Regional health threats

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AngloGold Ashanti is set to implement an Integrated Malaria Control programme in Obuasi and outlying villages within the Obuasi Municipal Assembly area in mid 2006, with the aim of reducing malaria incidence in the region by 50% within two years. This campaign, first reported in the Report to Society 2004 (See case study: A scientific approach to malaria control at Obuasi), was originally scheduled to begin at the beginning of 2005, but was delayed to allow the programme planners more time to establish a proper scientific base from which to launch the project, and to interact with the community to determine their exact needs with regard to the prevention and treatment of malaria.

The focus of the programme is to formulate, develop and implement a sustainable system that will reduce the severe burden of malaria at Obuasi, promote community development, educate the community in all means of preventative measures and assist health practitioners in the early detection and treatment of malaria. The programme is to be managed in partnership with relevant stakeholders and in line with the Ghana Government's malaria policy.

The Obuasi mine hospital, the Edwin Cade Memorial hospital, currently treats an average of 6,000 malaria patients per month, 1,900 of whom are mine employees. With an average of three days off per patient per bout of malaria, this equates to approximately 5,100 man shifts lost per month. Coupled with the slower work rate experienced during recuperation, malaria results in major production losses, and monthly medication costs alone often exceed $40,000.

The main components of the Integrated Malaria Control programme for Obuasi are:

• Vector control – Indoor residual spraying of the estimated 90,000 structures in the municipal area as well as the use of insecticide-impregnated bed nets. The cost of the spraying is estimated at $823,000 per year.
• Larviciding of temporal and permanent water bodies which support mosquito breeding
• Disease management – Effective treatment protocols (such as early detection and diagnosis of malaria) have been introduced at the hospitals in Obuasi. These, coupled with the provision of the new malaria treatment drugs will help ensure acceptable cure rates and reduce the pool of infected individuals.
• Surveillance and monitoring – A malaria information system will measure programme outcomes to World Health Organization (WHO) established standards and monitor productivity, quality control and costs
• Information, education and communication – Programme liaison teams and volunteer community advocates have been trained to provide health information on malaria prevention, symptoms and treatment. Educational material such as pamphlets, posters and videos on malaria will also be circulated.

A malaria control centre in the Sansu area is nearing completion and, although primarily the headquarters for the Obuasi programme, it will also serve as a training centre for members of AngloGold Ashanti's malaria projects at other mines, and also for other companies operating in Ghana. It is seen as an asset to Ghana and Africa in the fight against malaria and as such will be available for use as a satellite research centre by the Noguchi Memorial Institute for Medical Research at the University of Ghana, government offices and training facilities. Incorporated is an insectary and laboratory, which will be used for surveillance, research, and maintaining a mosquito colony to measure and test insecticide efficacy and vector resistance.

The resident entomologist is a local graduate, who was nominated by the Noguchi Institute and sponsored, by AGA, for a doctorate in Entomology at Wits University in South Africa.

Job creation

In addition to the entomologist, 125 additional jobs have been created by the programme within the local community. A course for spray team supervisors was conducted in association with Avima, the company supplying the insecticide, and covered all aspects of indoor residual spraying with emphasis on community relations and administration. Personnel from the Ghana Health Services, Ghana National Malaria Programme and the University of Ghana School of Public Health participated in the course.

In all, 116 spray operators were subject to stringent selection criteria and an intensive training course in the methodology and techniques of indoor residual spraying. Specialists involved in the Lubombo Spatial Development Initiative (LSDI) malaria control programme of South Africa, Mozambique and Swaziland provided training assistance.

The skills provided to the trainees can also be applied in agriculture and in pest control operations.

Community involvement

The community liaison section of the malaria control centre is a vital component of the campaign since the success of the programme depends on its acceptance by the community. Presentations have been made to local stakeholders including the relevant government departments, the director of health services in Obuasi, the WHO malaria officer, community liaison committees, assemblymen, local and district chiefs, NGOs, church groups and schools.

"The programme is a partnership with the Obuasi community and all relevant parties have indicated their support of the campaign," said Steve Knowles, Manager: Malaria Control Programme. "The Director of Obuasi Health Services has also aligned his public health focus with our malaria control programme."

150 community malaria advocates (volunteers from the different communities and surrounding villages) were appointed to educate people on the need to change the environment in which they live, so as not to encourage or harbour mosquito breeding. These volunteers followed an intensive two-day training course on the cause and prevention of malaria presented by the Obuasi Malaria Control staff. They were issued with a distinctive shirt and cap to ensure they were easily recognisable, so that the community could approach them with questions or concerns. This feature of the campaign has been extremely successful and the advocates assisted the Noguchi Institute during their baseline malaria prevalence study in Obuasi and the town planning department of the local municipality in verifying data. They will also help the spray teams with community awareness during the indoor residual spraying phase.