Uganda National Malaria Control Programme

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• Uganda National Malaria Control Programme
• MALARIA TREATMENT POLICY

Dr. F. K. Kato.Senior Medical Officer,Uganda
National Malaria Control Programme Ministry of
Health Phone [phone]
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• GLOBAL MALARIA CONTROL POLICY

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ROLL BACK MALARIA (RBM)

• Roll Back Malaria is a global movement for
  enlisting everybodys participation in malaria
  control. It aims at minimizing suffering from
  malaria and it approaches it from a partnership
  viewpoint . It was launched in 1998 by
• World Health Organisation (WHO)
• United Nations Childrens Fund (UNICEF),
• the United Nations Development Programme (UNDP)
• and the World Bank (WB).
• This global partnership includes governments,
  development partners, civil societies, private
  sector, professional associations, research
  groups and the media. Each partner contributes
  according to their comparative advantages as
  offered by their location in society.
• It emphasizes strengthening health services and
  making effective prevention and treatment
  strategies more widely available.

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TARGETS OF RBM IN THE AFRICAN REGION

• The general goal of RBM in the WHO African Region
  is to control malaria to the level where it is no
  longer one of the major contributors to mortality
  and morbidity in the region.
• The targets of RBM in the African Region set by
  the founding partners in 1998 are
• To reduce by 50 the 2000 levels of malaria
  mortality and morbidity by the year 2010
• Further reduction of the 2010 morbidity and
  mortality levels by 50 and 75 respectively by
  2015.
• These 2015 levels will be further reduced by 50
  and 80 respectively by the year 2025
• By the year 2030, malaria will no more be a major
  public health problem in the Region

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THE ABUJA DECLARATION

• In 2000, African Heads of State made the Abuja
  Declaration on RBM. One of the items in the
  declaration is the following set of objectives
  and targets for 2005
• At least 60 of those suffering from malaria /
  fever have access to and are able to use correct
  and appropriate treatment within 24 hours
• At least 50 of households in targeted districts
  have at least one Insecticide Treated Mosquito
  Net
• At least 60 of those at risk of malaria,
  particularly children under five years of age and
  pregnant women sleep under Insecticide Treated
  Mosquito Nets
• At least 60 of all pregnant women who are at
  risk of malaria, especially those in their first
  pregnancy will have access to chemoprophyaxis or
  intermittent antimalarial treatment
• At least 60 of the epidemic-prone countries have
  capacity to detect early and respond
  appropriately to malaria epidemics
• Although some of the Abuja targets had not yet
  been achieved by 2005, good progress was made and
  interventions continue to be implemented

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• NATIONAL MALARIA CONTROL POLICY

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THE GENERAL OBJECTIVE OF THE UNPCP

• The general objective of the Uganda National
  Malaria Control Programme is to reduce malaria
  morbidity, mortality and disability and to
  minimize related social ill effects and economic
  losses attributable to malaria.

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Intervention Strategies

• Effective Malaria Case Management
• Facility based management of malaria
• Home based management of fever (HBMF)
•  Selective Vector Control.
• Indoors residual-insecticide spraying (IRS)
• Insecticide-treated mosquito nets (ITNs)
• Environmental management
• IPT for pregnant women
• Malaria epidemic preparedness and response
•   

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Enabling Strategies

• IEC/BCC for malaria prevention and control
• Capacity Building
• Training
• Logistical support
• Surveillance Research
• Drug efficacy studies
• Monitoring Evaluation
• KAP studies
• Infrastructure and Supplies
• Medicines and other supplies
• Diagnostic facilities
• Treatment facilities
• Programme Management
• Mobilisation and deployment of resources
  including transport
• Support supervision,

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THE UNMCP TARGETS FOR 2010 Health Sector
Strategic Plan II ( 2006-2010)

• To increase the proportion of pregnant women who
  have completed IPT2 from 34 in 2005 to 80 in
  2010
• To increase the proportion of households having
  at least one insecticide treated mosquito net
  from 15 in 2005 to 70 in 2010
• To increase the proportion of targeted structures
  for indoors residual insecticide spraying from 0
  in 2005 to 80 in 2010
• To increase the proportion of children under five
  with malaria getting correct treatment within 24
  hours from 25 in 2005 to 80 in 2010
• To reduce the case fatality rate among malaria
  patients under five from 4 in 2005 to 2 in 2010

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• NATIONAL MALARIA TREATMENT POLICY

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EFFICACY STUDIES IN 1998 1999

• Chloroquine resistant malaria was first reported
  in East Africa in1979.
• By 2000 efficacy studies using the WHO protocol
  showed mean clinical failures after 14 days
  follow up
• Chloroquine 30
• (range10 to 48)
• Sulfadoxine/Pyrimethamine 10
• (range 0 to 19)

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CHANGE TO INTERIM POLICY OF CQ SP

• Decision to change to an interim policy of
  Chloroquine Sulfadoxine/Pyrimethamine
  combination for the treatment of uncomplicated
  malaria was made by MoH in June 2000.
• The interim policy was officially launched on
  17th June 2002.

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EFFICACY STUDIES 2001-2004

• Efficacy studies using the WHO protocol
  conducted between 2001 and 2004 showed mean
  clinical failures
• Chloroquine Sulfadoxine/Pyrimethamine 21.4
  (range 3- 45) after 14 days of follow up
• Amodiaquine Sulfadoxine/Pyrimethamine 5.4
  (range 0.6-15.9) after 14 days of follow up
• Amodiaquine Artesunate 1.8
• (range 0-4.2) after 14 days of follow up
• Artemether/Lumefantrine no clinical failure
• after 28 days of follow up

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CHANGE OF POLICY TO ACTs

• In 17th May 2004 the Ministry of Health made the
  decision to change the national policy to
  Artemisinin based Combination Treatments (ACTs).
• Artemether/Lumefantrine was the ACT selected as
  first line treatment for uncomplicated malaria
  and Amodiaquine Artesunate as the alternative
  first line
• This new policy was launched on 25th April 2006

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NEW MALARIA TREATMENT POLICY - 1(Operational
when ACTs are available in health facilities)

• Uncomplicated malaria
• First line Artemether/Lumefantrine.
• Alternative first line Artesunate Amodiaquine.
  
• Second line Quinine
• Severe malaria
• Recommended Parenteral quinine
• Alternative Parenteral artemisinin derivatives

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NEW MALARIA TREATMENT POLICY 2(Operational
when ACTs are available in health facilities)

• Intermittent Preventive Treatment (IPT) in
  pregnancy
• Recommended Sulfadoxine/Pyrimethamine (SP)
• Uncomplicated malaria in special groups
• Pregnant women during the first trimester
  quinine (ACTs contraindicated).
• Pregnant women after the first trimester ACTs
  may be used.
• Children below 5Kg body weight quinine (ACTs
  contraindicated).

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ARTEMISININ DERIVATIVES
THE ACRICULTURAL PLANT Artemisia annua
THE RAW PRODUCT Artemisinin
THE ARTEMISININ DERIVATIVES Artemether
Artesunate Artemisinin Dihydroartemisinin
(actually a metabolite of the other derivatives)
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ARTEMISININ BASED COMBINATION TREATMENTS (ACTs)

• Combination therapy (treatment) is the
  simultaneous use of two or more blood
  schizontocidal medicines with different modes of
  action
• Artemisinin-based Combination Therapy (ACT) is a
  combination therapy where one of the components
  is an artemisinin derivative. ACTs are
  recommended by WHO for treatment of
  uncomplicated malaria
• Some ACTs are available as two medicines
  contained in one tablet i.e. they are fixed-dose
  artemisinin based combination treatments (FACTS)

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ARTEMETHER/LIMEFANTRINE 1ST LINE

• Artemether/Lumefantrine from NOVARTIS is
  available as co-formulated tablets branded
  COARTEM. Each tablet contains 20mg Artemether
  and 120mg Lumefantrine.
• The dose ranges from 1 tablet 12 hourly to 4
  tablets 12 hourly (depending on the patients
  body weight) for 3 days.
• The COARTEM bought by Ministry of Health is
  available in 4 colour-coded blister packs for
  different body weight groups
• Note
• Artemether/Lumefantrine (COARTEM) is hygroscopic
  (takes up water) and should be taken as soon as
  the blister pack has been opened.

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4 months up to 3 years
5-15Kg
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3 years up to 7 years
15-25Kg
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7 years up to 12 years
25-35Kg
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35Kg
12 years and above
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Thank you