` a case for environmental management control of malaria in anambra state ’
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` A Case for Environmental Management Control of ` A Case for Environmental Management Control of Malaria in Anambra State ’Malaria in Anambra State ’
Health and Economic Health and Economic Burden of Malaria and Burden of Malaria and
our Community our Community EnvironmentEnvironment
Henry Debem Henry Debem ((Ph.DPh.D. Student. Student))Walden University, USAWalden University, USA
PUBH 8165PUBH 8165Instructor : Instructor : Dr. Lezah Brown-Dr. Lezah Brown-
EllingtonEllingtonSpring Term, 2013Spring Term, 2013
Learning ObjectivesLearning Objectives What is Malaria?What is Malaria? Global Epidemiological Background of MalariaGlobal Epidemiological Background of Malaria Nigerian Context of Malaria BurdenNigerian Context of Malaria Burden
Health and EconomicHealth and Economic Brief Background of Anambra stateBrief Background of Anambra state Current Malaria Control Measures in Anambra StateCurrent Malaria Control Measures in Anambra State Common Points of Interference for Malaria Control Common Points of Interference for Malaria Control Key Stakeholders of Malaria Control in Anambra StateKey Stakeholders of Malaria Control in Anambra State Environmental Risk Practices in Anambra StateEnvironmental Risk Practices in Anambra State Environmental Management Control (EMC) MeasuresEnvironmental Management Control (EMC) Measures Efficacy and Cost Effectiveness of EMCEfficacy and Cost Effectiveness of EMC Other Advantages of EMCOther Advantages of EMC Recommendations for Malaria Eradication in Anambra Recommendations for Malaria Eradication in Anambra
State.State. Revision of the Learning ObjectivesRevision of the Learning Objectives
Presentation OutlinePresentation Outline
At the end of this presentation, participants At the end of this presentation, participants will be able to:will be able to:
Learn mosquito and malaria cycle Learn mosquito and malaria cycle Understand the health and economic burden Understand the health and economic burden
of malaria in the World and Nigeriaof malaria in the World and Nigeria Learn the current control measures in Learn the current control measures in
Anambra State and their Merits and DemeritsAnambra State and their Merits and Demerits Understand the superiority of Environmental Understand the superiority of Environmental
Management Control over othersManagement Control over others Make better informed and strategic decisions Make better informed and strategic decisions
in the fight against malaria in Anambra in the fight against malaria in Anambra Communities and beyond.Communities and beyond.
Learning ObjectivesLearning Objectives
Vector-borne disease caused by Vector-borne disease caused by
transmission of Plasmodium species transmission of Plasmodium species
by Anopheles mosquitoes.by Anopheles mosquitoes. Plasmodium specie is the malaria Plasmodium specie is the malaria
parasite that causes malaria in parasite that causes malaria in
humanshumans Transmission occurs through Transmission occurs through
mosquito bites on humans during mosquito bites on humans during
blood mealsblood meals Mosquitoes primarily breed in waterMosquitoes primarily breed in water
What is Malaria?What is Malaria?
Plasmodium sp. and Mosquito Life Plasmodium sp. and Mosquito Life CycleCycle
Images Retrieved from: 1. www.scienceblogs.com2. Skeeters. www.bcps.org
1. WHO (2013). Global health observatory. Retrieved from: http://www.who.int/gho/malaria/en/index.html
Global and African Context:Global and African Context: Malaria, a serious global concern particularly in AfricaMalaria, a serious global concern particularly in Africa
About half the world’s population (3.3 billion people) About half the world’s population (3.3 billion people)
are affected by Malariaare affected by Malaria
216 million cases occurred in 2010; 81% in African 216 million cases occurred in 2010; 81% in African
regionregion
Malaria caused over 600,000 deaths in 2010; 91% in Malaria caused over 600,000 deaths in 2010; 91% in
African regionAfrican region
Third leading cause of death for children under 5 yearsThird leading cause of death for children under 5 years
Almost 1 out of 5 deaths of children under 5 in Africa Almost 1 out of 5 deaths of children under 5 in Africa
is caused by Malariais caused by Malaria
Global Epidemiological Background of Global Epidemiological Background of MalariaMalaria
1. Chima, R., Goodman, C., & Mills, A. (2003). The economic impact of malaria in Africa: a critical review of the evidence. Health Policy, 63(1), 17-36.
2. National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010. 3. WHO (2013). Global health observatory. Retrieved from: http://www.who.int/gho/malaria/en/index.html
Nigeria Context of Malaria Burden Nigeria Context of Malaria Burden Health Burden:Health Burden:
Nigeria bears about 25% of the Nigeria bears about 25% of the
Malaria burden in AfricaMalaria burden in Africa
About 97% of the Nigeria’s About 97% of the Nigeria’s
population is at risk of Malariapopulation is at risk of Malaria
Estimated 110 million malaria Estimated 110 million malaria
cases and 300,000 death cases and 300,000 death
annually annually
Estimated 11% of maternal Estimated 11% of maternal
deaths is caused by malariadeaths is caused by malaria
1. Chima, R., Goodman, C., & Mills, A. (2003). The economic impact of malaria in Africa: a critical review of the evidence. Health Policy, 63(1), 17-36.2. Jimoh, A., O. Sofola, A. Petu, and T. Okorosobo. 2007. “Quantifying the Economic Burden of Malaria in Nigeria Using the Willingness to Pay
Approach.” Cost Effectiveness and Resource Allocation 2007, 5:6. doi:10.1186/1478-7547-5-6.3. Shepard, D., Ettling, M., Brinkmann, U., & Sauerborn, R. (1991). The economic cost of malaria in Africa. Tropical Medicine And Parasitology: Official
Organ Of Deutsche Tropenmedizinische Gesellschaft And Of Deutsche Gesellschaft Für Technische Zusammenarbeit (GTZ), 42(3), 199-203.
Nigeria Context of Malaria Nigeria Context of Malaria Burden…2 Burden…2
Economic burden:Economic burden: Costs can be divided into direct and indirect costCosts can be divided into direct and indirect cost
Direct costs – households and government expenditures on treatment and preventionDirect costs – households and government expenditures on treatment and prevention
Indirect costs – losses of labor productive time due to mortality and morbidityIndirect costs – losses of labor productive time due to mortality and morbidity
Nigeria Government losses close to $1 billion ($868,421,052) annually (Jimoh, Nigeria Government losses close to $1 billion ($868,421,052) annually (Jimoh,
et alet al, 2007), 2007) In general context (In general context (Other studies outside NigeriaOther studies outside Nigeria):):
Monthly expenditure on malaria treatment is between $0.41 and $3.88 per Monthly expenditure on malaria treatment is between $0.41 and $3.88 per
personperson
Treatment equivalent between $1.88 and $26 per household (Chima, Treatment equivalent between $1.88 and $26 per household (Chima, et alet al, ,
2003)2003)
Very poor households spend 28% of their income on MalariaVery poor households spend 28% of their income on Malaria
In Africa, government spend estimated $1.83 and $8.01 per person (Shepard, In Africa, government spend estimated $1.83 and $8.01 per person (Shepard, et et
alal, 1991), 1991)
1. National Population Commission [NPC] (2008). Demographic and Health Survey [DHS] 2008.
Brief Background of Anambra Brief Background of Anambra State State
Created in 1991 and Located in the Created in 1991 and Located in the
South Eastern NigeriaSouth Eastern Nigeria Eight most populated state Eight most populated state
(4,055,048) and second most densely (4,055,048) and second most densely
populated (840/kmpopulated (840/km22) in Nigeria.) in Nigeria. Total area of 4,844 kmTotal area of 4,844 km22
Dominated by Igbos by tribe (98%) Dominated by Igbos by tribe (98%) Capital City as Awka, while Onitsha Capital City as Awka, while Onitsha
and Nnewi are the biggest most and Nnewi are the biggest most
commercial citiescommercial cities
1. National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010.
Current Malaria Control Strategies in Current Malaria Control Strategies in Anambra Anambra
Most Malaria program in Nigeria, including the 1998 Most Malaria program in Nigeria, including the 1998
WHO RBM program adopted these Strategies:WHO RBM program adopted these Strategies:
Diagnosis and treatment (D&T) with effective medicines Diagnosis and treatment (D&T) with effective medicines
Distribution and use of insecticide-treated nets (ITNs) to Distribution and use of insecticide-treated nets (ITNs) to
achieve coverage of populations at risk, with particular achieve coverage of populations at risk, with particular
focus on Children under 5 and Pregnant womenfocus on Children under 5 and Pregnant women
Indoor residual spraying (IRS) to curtail transmission Indoor residual spraying (IRS) to curtail transmission
Intermittent preventive treatment (IPT)Intermittent preventive treatment (IPT)
1. Image retrieved from: www.crick.ac.uk2. National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010.
Common Points of Interference for Malaria Common Points of Interference for Malaria ControlsControls
ConcernsConcerns No emphasis on the vectors No emphasis on the vectors
life cycle (life cycle (Weak interventionWeak intervention)) Expensive particularly in Expensive particularly in
poor regions (poor regions (Cost of regular
purchases and maintenance) ) High behavioral High behavioral
adherence / compliance adherence / compliance
requirements. requirements. E.g. only 35% of E.g. only 35% of
the population in the South Eastern the population in the South Eastern
Nigeria use at least one bed netNigeria use at least one bed net
(NMCP, 2012).(NMCP, 2012).
1. National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010.
Stakeholders of Malaria in Stakeholders of Malaria in Anambra StateAnambra State
Government:Government: Federal and State of Ministries of HealthFederal and State of Ministries of Health National and State Malaria Control ProgramsNational and State Malaria Control Programs Local Health DepartmentsLocal Health Departments Primary Health Care DepartmentsPrimary Health Care Departments
Non Governmental Organizations (NGOs)Non Governmental Organizations (NGOs) Community based Non-Governmental OrganizationsCommunity based Non-Governmental Organizations Community groups and CoalitionsCommunity groups and Coalitions
Major Donor AgenciesMajor Donor Agencies WHOWHO USAIDUSAID DFIDDFID World BankWorld Bank Global FundGlobal Fund
1. Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine & International Health: TM & IH, 6(9), 677-687.
Environmental Management Control Environmental Management Control (EMC) Strategies (EMC) Strategies
Vegetation ClearanceVegetation Clearance
Fumigation of bushesFumigation of bushes
Draining swampsDraining swamps
Surface application of oil to Surface application of oil to
open water bodiesopen water bodies
Modification of River Modification of River
boundariesboundaries
Disposal of all potential open Disposal of all potential open
water storage facilities and water storage facilities and
objects away from residential objects away from residential
area. area.
Environmental Risk Practices in Environmental Risk Practices in Anambra State Anambra State
Indiscriminate dumps of Indiscriminate dumps of
refuses and wastes close to refuses and wastes close to
residencesresidences
Dumps in swamps and Dumps in swamps and
drainages causing stagnant drainages causing stagnant
waterswaters
Abandonment of vegetation's Abandonment of vegetation's
and bushes within residential and bushes within residential
areas. areas.
Farming within residential Farming within residential
areasareas
1. Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine & International Health: TM & IH, 6(9), 677-687.
Efficacy and Cost Effectiveness of EMCEfficacy and Cost Effectiveness of EMC Studies have shown that EMC in combination with Studies have shown that EMC in combination with
quinine and ITN is capable of:quinine and ITN is capable of:
Reducing malaria related incidence, morbidity, and Reducing malaria related incidence, morbidity, and
mortality rates by 70 – 95% within 3 - 5 yearsmortality rates by 70 – 95% within 3 - 5 years
Averting estimated 4173 deaths and 161,205 Averting estimated 4173 deaths and 161,205
malaria attacks in one local community in 20 yearsmalaria attacks in one local community in 20 years
Saving estimated $858 per death and $22.20 per Saving estimated $858 per death and $22.20 per
attack .attack .
Averting disability adjusted life year (DALY) to the Averting disability adjusted life year (DALY) to the
cost of $524 – 591 per DALYcost of $524 – 591 per DALY
Other Advantages of EMCOther Advantages of EMC Strong benefits of the EMC strategy is the potential to: Strong benefits of the EMC strategy is the potential to:
Leverage the available community resources; hence, Leverage the available community resources; hence,
saving great costsaving great cost
Create more effective community sustainability and Create more effective community sustainability and
ownership. ownership.
Encourage sound community participation and communal Encourage sound community participation and communal
efforts. efforts.
Provide less stringent behavioral complianceProvide less stringent behavioral compliance
No significant side effectNo significant side effect
Address other of other environmental issues unrelated to Address other of other environmental issues unrelated to
malaria. malaria.
1. Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine & International Health: TM & IH, 6(9), 677-687.
Recommendations for Malaria Recommendations for Malaria Eradication in our CommunitiesEradication in our Communities
First, malaria eradication, rather than malaria control should First, malaria eradication, rather than malaria control should
be emphasized in the state policy and strategic plan for be emphasized in the state policy and strategic plan for
communities.communities. Channel more proportion of Malaria control donor and Channel more proportion of Malaria control donor and
government funds to community EMCgovernment funds to community EMC Empower and involve the State environmental Protection Empower and involve the State environmental Protection
Agency (EPA) as active stakeholders in the fight against Agency (EPA) as active stakeholders in the fight against
MalariaMalaria Strengthen the community participation in the community Strengthen the community participation in the community
EMC EMC Leverage the community resources to support this strategyLeverage the community resources to support this strategy Empower the community leaderships to support this course in Empower the community leaderships to support this course in
every community.every community.
ReferenceReferenceChima, R., Goodman, C., & Mills, A. (2003). The economic impact of malaria in Africa:
a critical review of the evidence. Health Policy, 63(1), 17-36.Jimoh, A., O. Sofola, A. Petu, and T. Okorosobo. 2007. “Quantifying the Economic
Burden of Malaria in Nigeria Using the Willingness to Pay Approach.” Cost Effectiveness and Resource Allocation 2007, 5:6. doi:10.1186/1478-7547-5-6.
National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010.
National Population Commission [NPC] (2008). Demographic and Health Survey [DHS] 2008.
Shepard, D., Ettling, M., Brinkmann, U., & Sauerborn, R. (1991). The economic cost of malaria in Africa. Tropical Medicine And Parasitology: Official Organ Of Deutsche Tropenmedizinische Gesellschaft And Of Deutsche Gesellschaft Für Technische Zusammenarbeit (GTZ), 42(3), 199-203.
Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine & International
Health: TM & IH, 6(9), 677-687.WHO (2013). Global health observatory. Retrieved from:
http://www.who.int/gho/malaria/en/index.html
1. Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine & International Health: TM & IH, 6(9), 677-687.
Revision of Learning ObjectivesRevision of Learning Objectives Have we achieved the objectives of this presentation, Have we achieved the objectives of this presentation,
otherwise ask questions for further clarifications?otherwise ask questions for further clarifications? Do you understand the mosquito and malaria cycle?Do you understand the mosquito and malaria cycle? Do you understand the health and economic? burden of Do you understand the health and economic? burden of
malaria in the World and Nigeria?malaria in the World and Nigeria? Do you know the available malaria control measures in Do you know the available malaria control measures in
Anambra State and their Merits and Demerits?Anambra State and their Merits and Demerits? Do you know the advantages of EMC over others?Do you know the advantages of EMC over others? Can you now make better informed and strategic Can you now make better informed and strategic
decisions on the fight against malaria in your decisions on the fight against malaria in your
communities?communities?
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