Eritrea national malaria control program on the road to malaria eradication
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Eritrea National Malaria Control Program: On the road to malaria eradication. Saleh Meky Minister of Health Government of Eritrea. Roll Back Malaria Initiative. case management, vector control, insecticide-treated nets (ITNs),

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Eritrea National Malaria Control Program: On the road to malaria eradication

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EritreaNational Malaria Control Program: On the road to malaria eradication

Saleh Meky

Minister of Health

Government of Eritrea


Roll Back Malaria Initiative

  • case management,

  • vector control,

  • insecticide-treated nets (ITNs),

  • information, education and communication material, training,

  • epidemic forecasting and preparedness,

  • operations research and monitoring,

  • evaluation and supervision.


Success

  • Eritrea as one of the four countries in the world with successful malaria control programs

  • Together with India, Brazil and Vietnam

    (Source: The World Bank Rolling Back Malaria: Global Strategy and Booster Program)


Common elements of success

  • Conducive country conditions

  • Targeted technical approach

  • Data-driven decision making

    • surveillance and operational research

  • Strong leadership and commitment at all levels of government

  • Community planning and implementation

  • Adequate financing


The Eritrean Program

  • Established in 1999 following devastating malaria epidemics (1997-1998)

  • Support from WHO, USAID, WB, Global Fund

  • Introduced:

    • Early diagnosis and treatment at health facility and community levels

    • Proper management of severe malaria at zoba/subzoba level

    • Reduction of man-mosquito contact through ITN (national coverage)

    • Community awareness through the promotion of information, education, and communication

    • Environmental management through community participation and prevention and control of malaria outbreaks.

  • Reduced malaria morbidity and mortality by 80% during 1999-2005


Eritrean experience

  • Success factors:

    • Targeted integrated vector management

    • Massive community mobilization

    • Organization and supervision

    • Evidence-based

  • Corroborating factors:

    • No year round malaria transmission and

    • Manageable country size

  • Once targets were exceeded more donor interest and funding


Country conditions

  • Seasonal malaria and low to moderate transmission

  • Small country

    • 121,320 sq km

    • Population 4,906,585 (est. 2007 World Bank).

  • Arid environment and seasonal rainfall patterns

    • temporary free-standing pools of water,

    • clearing and levelling an attractive option.


Targeted integrated vector management:Nets


Targeted integrated vector management:Breeding sites treated, filled or drained(Average per year per zobas)


Targeted integrated vector management:Indoor Residual Spraying(per year, per zoba in GB,DB and SKB)


Massive community mobilization:information and communication malaria sessions (average per year, per zoba)


Massive community mobilization:population participating in site cleaning (average per year, per zoba)

  • Community participation very significant factor in explaining breeding site cleaning


Evidence-based: examples

  • 2005 RTI studies showed that the most prevalent mosquito is anopheles arabiensis (bites early in the evening and late morning, not only in the middle of the night).

    • Use of ITNs as a sole prevention mechanisms is insufficient

    • Indoor residual spraying perhaps required

  • Sintasath et al. 2005 showed that housing construction known as agudo, in the western lowland of Eritrea, increases risk of parasitemia.

    • Implication for housing materials


Effectiveness of malaria interventions on incidence(preliminary findings)Carneiro, Hassane, Legovini, Sy 2008

  • Areas (subzobas) with above average ITN distribution reduced

    • Under five malaria incidence by 4 cases per month (23% reduction per month)

    • Above five malaria incidence by 8 cases per month (14% reduction per month)

  • Areas (subzobas) with above average larvae site cleaning (treatment, filling and draining) reduced

    • Above five malaria incidence by 9 cases per month (15% reduction per month)


Increasing access to ITNs to 100 per 1000 population reduced malaria under five incidence by 76 cases.


Moving forward

  • Securing longer term financing is a priority:

    • Need evidence on the economic impact of malaria interventions to motivate continued investments in malaria control

    • Need rigorous evaluation of the elements of the program and complementary interventions to understand what is required to eliminate malaria


Moving toward evidence-based eradication

  • Impact evaluation cross-country workshop (Asmara, Feb 2008)

    • Capacity for evidence-based policy making

    • Community of practice across malaria programs in the region (15 delegations from national malaria and HIV programs)

    • Dissemination of Eritrean and other successful practices across the Africa region (site visits)

  • Experimental approach to understanding what more needs to be done to eradicate malaria

    • Randomized evaluation of indoor residual spraying value added to the national program

    • Randomized evaluation of communication and community mobilization approaches


Thank you


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