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Achievements of 20002004 Country RBM Plan

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Eritrea adopted RBM initiative in 1998. National Conference on RBM held in Mendefera in July 1999 ... control of mosquitoes in Eritrea organized by the NMCP HQ ... – PowerPoint PPT presentation

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Title: Achievements of 20002004 Country RBM Plan


1
Achievements of 2000-2004Country RBM Plan
  • Dr. Tewolde G/Meskel
  • Manager, NMCP

2
1 Background
  • Eritrea adopted RBM initiative in 1998
  • National Conference on RBM held in Mendefera in
    July 1999
  • The draft five years country malaria control
    strategic plan for 2000-2004 discussed and
    launched
  • Annual malaria action plans continued to be
    updated based on the 5 yrs Strategic POAs

3
2 Objective of RBM FYP (2000-2004)
  • General objective
    To reduce malaria to such a low level
    that it is no longer a major public health
    problem in the Country.
  • Specific Objectives
  • Reduce Malaria morbidity by 80 from 1999 levels
  • Reduce malaria mortality by 80 from 1999 levels
    and
  • prevent epidemics of malaria

4
3 Strategies
  • Case Management(Early detection and prompt
    treatment)
  • Integrated Vector Management Use of ITNs,
    Environmental Management, Larviciding, Indoor
    residual spraying in selected villages
  • Epidemic Prevention (preparedness, monitoring of
    sentinel sites, forecasting/meteorological
  • Capacity Building (Training of HWs, CHAs, PHTs
    etc)
  • Health Promotion
  • Operational Research
  • Monitoring and Evaluation

5
4 RBM partners
  • FINCNCIAL AND TECHNICAL SUPPORT
  • WHO
  • WHO/PHARPE (Italian corporation)
  • UNICEF
  • USAID
  • World Bank (HAMSET)
  • GFATM (Since 2004)
  • JICA/Unicef (Since 2004)
  • Ministries MoA, MoE, MoI, MoLWE, Local
    Government, Dep. of Environment among others
  • Associations
  • Youth and Women Associations
  • PFDJ, Zonal, sub zonal and village
    administrators

6
5 Major Accomplishment A Capacity
building/Training
  • Refresher training on Malaria Microscopy for 133
    laboratory technicians
  • Training workshop on Epidemic Preparedness and
    Forecasting for Zonal Malaria Coordinators and
    NMCP HQ staff organized by the NMCP/HQ and EHP.
  • Planning workshop on the Village Pilot Project
    for the control of mosquitoes in Eritrea
    organized by the NMCP HQ and EHP.
  • Training on data management and evaluation of
    malaria case management at health facilities
    organized by the NMCP HQ and WHO.

Participants of the refresher training for
laboratory tech.
7
5 Major Accomplishment
  • A Capacity building/Training Cont.
  • Training on Anti Malarial Drugs efficacy studies
    conducted by NMCP HQ and Zones.
  • Training on operational research methodology
    conducted for Zonal Malaria Coordinators and NMCP
    HQ staff by Tulane University, USA.
  • Training on malaria entomology field techniques
    provided for Malaria Technicians by EHP through
    ICIPE experts.
  • Training on data management and analysis given to
    the Zonal Malaria Coordinators and NMCP HQ by
    Tulane University, USA.
  • Data management training provided for zonal Data
    clerks and NMCP HQ staff by WHO.
  • Training on mosquito sample processing, larvae
    and adult identification, blood meal and
    sporozoite ELISA for the HQ technical staff.

8
5 Major Accomplishment
A Capacity building/Training Cont.
Personals trained in case management in the last
five years
9
5 Major Accomplishment
  • A.2 Case management Slide crosschecking,
    Procurement and distribution
  • At national level, slide crosschecking for
    slides sent from zones has been conducted
  • Antimalarial drugs (1st and 2nd line drugs) and
    other supportive drugs
  • Microscopes, reagents and other laboratory
    supplies
  • Rapid diagnostic test kits for HFs with out
    microscopy
  • were procured and distributed to all HFs

A malaria microscopist crosschecking slides sent
from zones
10
5 Major Accomplishment
Summary of Blood Films Cross-Checked At NMCP For
Malaria Parasite in 2004
11
5 Major Accomplishment
  • C Integrated vector management
  • 1 ITN distribution bed net re-impregnation
  • ITNs procured and dispatched to all zones
  • Insecticides for bed nets impregnation and
    re-impregnation procured and distributed to all
    zones based on their request
  • Extensive campaign related to bed
  • net re-impregnation conducted
  • Re-impregnation sites expanded
  • from HFs level to kebabi/village level
  • Re-impregnation materials procured
  • locally and provided to each re-impregnation
    site

CHAs involving in bed net re-impregnation
campaign in Hamelmalo health station
12
No. of ITNs distributed bed nets Re-impregnated
in the last five years
13
5 Major Accomplishment
  • C Integrated vector management
  • 2 Indoor residual spraying
  • Spray pumps and spare parts for spray pumps
    procured and distributed
  • Insecticides (DDT and Temephos) for indoor
    residual spraying procured and distributed

14
Spraying activities conducted by year
2 Indoor residual spraying cont.
15
5 Major Accomplishment
  • B Integrated vector management
  • 3 Environmental management and larviciding

Mattocks, Shovel, sickles, hoes and wheel barrows
for EM procured and distributed to zones
16
5 Major Accomplishment
  • D Epidemics Prevention and control
  • Manual on malaria epidemic forecasting and
    preparedness for prediction, prevention,
    detection and control of malaria epidemics in
    Eritrea was prepared and distributed to the
    malaria control staff.
  • Epidemics thresholds have been developed for
    health facilities based on past data.
  • Key malaria control staff members trained on
    malaria epidemic forecasting and preparedness.
  • Twenty sentinel sites for epidemic detection
    established and provided necessary equipments.

17
5 Major Accomplishment
  • D Epidemics Prevention and control Cont.
  • Guidelines and standard operating procedures for
    sentinel sites developed and distributed to all
    zones.
  • Weekly and monthly malaria morbidity and
    mortality data, climatic data (temperature,
    rainfall and humidity) collected in each site and
    graphs made for each parameter so that malaria
    incidence can be monitored.
  • Antimalarial drugs, insecticides and other
    necessary materials were procured for emergency
    and kept in stock.

18
5 Major Accomplishment
  • E Health Promotion
  • A malaria communication strategy was developed
    based on the formative research on communitys
    KAP and health seeking behaviour conducted
  • Intensive health education on malaria and its
    control for general population, community leaders
    and influential people
  • IEC campaigns using brochures on malaria
    treatment and danger signs, posters on ITN use,
  • Weekly radio and television spots,
  • Mobile video unit presentations (MVU) and
    billboards (by ESMG)

19
5 Major Accomplishment E Health
Promotion (Cont.)
  • E.1 Health promotion activities conducted by
    zones during the African and National Malaria
    Weeks
  • Bicycle race, SARA clubs
  • Student competition
  • Distribution of broachers using students
  • Foot race with slogans containing malaria
    massages
  • Mass treatment of bed nets
  • Mobilizing community for conducting environmental
    management
  • Seminars for village administrators, community
    leaders and elders

20
5 Major Accomplishment
  • E.2 Health promotion activities conducted in
    cooperation with ESMG Cont.
  • Three video spots and two radio spots in
    Tigrigna, Tigre and Arabic produced and aired
    through ERITV and Dimtsi Hafash respectively
    (Africa and National Malaria weeks)
  • Mobile video presentations made in remote
    villages
  • Six billboards which reflect the proper use of
    bed nets two in Tigrigna, two in Kunama and two
    in Tigre
  • Brochures
  • Treatment guideline produced and distributed to
    zones

21
5 Major Accomplishment
  • F Operational Research
  •  Study on geographical distribution and
    behavioral patters of anopheline mosquitoes in
    Eritrea conducted and result of the study
    published in international scientific journals
  • Malaria parasitological survey
  • Health facility malaria case management
    assessment conducted in Debub and Gash-Barka
    zones.

22
5 Major Accomplishment
F Operations Research Cont.
  • CQSP and ARTAQ efficacy studies conducted in
    six sites (Adiquala, Goluj,, Tesseney Tokombia,
    Sawa and Hagaz)

A laboratory technician examining malaria slides
from one efficacy study site
23
Anti-Malarial Drug Therapeutic Efficacy Results
(Year 2004)
A ARTAQ Treatment outcome
24
Anti-Malarial Drug Therapeutic Efficacy Results
(Year 2004) cont.
B CQ SP Treatment Outcome
25
Result by age group from sites with adequate
sample size
Anti-Malarial Drug Therapeutic Efficacy Results
(Year 2004) cont.
26
Results of five and above patients for Tesseney
hospital with adequate sample size (2002 , 2003
and 2004)
27
5 Major Accomplishment
F Operations Research Cont.
  • Firs and second rounds village pilot project on
    Bti and Bs as alternatives to Temephos

Members of the entomology teams checking breeding
sites for larvae in one of the village pilot
project villages, Ghindae
28
5 Major Accomplishment
F Operations Research Cont.
  • Treatment seeking behavior study conducted in
    Gash-Barka zone.
  • Susceptibility and Bioassay studies conducted in
    Anseba and Gash-Barka zones.
  • The entomology lab/Insectary established in
    Mendefera is functioning partially.
  • Another two entomology labs/Insectaries one in
    Anseba and the other one in Gash Barka?Tessenei
    near completion

29
5 Major Accomplishment
  • F Operational Research (Cont.)
  • ITNs availability, use and re-treatment study
    conducted in Anseba, Debub and Gash-Barka zones
  • Based on the preliminary result of the ITN use
    and availability survey (Sep 2003) in 3 zones
    showed that
  •  46 of HHs in malarious areas have at least 2
    ITNs
  • 63 of
  •  56 of 5-14 slept under ITNs the previous night
  • 50 of adults slept under ITNs the previous
    night
  • 40 of pregnant women slept under ITNs the
    previous night

30
2004 Major Accomplishment (Cont.)
F Operations Research Cont.
Opening Session on RBM 5 years
Evaluation Survey Training
31
F Operational Research (Cont.)
  • The RBM evaluation survey
  • Result of the RBM survey helped the program to
    identify its weaknesses and strengths and to
    prepare the next five year RBM strategic plan
    based on the findings.
  • Based on the preliminary report of the 2004 RBM
    survey in 4 zones
  • 60.2 of
  • 48.7 of 5-14 slept under ITNs the previous
    night
  • 53 of pregnant women slept under ITNs the
    previous night
  • Percent of house holds owning two or more ITNs in
    the three zones was found to be 66 percent

32
Proportion of Households Owning Nets and
Re-treatment Rates, Eritrea 2001 and 2004
Figure 2
100
87.7
81.6
79
73
80
67.9
62
60
2001
Percent
2004
40
20
0
Own any net
Own ITN
ITN re-treated in
6months
33
Proportions of Children and Pregnant
Women Using ITNs, Eritrea 2001 and 2004
65.4
70
59
53.4
60
50.4
50
40.1
39.3
40
2001
Percent
30
2004
20
10
0

5 slept under
Preg mother
ITN
ITN
slept under ITN
34
Proportion of Households Participating in
Environmental Malaria Control, Eritrea 2004
100.0
80.6
80.0
60.3
58.6
57.4
60.0
44.5
Percent of Households
40.0
20.0
0.0
Anseba
Debub
Gash-
Northern
Natiional
Barka
Red Sea
Average
Zone/Zoba
35
Key Problems/Issues Identified from the RBM Survey
  • Case management still a weak area
  • Clinical and counseling practice/skills of
    clinicians are weak
  • Patients are presenting late for treatment
  • RDTs uses in hospitals and health centers where
    the functioning microscopy available.
  • Sustainability and enumeration issue of CHAs
    (Drop out rate of the trained Community Health
    Agents is very high due to lack of incentives)
  • Most processes such as planning, policy
    formulation etc are top down
  • Sustainability of ITN distribution

36
Key Problems/Issues Identified from the RBM
Survey Cont.
  • Extensive and detailed malaria mapping/stratificat
    ion of the country has not yet been done.
  • Monitoring and supervision of environmental
    management and IRS is poor
  • Lack of monitoring vector resistance and
    efficacy of currently use insecticides
  • Integration with IMCI, safe motherhood and IDSR
    are weak
  • Lack of integration of various data sources for
    routine malaria data
  • In-service training weak and inadequate
  • Shortage of trained staff at all levels

37
Key Problems/Issues Identified from the RBM
Survey Cont.
  • Lack of organized community- based management
    information system.
  • Slow implementation of malaria communication
    strategy
  • Weak inter-sectoral collaboration (line
    ministries, Associations)
  • Inadequate community participation
  • Involvement of partners and communities in
    planning and monitoring is still weak
  • Involvements of NGOs are very low
  • Health workers IPC/counseling skills are
    inadequate
  • Shortage of trained staff at all levels

38
Key Problems/Issues Identified from the RBM
Survey Cont.
  • Transportation for supervision/monitoring of
    malaria control activities is poor.
  • Low Per diem rate
  • Financial system is not sensitive to tracking
    the budget and expenditure
  • Operational research on malaria still
    inadequate
  • Supervision, monitoring and evaluation of
    interventions are weak
  • The registration of births and deaths in Eritrea
    is not yet well developed, and thus the true
    percentage of deaths from malaria is not known.

39
5 Major Accomplishment
  • G Monitoring and evaluation
  • Regular supportive supervision to zones
  • Monthly meeting for NCMP staffs HQ
  • Quarterly meeting for malaria zonal coordinators
  • At the end of each year, an assessment workshop
    has been conducted
  • Five year RBM evaluation dissemination workshop
    conducted

Malaria quarterly Coordination meeting
40
Overall Impact of Malaria Control Efforts in the
country
Impact on morbidity Overall malaria morbidity
in OPD has been reduced by 84.5 of the year
1999 level.
41
Overall Impact of Malaria Control Efforts in the
country
Impact on mortality Over all malaria deaths have
been reduced by 84 of the year 1999 level.
42
Overall Impact of Malaria Control Efforts in the
country
  • Impact on case fatality
  • Case fatality rates have reduced from 2.3 to 0.9
    and from 2.4 to 0.3 for under five, and five and
    above respectively

43
  • Impact on bed net re-impregnation rate
  • Bed net re-impregnation rate increased from 17.2
    in 1999 to 83.5 in 2004

44
Overall Impact of Malaria Control Efforts in the
country
  • Impact on diagnostic capacity of lab.
    Technicians
  • Cross-checking of slides has helped
  • In identifying laboratory technicians who need
    re-fresher training and give them refresher
    training
  • Make extensive supervision to these sites
  • improve diagnosis of malaria parasites by the
    lab technicians following training and
    supervision

45
Overall Impact of Malaria Control Efforts in the
country
  • Impact of free ITN distribution
  • Free distribution of ITNs and mass
    re-impregnation campaigns have contributed to
    empowering people to use personal protection.

46
Major Contributory factors for the over all
reduction in malaria
  • High ITN coverage, re-impregnation and
    utilization.
  • Introduction of combination therapy of CQSP as
    first line drugs.
  • Early diagnosis and timely case management.
  • High levels of community awareness and
    participation for environmental vector control.
  • Effective and functional partnership of country
    and outside RBM partners
  • Commitment and dedication of the Government,
    MOH, malaria control staff and general health
    workers.

47
Major Contributory factors for the over all
reduction in malaria cont.
  • Technical and financial support received through
    RBM initiative.
  • Effective planning and implementation of program
    activities at central and zonal level.
  • Continuous supervision, regular monitoring and
    evaluation of program activities at central and
    zonal level.
  • Unusually low rainfall and shorter rainy
    seasons.

48
Challenges
  • Sustainability of community participation,
    ownership support for CHAs incentives
  • Sustainability of community based interventions
    (bednet issues, source reduction, case
    management).
  • Lack of continuous monitoring and impact
    evaluation
  • Cross-border malaria concern in the future

49
Challenges cont.
  • The significant reduction of malaria morbidity
    creates other challenging issues/factors
  • -(i) low immunity of population,
  • tendency to develop severe malaria
  • prone to malaria epidemics
  • -(ii) challenge of sustaining the
  • achievements and successes obtained.
  • -(iii) creates complacence/relaxation among
  • population, MOH, Partners among others

50
Challenges cont.
  • Early diagnosis using Microscopy at lower level
    of HFs (health stations and clinics).
  • AMDs resistance concern and change process to new
    first AMDs (Artesunate combinations).
  • Coordination of Activities among IMCI, IDSR, EH
    and RH
  • Meteorology Unit decided to charge us for the
    data despite our partnership in HAMSeT and
    construction of 8 Meteorological Stations in the
    Country.
  • Perdiem issue !!!!

51
KILL MOSQUITOES !!!KILL MALARIA !!!!!Let Us
Work Seriously to Sustain the Achievements
!!work harder smarter !!!in the coming 5
yrs
52
Thank you for Listening !!!!!!!
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