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Malaria control in Eritrea: a success story International PHC Conference Ouagadougou, Burkina-Faso 28 – 30 April 20 PowerPoint Presentation
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Malaria control in Eritrea: a success story International PHC Conference Ouagadougou, Burkina-Faso 28 – 30 April 2008. By Dr. Tewolde Ghebremeskel Head, National Malaria Control Program Ministry of Health, State of Eritrea. Presentation Outline. Country Profile

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Malaria control in Eritrea: a success storyInternational PHC Conference Ouagadougou, Burkina-Faso 28 – 30 April 2008

By Dr. Tewolde Ghebremeskel

Head, National Malaria Control Program

Ministry of Health, State of Eritrea

presentation outline

Presentation Outline

Country Profile

Burden of Malaria in Eritrea

Interventions

Achievements

Lessons learnt

Challenges/Concerns

Conclusion

country profile
Country Profile

Area: 124,320 sq. km

Population: 3.6 million

Population distribution

<5 years old: 15%

pregnant women: 5%

Rural: 80%

Urban: 20%

burden of malaria in eritrea
Burden of Malaria in Eritrea
  • 3 epidemiologically distinct strata:
    • Coastal plains (0-1000m)
    • Western lowlands (700-1500m)
    • Highlands (1500-2000m and above)
  • 67% (2.4 million) of population live in malaria risk areas
  • Parasite distribution: P. falciparum (84%), P. vivax (16%)
  • Main vector:Anopheles arabiensis
burden of malaria in eritrea contd
Burden of Malaria in Eritrea….Contd
  • Malaria is seasonal, focal, and unstable.

- 2 main transmission seasons:

      • September – November (central, southern, western lowlands)
      • January – March (coastal plains)
  • High malaria epidemic risk
      • Displaced populations due to border conflict
      • High population mobility/movement
      • Low immunity
      • Drug resistance
integrated malaria interventions
INTEGRATED MALARIA INTERVENTIONS

CASE MANAGEMENT

IVM

EPIDEMIC

PREVENTION

M & E

CAPACITY BUILDING

HEALTH PRHOMOTION

OPERATIONAL RESEARCH

HFs

CHAs

Larviciding

ITNs

IRS

Source reduction

REDUCTION IN MALARIA MORBIDITY & MORTALITY

case management
Case management
  • First line treatment of uncomplicated malaria:
      • Chloroquine (Until 2001)
      • Chloroquine plus SP (2002-2007)
      • Artesunate plus Amodiaquine (since August 2007)
  • Approximately 80% of all febrile cases were managed by CHAs
  • CHAs were trained in the utilization of the guidelines for referrals
  • Pull system of drug distribution from catchment health facility to the CHAs.
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Integrated vector management

  • Insecticide Treated Nets/Long lasting insecticidal Nets (ITNs/LLINs)
    • Free distribution of ITNs to vulnerable groups
    • Tax exemption of importation of malaria control commodities
    • Above 90% ITN re-treatment rate at no cost to the beneficiary
  • Indoor Residual Spraying (IRS) in high endemic areas
  • Source Reduction or Elimination of breeding sites.
  • Larviciding
capacity building
Capacity building
  • Training of CHAs on case management, referral and integrated vector management:
      • Bring services closer to the population
      • Strengthen the linkage with health facilities
      • Promote community empowerment, ownership & sustainability of malaria control interventions.
  • Strengthening of referral health facilities through regular training & refresher courses for
        • health workers to manage complicated malaria cases,
        • laboratory technicians for detection of malaria parasites,
        • Zonal/district malaria technicians who are part of district health team.
  • Strengthening of institutional capacity for
      • Equitable distribution of malaria supplies and equipment
      • Equitable distribution of health services
      • Provision of affordable services including drugs
operational research
Operational Research
  • Drug /insecticide efficacy studies.
    • Regular yearly drug efficacy study for monitoring purposes
    • Analysis of non response of febrile cases referred by CHAs and confirmed as malaria
    • Analysis of weekly report and trends of malaria cases at sentinel sites.
    • Quarterly review of malaria morbidity trends including treatment failure rates from health facilities by a technical committee.
  • Participatory drug efficacy studies in low endemic areas for policy change.
health promotion
Health Promotion
  • Community empowerment, ownership & use of CHAs for positive behavioral change
  • Involvement of Eritrean social marketing group.
    • Operates at grass root level
    • Provides services at no cost
    • Distributes ITNs at affordable cost
  • Annual National Malaria Campaign weeks.
  • Use of various channels of communications
    • Mass media
    • promotional materials
    • Interpersonal communication
    • Drama, malaria related films, folktales,
supervision monitoring evaluation
Supervision, Monitoring & Evaluation
  • Monitoring & supervision
      • Regular supervision of CHAs by public health technicians
      • Routine utilization of supervisory check list by PHT
      • Monitor the operationality of Malaria Sentinel sites
      • Conduct regular quarterly review meetings
      • Follow up status of implementation of recommendations.
  • Evaluation
      • National annual review meetings (RBM partners meeting)
      • Dissemination of annual reports
      • Midterm and final evaluation of strategic plan
promotion of partnerships
Promotion of partnerships
  • Coordination mechanisms
      • Map out who does what & where
      • Strong & functional Zonal/District malaria control teams
      • HIV/AIDS, Malaria, Sexually Transmitted Disease and TB (HAMSET) steering committee meetings at national and district levels
      • Integrated multi-sectoral approach initiated by the Government to manage HAMSET Project
  • Mobilization & utilization of resources.
      • Effective internal & external resource mobilization
      • Good financial accountability
      • Effective utilization of available human and material resources
trends of malaria mortality among top 10 diseases in children 5 years
2000

ARI

Diarrhea

Malaria

Anemia

Septicemia

TB

HIV/AIDS

Heart failure

Burns

Soft tissue injury

Trends of malaria mortality among top-10 diseases in children <5 years

2007

  • ARI
  • Anemia & malnutrition
  • Diarrhea
  • Septicemia
  • Perinatal respiratory problem
  • Slow fetal growth, Malnut etc
  • Intrauterine Hypoxia/Birth Asphyxia
  • HIV/AIDS
  • Malaria
  • TB, all types

Source: NHMIS

* Source: Eritrea Health Profile, 2000

trends of malaria mortality among top 10 diseases in adults
Trends of malaria mortality among top-10 diseases in ADULTS

2000

  • Malaria
  • TB
  • Anemia & malnutrition
  • ARI
  • HIV/AIDS
  • Diarrhea
  • Hypertension
  • Other liver diseases
  • Diabetes Mellitus
  • Septicemia

2007

  • ARI
  • Anemia & malnutrition
  • HIV/AIDS
  • Diarrhea
  • Septicemia
  • TB, all types
  • Perinatal resp. problem
  • Hypertension
  • Other liver diseases
  • Diabetes Mellitus

* Source: Eritrea Health Profile, 2000

Source: NHMIS

lessons learnt
Lessons Learnt
  • High political commitment, promotion of community ownership and empowerment play a significant role in malaria control.
  • It is possible to achieve the Abuja targets through the implementation of integrated and comprehensive interventions. (free distribution of ITN, community based case management by CHAs, integrated community based vector management)
  • Regular operational research is important for evidence based decision making & policy change.
  • Improved coordination of partners and sectors during planning, implementation, Monitoring & Evaluation is crucial for the success of malaria control programs.
  • Proper and accountable management of available financial and material resources enhances program effectiveness and donor confidence
challenges
Challenges
  • Complacency due to current achievements.
  • Utilization of ACTs by CHAs.
  • Health seeking behaviour
  • Competing priorities
  • Skilled human resource
  • Cross border transmission.
conclusion
Conclusion

Eritrea has moved towards malaria pre-elimination phase primarily due to

  • Strong Political commitment
  • Commitment of MOH staff and other relevant sectors
  • Involvement of community including the use of CHAs in planning, implementation, monitoring and evaluation
  • Better coordination of partners
  • Proper management of available resources
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MERCI

THANK YOU

YEKENYELEY

SHUKREN