Malaria statistics for under 5, including morbidity

1
Malaria statistics for under 5, including
morbidity mortality

• Southern Sudan
• 50 of all clinic visits
• mortality rates not known
• diagnosis 80 clinically, 20 slides
• source of information ADRA clinical reports -
  reliable
• Rwanda
• 40 OPD visits
• 15.4 of all children in OPD have positive smear
• 59 of all U5 deaths
• 54 of overall deaths
• source of infor. MOH - reliable

• Ethiopia
• 30 OPD visits are malaria
• morbidity rate 15 of U5 s
• 13 - 35 of all deaths are from Malaria
• case fatality rates 15 - 17
• source of data is MOH - reliable
• Uganda
• 29 - 50 of all OPD
• 20 of all admissions
• 23 of all under 5 mortality
• 5 case fatality rates
• Source of data MOH - from HMIS surveys -
  reliable

2
Malaria statistics for under 5, including
morbidity mortality

• Somalia
• the health facilities are supported by UNICEF and
  data is analysed by UNICEF

• Tanzania
• 31 of all OPD cases
• 15 of admissions
• 20 of U5 mortality
• Source of data MOH - reliable

3
Comments on the data / statistics

• Different countries are collecting on different
  indicators - although some are different
• Sudan figures are only for a limited population
  that can be accessed
• Case fatality rates give an indication of quality
  of the services but may also depend on endemicity
  of the areas e.g. hypoendemic areas are epidemic
  prone and have higher fatality
• Several factors affect the reliability of the
  data including
• diagnostic facilities - most diagnosis in the
  region is clinical
• system for recording and compiling of data-
  systems may be in place but are sometimes not
  utilised properly
• motivation, work load and experience of the
  person(s) collecting the data
• the small proportion of patients that are treated
  in the facilities from which the data is
  collected (many cases are treated outside the
  formal health sector) .
• If countries can get well organized supervised
  systems lots of useful data could be collected

4
Protocol for malaria case finding management

• Somalia
• No national protocol. There are UNICEF, WHO
  guidelines developed through the working groups.
  The availability utilisation of the guidelines
  depends on the agency. (Somaliland does have
  protocol.
• Rwanda
• There is a national protocol - recently revised -
  implementation at service delivery level varies
  by region, the supervision system the persons.
  Policy does not allow community level
  distribution.
• Uganda
• there is a national protocol - training has been
  done but implementation is dependent on the area,
  work ethics, access to drugs, supervision.
  Community component designed - but not yet in
  community

5
Protocols cont.

• Tanzania
• Has the protocol including the national drug
  policy, service providers have been trained at
  all levels and the guidelines are available.
  They are used, there is close supervision by the
  DHMT
• Southern Sudan
• standard treatment guidelines developed for first
  level workers, primary health care workers
  hospital level used by the 42 NGOs under UNOLS
• Ethiopia
• Protocol developed, disseminated to all levels
  but implementation depends on level of
  supervision

6
Drug policies for uncomplicated malaria for
severe malaria - availability of drugs

• Tanzania
• first line drug for uncomplicated malaria is SP
  (since August 2001) available at all levels,
  including community level
• second line drug is Amodiaquine available in the
  health facilities
• Drugs supplied by the national medical stores
  through essential drug kit to government health
  units - sometimes there is drug shortages. There
  are also other sources of drugs e.g. private
  pharmacies
• limitations to access by communities include cost
  (cost about 1 for a course of treatment),
  logistics for distribution of drugs education
  of the community
• Quinine recommended for severe malaria available
  mostly at hospital level though recommended for
  levels down to dispensary level (level 2)

7
Drug policies and availability cont...

• Rwanda
• first line is combination of SP AQ not yet in
  use all through the country - in some parts
  chloroquine is till being used.
• Supplies are there but the drugs are expensive
  2-3 for a course . Fear of poor quality service
  is another limiting factor.
• Work with the private drug shops, ordinary shops
  and community level not yet allowed
• Quinine is drug for severe malaria at all levels
• Ethiopia
• has drug policy. SP is first line for
  uncomplicated malaria- drugs are affordable -
  sometimes unavailable in health facilities but
  available with private vendors though more
  expensive(less than 0.5)
• Quinine used for severe malaria - in hospitals
  higher level health units
• ordinary shops do not sell antimalarials - it is
  drug shops pharmacies that sell drugs
• Community health workers where they exist - carry
  the antimalarial drugs - depends on different
  regions of the country
• community education going on -

8
Drug policies availability

• Southern Sudan
• first line is CQ available to lowest level run by
  CHW. In health centres there is CQ SP. Severe
  cases Quinine IV if qualified staff - otherwise
  oral quinine
• drugs only available from NGO or from
  neighbouring country
• poor access to health facilities referrals
• logistics big problem , plane mostly- drugs
  usually given free - cost sharing is being
  started in SPLM area
• Uganda
• National drug policy still has to undergo some
  approvals to be used at community level -
  combination of SP/CQ - most people still using
  chloroquine. Community education going on.
• Limitations include policy bureaucracies
  community education
• Quinine for severe malaria - at all levels

9
Drug Policies cont.

• Somalia
• drug policies not there but since June RBM
  started - protocol from UNICEF WHO being used
  that recommends SP - still just being introduced
  to the health workers. In most of the areas
  there are lots of drugs sellers not under any
  control - first line is Chloroquine- usually
  taken only what can be afforded - usually
  incomplete dose. In the world vision areas,
  Chloroquine is used as first line, second line SP
  - quinine available for severe malaria if there
  is a qualified staff. Logistics a big problem

10
Summary of obstacles to accessibility to drugs.

• Logistics
• Availability
• affordability
• security
• new programs
• bureaucracies
• lack of qualified staff
• poor quality of services
• lack of information on correct drugs, sources of
  drugs, dosages etc

11
What can NGOs do to enable community members
access treatment for malaria?

• Empower communities with knowledge - use all
  available channels for sharing information
• NGOs have ability to do community level demand
  creating services - can work with communities to
  demand services and come with solutions - however
  creation of demand should go on with making the
  services available e.g. from Africare - Uganda
  which created demand then linked with government
  to make the services available e.g. of
  innovative story from Southern Sudan
• addressing factors that affect availability of
  drugs -
• need to bring together key players to assess the
  malaria situation and come up with joint
  solutions correct mix of interventions
• NGOs working closely with both government
  communities to generate solutions
• linkage between health component income
  generating sectors