination.
Statistics of Malaria
There are about 3,500 mosquito species, some of which do not bite or spread malaria. Up until March 2023, only Anopheles Gambie SL was responsible for transmitting malaria in Ghana. Malaria is an infectious disease, caused by parasites (Plasmodium). In 2021, there were an estimated 247 million cases of malaria worldwide with 619 000 deaths. According to the World Health Organization, the African Region carries a disproportionately high share of the global malaria burden accounting for 95% of all malaria cases and 96% death. Children under five accounted for 79% of malaria deaths in the African region. Malaria Prevalence in Ghana, according to the Ghana Health Service, reduced from 27.5% in 2011 to 8.6% in 2022. That notwithstanding, the World Malaria Report, 2022, indicates Ghana significantly contributes to malaria cases globally. It is against this backdrop that confirmation of the Anopheles Stephensi in the country becomes worrying.
About Anopheles Stephensi
The Anopheles Stephensi is a unique vector known to breed in a myriad of sources such as ponds, swamps, marches and other man-made containers. It practically can breed in almost all water sources, some of which are not the traditional breeding sites of common Anopheles species, particularly in urban areas. The vector also survives in extremely high temperatures during the dry season when malaria transmission usually declines. It is known to spread fast and adapt to different climatic conditions posing challenges to its control. It is therefore anticipated that it could put an additional 126 million people in urban areas at risk of malaria. In an interview, a Researcher in Vector and Parasite Biology and Epidemiology, the University of Ghana Medical School, Prof. Yaw Afranie, gave background to the research carried out at 15 sentinel sites in the Greater Accra region which confirmed the presence of the Anopheles Stephensi in Dansoman and Tuba.
“In Accra, we decided to focus on Opeibea, Dzorwulu and Tuba. We also choose sites that have lower socio-economic indicators, so this may be called a slum. So we chose Nima, Chokor and New Fadama. We also chose middle-class sites, including Madina, Dansoman and Teshie. Places where people have somewhat higher socio-economic background, including East Legon Cantonments and Tantra Hill. We also wanted to see what happens just outside the city, before we get into the rural areas, that is the peri-urban sites. And we chose sites that are just outside of Accra, including Medie, on the way to Nsawam. Oyarifa on the way to Aburi and East Legon Hills is after Adjirigano. These sites we chose them because we think the green habitat in those sites will be different from one place to another, that will affect the number of mosquitoes that will be in those sites”
A visit to Tuba
Tuba is located in the Ga South Municipality of the Greater Accra Region, it is one of the communities where the presence of the Anopheles Stephensi has been confirmed. Tuba which is translated to mean “unless you baptize” is predominantly a Muslim Community. Founded by Muslims, oral history has it that to reside in the area in the olden days, one had to mandatorily convert to Islam, if they were not Muslims already. It is a farming community, where the majority of residents engage in farming and other menial activities. What is the awareness level of residents in order to remain safe?
Nana Trader,“I have heard about it on the radio. They said they are at Tuba and Dansoman and they are very deadly. I don’t know what it looks like. I believe they found their way here because of the unsanitary conditions we live in. I am certain it is the same unsanitary conditions that have brought them to Dansoman.
A student Beatrice Nti said “I heard it three days ago that it kills instantly. Tuba is a town, but somehow looks like a slum in some areas. There is filth all around, choked gutters, no dustbins.
Auntie Akosua, a second-hand dealer said “I’m hearing about it for the first time from you. But I want to ask what this new mosquito looks like? how would you be able to differentiate between the new and the old? so I know what to do after a bite. I think we are exposed to filth because we don’t have any appropriate place to dump refuse, there are also no dustbins which makes people to dump refuse indiscriminately, I believe it is part of the reasons these mosquitoes have found their way here”
Another resident said “Mosquitoes have recently become a nuisance in this area, but it is still the old ones that we are familiar with.
Hajia, trader “No I have not heard about it. The gutters are choked so mosquitoes can breed inside.
Sheriff, Plumber, I’m not aware about that, if it’s not you I wouldn’t have known anything about that. Tuba community sometimes how they throw their garbage into the bushes it can cause that, because of how they make their gutters and other things”
Concerns over Weija Irrigation Dam and other issues
The Weija Irrigation Dam is constructed over River Densu, it is a multipurpose Dam, in which a 7.4-kilometer stretch of canal transports water from the river to the storage reservoir in Tuba. The Dam is used to supply all-year-round water to vegetable farmers at the Tuba irrigation farm. The reservoir, according to some residents, could be a reason the Anopheles Stephensi is in the area. For some others it is an appeal for dustbins and Larviciding as sanitary conditions in the community are in a poor state.
Humu a student “There is a lot of refuse in the dam. Where they have blocked the refuse from entering inside they have removed it, so refuse are now entering inside”
Sheriff, the dam has been here for many years, and the dam is sometimes clean because some people use it to bathe, wash and drink. So I don’t think that will cause that thing.
Julie food vendor “We would have to get Insecticide to spray our rooms to keep us protected. If you have a mosquito coil too it can be used. We also don’t have dustbins and will plead if we can be provided”
Sherifa student “They placed measures such as sleeping under mosquito nets, and keeping a clean environment. We need dustbins and maybe we can organize clean-up exercises to clear choked gutters”
Auntie Akosua second-hand dealer “We would appreciate it if we can be provided with a mosquito net to protect us from these mosquitoes. That is very dear to us. Or if we can be provided with spray for our rooms and workplaces it will go a long way to help us”
Another resident said “It will be a good initiative if we can be provided with dustbins. I say so because the lack of dustbins in the community makes people dispose of refuse indiscriminately. Having well designated landfill site in the community can contain breeding of mosquitoes in the community”
Take of AssemblyMan
Tuba falls under the Gedan Tuba Municipal Assembly, AssemblyMan for the area, Narteh Dawud Kweitsu, is equally worried about the situation which for him is not surprising.
“ I was told by our community doctor that this is the case. I said ok this is not surprising because the farm there you will see stagnant water. You will see running water all the time. When it rains too we have some drains that you see water all over. By all means it can produce mosquitoes.
On whether there has been enough sensitization on the Anopheles Stephensi, he said “no! no! because the people coming, you see them only hunting for mosquitoes.
On the dam contributing to breeding of the Anopheles Stephensi, he said “Mosquitoes they don’t like clean water, they like dirty water. So I don’t think that is part of it. They pump it today and it goes to the farm. They pump another one”
Mr. Kweitsu believes the development is one that must be of National Concern. He, therefore, appealed for the intervention of the government in order to contain breeding. “It will require the government to do a massive spray, within the community, and within our river bodies, the gutters and the drains wherever they will find that there is stagnant water. Without doing that it can spread. They can go to the farm area spray everywhere with the chemical that they believe can kill such mosquitoes”
To further interrogate the concern with the Dam, a supervisor at the facility was contacted, speaking on condition of anonymity he downplayed the suggestions. He believes insanitary conditions residents live in is what could be the cause.
“the Dam is always clean, there is no mosquito around, we have been using it bathing and washing with it there’s nothing, we are safe here. They should always make their areas clean, tidy the place, clear all the waters”
Asked about possibilities of Larviciding the Dam, he said it can be possible only if right processes are followed through to ensure safety of the consuming public.
“we use it for the farm so if any chemicals go inside this water, it will affect the people in the town, because they are taking this water, washing bowls, washing their things. Whatever they are doing in the house they use this water. We have tomatoes, peppers and others. Right now we have corn, so if we have any chemicals polluting this water then it affect the whole nation, because that is the water we are using”
Experts take on the Tuba Irrigation Dam
On whether the Irrigation Dam in Tuba has in anyway contributed to the presence of the Anopheles Stephensi in the community, Researcher in Vector and Parasite Biology and Epidemiology, University of Ghana Medical School, Prof. Yaw Afrane discounted such a notion. He said Stephensi is not only targeting Dansoman and Tuba.
“it is not that they will only live at Tuba, now they have been found in Tuba, but the next time, they may be on their way to Cape Coast because they fly. I don’t think that they are only targeting only a few places.
A visit to Dansoman
The next community was Dansoman. Which is an urban area. Here are thoughts of residents.
Regina, – Businesswoman “I have heard there’s a new breed of mosquito in this area, Dansoman. Personally, what I’m doing to keep safe is sleeping in a mosquito net and also spraying my room before I go to bed.
David student “I know the female Anopheles mosquito, I don’t know about the Stephensi, it’s new to me. If enough education has been done I’m sure I would have known about it. Because most of the time, I’m always on the internet. The Ghana Health Service has not done much about it. The Ministry of Health should have advertised or done more publicity about this mosquito breed. Mosquitoes are located usually in bushy areas, marshy areas, and unkempt or unclean environments. If there are new breeds then it means the township is becoming dirty. It could also be evolution because they are also adapting to the chemicals we are using”.
Emmanuel Nkansah “I have to be Frank with you. I have not heard that and I just got it from you, so I have to take it that I have heard it. The gutters are choked if it hadn’t been the rain, you could have seen a whole lot of mess. If we don’t clean the environment that is the problem that we gonna face”
Nii- pensioner “No!! I have not heard about it. Some people keep the environment clean, while others also do just the opposite. We must therefore be united in a bid to keep the environment clean”
Auntie Lizzy a Grocery seller, “I have not heard about the new mosquito. What I heard was rather about rats and the fact that if you step on its urine you can get disease. This new mosquito is therefore news to me and I will try and protect myself. We have not done anything to attract the mosquitoes. If you take a look at our gutters they are clean. We hardly litter around. If there is anything smelly it has to be the salted fish I sell here, but even that its sweet, so there is no way the mosquito can be here”
Auntie Lizzy maintains “we will not allow it to be here. We will continue to clean the vicinity so forget about it, there is no way it can be here”
Just like residents in Tuba, worried residents of Dansoman also have some recommendations.
Regina Entrepreneur “The Ghana Health Service is not doing much education about this. They should go round or, maybe do TV or radio adverts for people to know that there is a new breed of mosquito in Dansoman. They should bring in more mosquito nets so that people can come around and share for everyone so we could be safe”.
David Student “The MP Hon. Ursula Owusu should be aware of this and she should use her power to do more outreach, communication. The polyclinic is here, there are a lot of schools in Dansoman that they can pass these messages across.
Emmanuel Nkansah “ we have to cover the water that we drink, because they breed in the waters. The Assembly must also spray the areas for us, I think that will help.
Impact of Anopheles Stephensi in Ghana’s malaria elimination Drive
What does the confirmation of the Anopheles Stephensi means in Ghana’s healthcare system? Senior Research Fellow, Department of Parasitology Dr. Samuel Kwaku Dadzie, believes it is a development that has seen an update of the country’s Vector control guidelines.
“We actually don’t know how widespread the species is in Ghana. The two samples that were found are enough to let us sit up and say what do we do? And what’s the implication for us if the species becomes widespread?
Dr. Dadzie said “There is already vector surveillance happening in Ghana across different sites. So what we now have to do is to enhance surveillance protocols to enhance Anopheles Stephensi mosquitoes especially because their behaviour is slightly different from what we know. Vector control guidelines currently are also being updated to include Anopheles Stephensi.
National Malaria Elimination Programme
The outbreak of the Anopheles Stephensi unfortunately comes at a time Ghana is ramping up efforts at malaria elimination. Leading this agenda is the National Malaria Elimination Programme. Programme Manager Dr. Kezia Malm, said vector control activities around the country have been further enhanced in these two communities. She has a word of advice for Ghanaians
“We at the national level are focused on solutions, so we urge everybody else to be focused on solutions. We are in Tuba we are in Dansoman, we are in the rest of the country to give the information”
Adding on she said “to the communities please the onus lies on you to behave in such a way that you don’t create a breeding ground for these mosquitoes. We need to make sure that we protect ourselves. What we can do is to give you the information and the tools, but you need to protect yourself”
African Malaria Media Research Network
For the majority of the people engaged in both Tuba and Dansoman they heard about the Anopheles Stephensi through the mass media. This brings into sharp focus the role the media has in all this. The African Malaria Media Research Network, AMMREN is one key stakeholder coordinating activities of journalists in the fight against malaria. Executive Director, Dr. Charity Binka, believes the media has a role to play, especially with regard to disseminating accurate information in order not to create fear and panic within these two communities.
“As we were told by the experts, we need to pay more attention to how we manage our environment. This kind of message can only be carried by the media, through our health programmes, and through our reportage. So I think that we need to allay the fears of the people through the media. Let’s them know that they don’t have to panic, that they can do basic things to be able to protect themselves“
Visit to Dansoman and Tuba Health Facilities
The news Team was at the Dansoman Polyclinic as well as Tuba Community Clinic to ascertain whether the Anopheles Stephensi, is already reflecting cases reported at the facilities. But, it was extremely difficult to get any data on this.
Conclusion
As experts conduct research to determine what could work for the country in reducing the potency of the Anopheles Stephensi, the clarion call is for all Ghanaians to strictly keep observing existing interventions. May we not see the Anopheles Stephensi as a Tuba and Dansoman problem, but a national problem that deserves an all hands on Deck approach.
