Title: Achievements of 20002004 Country RBM Plan
1Achievements of 2000-2004Country RBM Plan
- Dr. Tewolde G/Meskel
- Manager, NMCP
21 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
32 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
43 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
54 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
65 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.
75 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.
85 Major Accomplishment
A Capacity building/Training Cont.
Personals trained in case management in the last
five years
95 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
105 Major Accomplishment
Summary of Blood Films Cross-Checked At NMCP For
Malaria Parasite in 2004
115 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
12No. of ITNs distributed bed nets Re-impregnated
in the last five years
135 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
14Spraying activities conducted by year
2 Indoor residual spraying cont.
155 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
165 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.
175 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.
185 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)
195 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
205 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
215 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.
225 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
23Anti-Malarial Drug Therapeutic Efficacy Results
(Year 2004)
A ARTAQ Treatment outcome
24Anti-Malarial Drug Therapeutic Efficacy Results
(Year 2004) cont.
B CQ SP Treatment Outcome
25Result by age group from sites with adequate
sample size
Anti-Malarial Drug Therapeutic Efficacy Results
(Year 2004) cont.
26Results of five and above patients for Tesseney
hospital with adequate sample size (2002 , 2003
and 2004)
275 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
285 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
295 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
302004 Major Accomplishment (Cont.)
F Operations Research Cont.
Opening Session on RBM 5 years
Evaluation Survey Training
31F 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
32Proportion 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
33Proportions 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
34Proportion 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
35Key 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
36Key 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
37Key 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
38Key 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.
395 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
40Overall 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.
41Overall 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.
42Overall 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
44Overall 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
45Overall 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.
46Major 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.
47Major 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.
48Challenges
- 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
49Challenges 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
50Challenges 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 !!!!
51KILL MOSQUITOES !!!KILL MALARIA !!!!!Let Us
Work Seriously to Sustain the Achievements
!!work harder smarter !!!in the coming 5
yrs
52Thank you for Listening !!!!!!!