directorate of malaria control (domc), islamabad
TRANSCRIPT
Directorate of Malaria Control
(DOMC), Islamabad
FOREWORD
Malaria ranks sixth amongst the top ten causes of deaths and fourth
amongst the communicable diseases causing deaths in low income
countries of the world. Pakistan is among seven countries of the WHO
Eastern Mediterranean Region sharing 95% of the total regional malaria
burden. An estimated 98% of Pakistan population (205 million) is at varying
risk while 60% (123 million) population at high risk for malaria.
This annual report provides information for the malaria disease burden
across Pakistan for 2017. A total of 369,615 confirmed malaria cases have
been reported to the Directorate of Malaria Control (DOMC) as a result
of screening of around 6.2 million cases from all health facilities in provinces across Pakistan.
Epidemiologically, Pakistan is divided into high and low burden sharing districts based on the reported
malaria cases each year. Government of Pakistan is providing free of cost malaria diagnostic and treatment
services in around 5000 health facilities throughout the country with its own resources. However, the
support of Global Fund is available for further strengthening of around 3500 of these health facilities. The
number of Global Fund grant supported districts has increased from 43 in 2016 to 66 in 2017.
The malaria disease burden is still very high as a marked increase in the overall number of reported
confirmed malaria cases is seen in 2017 as compared to 2016. The major during 2017 activities have
focused towards provision of long-lasting insecticidal nets, trainings of health care providers on malaria
case management, malaria diagnosis through microscopy and Rapid diagnostic test (RDT), malaria
information system and outbreak response and BCC activities at different levels.
Several important developments took place during 2017. DOMC carried out nationwide consultation
meetings for development and successful submission of the New Funding Request for next three years
(2018-2020) under the program continuation to the Global Fund (TGF). Malaria Information System got
on board with new set of tools and trained personal to capture disaggregated information for confirmed
malaria cases. An online District Health Information System (DHIS-2) has been developed with the support
of Indus Health Network by end of the year. This will replace the manual excel based reporting system in
all the Global Fund grant supported districts in the next year.
Directorate of Malaria control (DOMC) is making utmost efforts to achieve the given targets and I can
see that with focused efforts, dedication and hard work of our teams, we will be able to eliminate Malaria
from Pakistan. I really appreciate the support of our partners including the Provincial Programs of
Balochistan, KP, KP-Tribal Districts and Sindh, the Global Fund, World Health Organization (WHO) and
Indus Health Network (IHN/TIH).
I believe that persistent efforts can bring positive change, and DOMC is focusing on that change, informing
policies and improving quality of services to control malaria and save precious lives.
Dr. Abdul Baseer Khan Achakzai
Director, Directorate of Malaria Control (DOMC)
M/O NHSR&C, Islamabad.
ACKNOWLEDGMENTS
Malaria annual report has been regularly developed by the Directorate of Malaria Control (DOMC) since
2016 onwards. This year report is focused on reporting of the malaria burden from all districts of Pakistan
including those supported by the Global Fund grant. The report has been developed primarily through a
secondary analysis of the programmatic and surveillance data received at the DOMC for the malaria
control activities in Pakistan.
We are also extremely thankful to our technical partner WHO, the Provincial Malaria Control Programs
of Balochistan, KP, KP-Tribal Districts (Ex. FATA) and Sindh, and the Global Fund for supporting malaria
control activities in Pakistan.
We would also like to appreciate the private sector Principal Recipient (PR), Indus Health Network
(IHN/TIH) and Sub-Recipients (SRs) of this grant including Association for Community Development
(ACD), Association for Social Development (ASD), Balochistan Rural Support Program (BRSP), Frontier
Primary Health Care (FPHC), National Rural Support Program (NRSP) and Pakistan Lions Youth Council
(PLYC) for all their hard work and efforts to ensure that all the planned activities are timely executed in
the best possible manner.
Lastly, we owe pronounced acknowledgements for the needy, deserving and suffering communities living
in the grant supported districts who have been a great source of motivation for us to deliver in the field
and continuously strive for malaria elimination from Pakistan.
CONTENTS
1. EXECUTIVE SUMMARY ................................................................................................................................... 8
1.1. INTRODUCTION ............................................................................................................................................ 8 1.2. DISEASE BURDEN & PROGRAMMATIC ACHIEVEMENTS ............................................................................... 8 1.3. PROVINCIAL FINDINGS ................................................................................................................................. 9 1.4. MALARIA CONTROL & PREVENTION ............................................................................................................. 9
1.4.1. Long Lasting Insecticidal Nets (LLINs) .................................................................................................. 9 1.4.2. BCC activities ..................................................................................................................................... 10
1.5. ISSUES AND CHALLENGES ........................................................................................................................... 10
2. MALARIA OVERVIEW ................................................................................................................................... 11
2.1. GLOBAL SITUATION .................................................................................................................................... 11 2.2. SITUATION IN PAKISTAN ............................................................................................................................. 11 2.3. PROGRAM GOAL AND OBJECTIVES5 ........................................................................................................... 12
2.3.1. Goal ................................................................................................................................................... 12 2.3.2. Objectives .......................................................................................................................................... 12
3. COUNTRY OVERALL FINDINGS ..................................................................................................................... 13
3.1. POPULATION COVERAGE ............................................................................................................................ 13 3.2. OVERALL DISEASE BURDEN IN 2017 ........................................................................................................... 13 3.3. ANNUAL PARASITE INCIDENCE (API) .......................................................................................................... 13 3.4. ANNUAL BLOOD EXAMINATION RATE (ABER) ............................................................................................ 14 3.5. TEST POSITIVITY RATE (TPR) ....................................................................................................................... 14
4. THE GLOBAL FUND (TGF) GRANT SUPPORTED DISTRICTS ............................................................................ 15
4.1.1. The Global Fund (TGF) Grant ............................................................................................................. 15 4.2. TGF GRANT GOAL AND OBJECTIVES ........................................................................................................... 15
4.2.1. Goal ................................................................................................................................................... 15 4.2.2. Objectives .......................................................................................................................................... 15 4.2.3. Total number of health facilities under the Global Fund grant ......................................................... 16
4.3. TGF DISTRICTS POPULATION COVERAGE .................................................................................................... 16 4.4. DISEASE BURDEN IN TGF SUPPORTED DISTRICTS ....................................................................................... 16 4.5. ANNUAL PARASITE INCIDENCE (API) .......................................................................................................... 18 4.6. ANNUAL BLOOD EXAMINATION RATE (ABER) ............................................................................................ 19 4.7. TEST POSITIVITY RATE (TPR) ....................................................................................................................... 20 4.8. TREND OF API, ABER AND TPR .................................................................................................................... 21
5. PROVINCIAL PROGRESS / ACHIEVEMENTS ................................................................................................... 22
5.1. KHYBER PAKHTUNKHWA (KP)..................................................................................................................... 22 5.2. SINDH ......................................................................................................................................................... 24 5.3. KP-TRIBAL DISTRICTS (FATA) ........................................................................................................................... 26 5.4. BALOCHISTAN............................................................................................................................................. 29
6. MALARIA CONTROL INTERVENTIONS .......................................................................................................... 32
6.1. LLINS/MOSQUITO NETS DISTRIBTION ........................................................................................................ 32 6.1.1. Mass distribution of LLINs ................................................................................................................. 32 6.1.2. Continuous distribution of LLINs through Antenatal Care (ANC) Clinics ............................................ 33
6.2. CAPACITY BUILDING ................................................................................................................................... 33
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6.2.1. Malaria case management................................................................................................................ 33 6.2.2. Malaria Diagnosis .............................................................................................................................. 33 6.2.3. Malaria information system (MIS) and outbreak response ............................................................... 34 6.2.4. Behavior Change Communication (BCC) activities ............................................................................ 34 6.2.5. Development of guidelines and training manuals ............................................................................. 35 6.2.6. Surveys conducted during 2017 ......................................................................................................... 35
7. ISSUES AND CHALLENGES ............................................................................................................................ 36
7.1. DELAYS IN ESTABLISHMENT AND FUNCTIONALITY OF NEW HEALTH FACILITIES ............................................................... 36 7.2. DELAYS IN REPORTING FROM THE NEW DISTRICTS................................................................................................... 36 7.3. INCREASED NUMBER OF YEARLY MALARIA CASES .................................................................................................... 36 7.4. FRAGMENTED HEALTH SYSTEM AND PARALLEL REPORTING SYSTEM ............................................................................ 36 7.5. LACK OF COMPLIANCE TO THE NATIONAL MALARIA TREATMENT GUIDELINES ................................................................ 36 7.6. LOWER COVERAGE OF MALARIA TRAININGS........................................................................................................... 37 7.7. CHALLENGES RELATED TO THE LLINS DISTRIBUTION................................................................................................ 37 7.8. UNREGULATED PRIVATE SECTOR ......................................................................................................................... 37
8. IMPORTANT EVENTS DURING 2017 ............................................................................................................. 38
8.1. ONLINE DISTRICT HEALTH INFORMATION SYSTEM (DHIS-2) MALARIA MODULE .......................................................... 38 8.1.1. WHO mission to Pakistan for DHIS-2 ................................................................................................. 38 8.1.2. Inception session for the provincial programs ................................................................................... 38 8.1.3. Training of trainers (TOT) and the data entry operators on DHIS-2 malaria module ........................ 38
8.2. WHO REGIONAL TRAINING WORKSHOP ON M&E AND SURVEILLANCE (MUSCAT-OMAN; OCT-2017)............................. 39 8.3. WHO 9TH INTER-COUNTRY MEETING OF NATIONAL MALARIA PROGRAM MANAGERS FROM HANMAT AND PIAM-NET
COUNTRIES (CAIRO-EGYPT; OCT-2017) ........................................................................................................................... 39 8.4. WHO AND UNIVERSITY OF OSLO MISSION VISIT TO PAKISTAN FOR DHIS-2 (DEC-2017) .............................................. 39 8.5. PROCUREMENT & SUPPLY CHAIN ....................................................................................................................... 39
9. ANNEXURES ................................................................................................................................................ 40
9.1. LIST OF THE GLOBAL FUND GRANT SUPPORTED DISTRICTS ........................................................................................ 40 9.2. DOMC PROCURED AMDS AND HP DURING 2017 (FOR BOTH PRS) ......................................................................... 42
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ACRONYMS AND ABBREVIATIONS
ACD Association for Community Development
ABER Annual Blood Examination Rate
ASD Association for Social Development
ACTs Artemisinin-Based Combination Therapy
API Annual Parasite Incidence
ASD Association for Social Development
BHU Basic Health Unit
BRSP Balochistan Rural Support Program
DHIS District Health information System
DHQ District Headquarter
DOMC Directorate of Malaria Control
FATA Federally Administered Tribal Areas
FPHC Frontier Primary Health Care
GTS Global Technical Strategy
IHN Indus Health Network
IRS Indoor Residual Spraying
LLINs Long Lasting Insecticidal Nets
MC Microscopy
MDGs Millennium Development Goals
MIS Malaria Information System
NFR New Funding Request
NRSP National Rural Support Program
PF Plasmodium Falciparum
PLYC Pakistan Lions Youth Council
PR Principal Recipient
PV Plasmodium Vivax
RDT Rapid Diagnostic Test
RHC Rural Health Center
SDGs Sustainable Development Goals
SPR Slide Positivity Rate
SR Sub-Recipients
TGF the Global Fund
THQ Tehsil Headquarter
TIH The Indus Hospital
TPR Test Positivity Rate
WHO World Health Organization
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LIST OF FIGURES
FIGURE 1 SHARE OF ESTIMATED MALARIA CASES, 2016 ........................................................................................................... 11 FIGURE 2 PROPORTION OF PLASMODIUM SPECIES, 2010 AND 2016 .......................................................................................... 11 FIGURE 3 TOTAL CONFIRMED MALARIA CASES IN 2017 ............................................................................................................ 13 FIGURE 4 API, ABER AND TPR IN 2017 .............................................................................................................................. 13 FIGURE 5 COUNTRY ANNUAL PARASITE INCIDENCE (API) OF 2017 ............................................................................................ 13 FIGURE 6 COUNTRY ANNUAL BLOOD EXAMINATION RATE (ABER) FOR 2017 ............................................................................. 14 FIGURE 7 COUNTRY TEST POSITIVITY RATE (TPR) FOR 2017 .................................................................................................... 14 FIGURE 8 FUNCTIONAL HEALTH FACILITIES UNDER TIH AND DOMC IN 2017 .............................................................................. 16 FIGURE 9 REPORTED CONFIRMED MALARIA CASES IN 2017 ....................................................................................................... 16 FIGURE 10 CONFIRMED MALARIA CASES REPORTED BY THE PROVINCES IN 2017 ........................................................................... 17 FIGURE 11 MONTHLY TRENDS OF CASES FROM 2014-2017 ..................................................................................................... 17 FIGURE 12 API, ABER AND TPR IN 2017 ............................................................................................................................ 18 FIGURE 13 ANNUAL PARASITE INCIDENCE (API) OF 2017 ........................................................................................................ 18 FIGURE 14 COMPARISON OF API IN LAST SIX YEARS ................................................................................................................. 19 FIGURE 15 ANNUAL BLOOD EXAMINATION RATE (ABER) FOR 2017 ......................................................................................... 19 FIGURE 16 COMPARISON OF ABER OF LAST SIX YEARS ............................................................................................................. 20 FIGURE 17 TEST POSITIVITY RATE (TPR) FOR 2017 ................................................................................................................ 20 FIGURE 18 COMPARISON OF TPR IN LAST SIX YEARS ................................................................................................................ 21 FIGURE 19 TRENDS OF API, ABER AND TPR OF LAST SIX YEARS ................................................................................................ 21 FIGURE 20 MALARIA CONFIRMED CASES DISTRIBUTION IN KP .................................................................................................... 22 FIGURE 21 DISTRICT WISE DISTRIBUTION OF CASES IN KP 2017 ................................................................................................. 22 FIGURE 22 BER, API AND TPR COMPARISON DISTRICT WISE OF KP 2017 ................................................................................... 23 FIGURE 23 MONTHLY TREND OF CASES REPORTED IN KP IN 2017 .............................................................................................. 23 FIGURE 24 YEAR WISE MONTHLY TREND OF CASES IN KP FROM 2014-2017 ............................................................................... 24 FIGURE 25 MALARIA CONFIRMED CASES DISTRIBUTION IN SINDH ............................................................................................... 24 FIGURE 26 DISTRICT WISE DISTRIBUTION OF CASES IN SINDH 2017 ............................................................................................ 25 FIGURE 27 BER, API AND TPR COMPARISON DISTRICT WISE OF SINDH 2017 .............................................................................. 25 FIGURE 28 MONTHLY TREND OF CASES REPORTED IN SINDH IN 2017 ......................................................................................... 26 FIGURE 29 YEAR WISE MONTHLY TREND OF CASES IN SINDH FROM 2014-2017 ........................................................................... 26 FIGURE 30 CASE DISTRIBUTION IN FATA ............................................................................................................................... 27 FIGURE 31 AGENCY WISE DISTRIBUTION OF CASES IN FATA 2017 ............................................................................................. 27 FIGURE 32 BER, API AND TPR COMPARISON AGENCY WISE OF FATA 2017 ............................................................................... 28 FIGURE 33 MONTHLY TREND OF CASES REPORTED IN FATA IN 2017 .......................................................................................... 28 FIGURE 34 YEAR WISE MONTHLY TREND OF CASES FROM 2014-2017 ........................................................................................ 29 FIGURE 35 MALARIA CONFIRMED CASES DISTRIBUTION IN BALOCHISTAN ..................................................................................... 29 FIGURE 36 DISTRICT WISE DISTRIBUTION OF CASES IN BALOCHISTAN 2017 .................................................................................. 30 FIGURE 37 BER, API AND TPR COMPARISON DISTRICT WISE OF BALOCHISTAN 2017 .................................................................... 30 FIGURE 38 MONTHLY TREND OF CASES REPORTED IN BALOCHISTAN IN 2017 ............................................................................... 31 FIGURE 39 YEAR WISE MONTHLY TREND OF CASES FROM 2014-2017 ........................................................................................ 31 FIGURE 40 MASS DISTRIBUTION OF LLINS IN PROVINCES/REGIONS IN 2017 ............................................................................... 32 FIGURE 41 DISTRICT WISE MASS DISTRIBUTION OF LLINS IN 2017 ............................................................................................. 33 FIGURE 42 LLINS ANC DISTRIBUTION IN 2017 ...................................................................................................................... 33 FIGURE 43 MALARIA TRAININGS CONDUCTED IN 2017 ............................................................................................................ 34 FIGURE 44 BCC (ADVOCACY AND AWARENESS SESSION CONDUCTED IN 2017.............................................................................. 34
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1. EXECUTIVE SUMMARY
1.1. INTRODUCTION
According to the WHO World Malaria Report 2017, 91 countries reported a total of 216 million cases
of malaria in 2016, an increase of 5 million cases over the previous year. In 2016, 85% of estimated vivax
malaria cases occurred in just five countries (Afghanistan, Ethiopia, India, Indonesia and Pakistan). Pakistan
is among seven countries of the WHO Eastern Mediterranean Region sharing 95% of the total regional
malaria burden. An estimated 98% of Pakistan population (205 million) is at varying risk while around 60%
(123 million) population at high risk for malaria. Pakistan is amongst the countries having a malaria control
program. Malaria stratification according to the National Strategic Plan (2015-2020) shows three
epidemiological strata. Stratum-I (API/TPR>5 annually) has the highest significance and includes 66 out of
the total 151 districts. TGF support has been mainly targeted for decreasing the burden of disease in the
highest endemic districts of the country through the provision of prompt diagnostic and treatment services
for malaria and prevention of the disease through providing insecticide treated nets (ITNs) and Indoor
Residual Spray (IRS) to the high risk group of communities.
1.2. DISEASE BURDEN & PROGRAMMATIC ACHIEVEMENTS
Overall country disease burden
A total of 369,615 confirmed malaria cases have been reported from all the health facilities across Pakistan
to the federal directorate. Around 6.2 million cases were screened at these facilities. Highest numbers of
the reported cases were P. Vivax (PV) 81.3% (300,426) followed by P. Falciparum (PF) 14.7% (54,405) and
Mix cases 4.0% (14,784). The cumulative API of all the districts/agencies of Pakistan in 2017 was 1.8 with
ABER of 3.04 and TPR of 5.9. Provincial breakdown indicates that during 2017 highest number of cases
was reported from KP 30.0% (110,739) followed by Sindh 26.5% (98,040), FATA 21.9% (80,924),
Balochistan 20.5% (75,790) and Punjab 01.1% (4,122).
The Global Fund Grant supported districts
The population coverage in the Global Fund supported districts was enhanced from 20.6 million in 2016
to 54.4 million in 2017 in four provinces. This has resulted in an increase of population by around 33.8
million (164%). The Global Fund grant support coverage has been enhanced during the year as the number
of reporting districts are increased from 43 in 2016 to 66 in 2017. The number of reporting health facilities
providing malaria diagnostic services have also been increased from 1955 in 2016 to 3396 in 2017. Around
3 million cases were screened at these facilities (0.8 million more than 2016).
A marked increase in the overall number of reported confirmed malaria cases is seen from 0.26 million in
2016 to 0.34 million in 2017. Highest number of the reported cases was P. Vivax (PV) 81% (277,713)
followed by P. Falciparum (PF) 15% (51,552) and Mix cases 4% (14,778). It has been seen that P. Vivax and
P. Falciparum cases had proportionally increased by 03% and 02% respectively while the proportion of mix
cases has decreased by around 05% in 2016 as compared to 2017. Provincial breakdown indicates that
during 2017 highest number of cases were reported from KP 31% (106,915) followed by Sindh 24%
(81,216), FATA 23% (80,924), Balochistan 21% (72,867) and Punjab 01% (2,121).
Regarding the trend of peak malaria season, 2017 reports highest number of cases with a peak reaching
in the month of August followed by September and October. The average API for TGF supported 66
districts and agencies was 6.3. Highest API was reported by FATA (16.2) followed by Balochistan, KP and
Sindh while lowest was reported by Punjab (0.7). The ABER for the year 2017 for TGF supported districts
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was reported to be 5.4. FATA (10.1) and Balochistan (5.8) reported the highest ABER followed by Sindh
(4.6). Punjab (0.9) reported the lowest ABER. The reported cumulative TPR was 11.6 for the year 2017.
FATA reported the highest TPR which was 16.1.
1.3. PROVINCIAL FINDINGS
During 2017, Khyber Pakhtunkhwa (KP) reported the highest number of cases with a total 106,915
cases as compared to 75,653 cases in 2016. A total of 101,854 cases of PV (95%) were reported followed
by PF 3992 (4%) and mix 1069 cases (1%). In 2017, KP reported API of 6.2, ABER of 4.6 and TPR of 13.4
as compared to API of 8.27, ABER of 6.27 and TPR of 13.2 in 2016. Highest number of cases were reported
from DI Khan (13182) followed by Charsadda (12715) and Bannu (12539). The highest API was reported
from district Tank of 20.6 followed by Lakki (13.5) and Bannu (10.7). Monthly trend of the number of
cases reported indicates a highest rise of cases in August reaching a peak of 10698 cases to 8771 cases in
October.
The number of malaria cases reported from Sindh was 81,216 as compared to 34,413 cases reported
during 2016. A total of 57,549 cases of PV (71%) were reported followed by PF 20,626 (25%) and mix
1069 cases (4%). Sindh reported an API of 4.6, ABER of 5.4 and TPR of 8.5 as compared to the reported
API of 5.67, ABER of 8.42 and TPR of 6.74 in 2016. Highest number of cases were reported from Thatta
(15,515) followed by Mirpur Khas (9597) and Khairpur (8920). Highest API was reported of district Thatta
(15.8) followed by Sujawal (7.9) and Umerkot (6.8). Monthly trend of the number of cases reported
indicates a highest rise of cases in August reaching a peak of 7902 cases to 5596 cases in October.
The number of malaria cases reported from FATA was 80,924 as compared to 84,002 cases reported
during 2016; hence a decline of around 04% (3078) cases despite no change in the number of reporting
agencies and FRs during the current as compared to the last year. A total of 72,392 cases of PV (89%)
were reported followed by PF 6653 (8%) and mix 1879 cases (2%). In 2017, FATA reported API of 16.2,
ABER of 10.1 and TPR of 16.1 as compared to the API of 17.54, ABER of 10.37 and TPR of 17.01 reported
during 2016. Highest number of cases were reported from Khyber (21068) followed by SWA (12556) and
Mohmand (7946). The highest API was reported by FR Lakki of 121.0 followed by FR Bannu (86.6) and FR
Tank (79.3). Monthly trend of the number of cases reported indicates a highest rise of cases in August
reaching a peak of 8204 cases to 7158 cases in October.
Balochistan reported a total 72,867 cases as compared to 66,032 cases reported during 2016. A total
of 44,655 cases of PV (61%) were reported followed by PF 19,666 (27%) and mix 8546 (12%) cases. In
2017, Balochistan reported API of 6.3, ABER of 5.8 and TPR of 10.7 as compared to reported API of 12.39,
ABER of 10.30 and TPR of 12.03 during 2016. Highest number of cases were reported from district
Jaffarabad (7912) followed by Zhob (7182) and Musakhel (6300). The highest API was reported of district
Musakhel of 37.7 followed by Sherani (25.9) and Zhob (23.1). Monthly trend of the number of cases
reported indicates a highest rise of cases in September reaching a peak of 6370 cases to 6032 cases in
October.
1.4. MALARIA CONTROL & PREVENTION
1.4.1. Long Lasting Insecticidal Nets (LLINs)
Around 1.19 million LLINs were distributed in TGF covered districts in 2017 through ‘Mass Distribution’.
Highest number of LLINs (0.6 million) distributed through mass distribution was seen in the Balochistan
province. Highest number of LLINs distributed through mass distribution was seen in South Waziristan
(145,152) followed by Dera Bugti (126,576). A total of 233,398 LLINs were distributed in 2017 through
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‘ANC clinics’ as compared to 195,754 LLINs distributed in 2016. Highest distribution through ANC clinics
took place in Sindh province (85,856).
1.4.2. BCC activities
In 2017, 52,888 personnel participated in the ‘advocacy sessions’ regarding preventive and curative services
pertinent to malaria. These participants then conducted community awareness sessions and a total of
around 1,442,302 members from the communities were reached.
1.5. ISSUES AND CHALLENGES
Following are the major issues and challenges faced during the year:
▪ Around 23 new districts were added under the Global Fund grant. SRs had to establish new malaria
diagnostic centers in these new districts. There was a delay in establishment and functionality of the
new centers mainly due to the delayed trainings of the facility focal persons.
▪ Due to the delays in training of the new facility focal persons and establishment of the new malaria
diagnostic centers, the reporting from the 23 new districts was also delayed till around July 2016.
▪ The number of malaria cases like the last year has shown an increase in the current year as well. This
increase can be attributed to the increased number of reporting health facilities, increased number of
grant supported districts, and better screening rates of malaria suspects.
▪ Malaria screening and confirmed cases data at the health facilities level is recorded and reported
through two parallel reporting and surveillance systems namely the District Health Information System
(DHIS) and Malaria Information System (MIS). When there are parallel reporting systems and different
recording and reporting tools from same health facilities, the data quality is usually compromised as
entering the data into separate platforms will result in more errors. An integrated disease reporting
system and use of the update online DHIS-2 are the potential options for better integrity and
coherence of reported data.
▪ Compliance to the national malaria treatment guidelines remained low mainly in few old and many
new grant supported districts. The turnover of health care providers and transfer of trained health
care providers is a big challenge. The overall coverage of trainings is far low than the desired levels.
▪ LLINs distribution along with Logistics arrangement of LLINs in terms of establishing warehouses and
transportation in the remote and security prone areas of Balochistan and FATA during the year has
been challenging. Issues were mainly seen in the districts of Dera Bugti, Musakhel, Jhal Magsi and
Jaffarabad in Balochistan while FR regions in FATA. These challenges resulted in delayed distribution
of LLINs in these remote districts.
▪ Ensuring the availability of key anti-malarial drugs (AMDS) in the security prone areas especially FR
regions in FATA has been a challenge. Mainly issues were access of logistics staff for the reporting and
providing the logistic support. Despite of these, above 90% stock availability was ensured.
▪ Both DOMC and IHN/TIH have scaled up the involvement of the private sector GPs (approx. 15 per
district) for the free of cost malaria diagnosis and treatment services, however their regulation as per
program requirement remains a challenge.
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2. MALARIA OVERVIEW
2.1. GLOBAL SITUATION
According to the WHO World Malaria Report 2017, 91 countries reported a total of 216 million cases
of malaria in 2016, an increase of 5 million cases over the previous year. The global tally of malaria deaths
reached 445,000 deaths, about the same number reported in 2015. All regions recorded reductions in
mortality in 2016 when compared with 2010, with the exception of the WHO Eastern Mediterranean
Region, where mortality rates remained virtually unchanged in the period. In 2016, 85% of estimated vivax
malaria cases occurred in just five countries (Afghanistan, Ethiopia, India, Indonesia and Pakistan).
Although malaria case incidence has fallen globally since 2010,
the rate of decline has stalled and even reversed in some
regions since 2014. Mortality rates have followed a similar
pattern. Effective surveillance of malaria cases and deaths is
essential for identifying the areas or population groups that
are most affected by malaria, and for targeting resources for
maximum impact. A strong surveillance system requires high
levels of access to care and case detection, and complete
reporting by all health sectors, whether public or private.1
2.2. SITUATION IN PAKISTAN
Pakistan is among seven countries of the WHO Eastern Mediterranean Region sharing 95% of the total
regional malaria burden.2 An estimated 98% of Pakistan population (205 million) is at varying risk while
around 60% (123 million) population at high risk for malaria. In this country, Malaria with Plasmodium vivax
is more common (88%), while malaria with Plasmodium falciparum is seen only during rainy seasons or post
rain accounting for 12% of the malaria burden.3
In 2016, with around 2.1 million cases, Pakistan
contributed to 12% of the overall P. vivax
malaria cases. Malaria is present in 91 countries,
some of these are those progressing toward
elimination and others with a high burden of
malaria that are in control phase experiencing
setbacks in their responses. Pakistan is amongst
the countries having a malaria control program.
Mass population movements within the country
and across international borders, unpredictable
transmission patterns, the low immune status of
the population, climatic changes, poor socioeconomic conditions, declining health infrastructure, resource
1 WHO, World Malaria Report 2017 2 EMRO WHO. Country Total reported cases Total confirmed Total reported cases Total confirmed Total
reported cases Total confirmed Afghanistan Djibouti. 2016;1–6 3 Khattak AA, Venkatesan M, Nadeem MF, Satti HS, Yaqoob A, Strauss K, et al. Prevalence and distribution of
human Plasmodium infection in Pakistan. Malar J. 2013;12(1):1–8
Figure 1 Share of estimated malaria cases, 2016
Figure 2 Proportion of Plasmodium species, 2010 and 2016
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constraints, poor access to preventive and curative services, and mounting drug and insecticide resistance
in parasites and vectors, all contribute to this huge disease burden.4
Malaria stratification5 according to the National Strategic Plan (2015-2020) shows three epidemiological
strata. Stratum-I (API/TPR>5 annually) has the highest significance and includes 66 out of the total 151
districts6. A significant reduction was observed in the overall incidence of P. falciparum cases by >80%
(73,925 in 2011 to 18,432 in 2015) in TGF supported districts7. This reduction is attributed mainly to TGF
interventions including ACT and LLINs.
Epidemiologically, it is classified as a moderate malaria endemic country with a National annual parasite
incidence (API) averaging at 1.16. Annual program data of 2016 shows that there is high variation of API
within different provinces of Pakistan (Sindh 1.06, KP 2.28, Balochistan 5.39, FATA 8.63 and Punjab 0.03).8
2.3. PROGRAM GOAL AND OBJECTIVES5
2.3.1. Goal
By 2020, reduce the malaria burden by 75% in high and moderate endemic districts/agencies and eliminate
malaria in low endemic districts of Pakistan.
2.3.2. Objectives
The key objectives of the programme are:
1. To achieve <5 API in high endemic areas of province of Balochistan, Sindh, KP and FATA region by
2020
2. To achieve <1% API within moderate endemic districts of Balochistan, Sindh, KP and Punjab by 2020
3. To achieve Zero API within low endemic districts of Sindh, KP and Punjab by 2020
Specific Objectives
1) To ensure and sustain the provision of quality assured early diagnosis and prompt treatment services
to >80% at risk population by 2020
2) To ensure and sustain coverage of multiple prevention interventions (IRS, LLINs & and other
innovative tools and technologies) to 100% in the target high risk population as per national guidelines
and coverage in foci in moderate and low risk districts by 2020
3) To increase community awareness up to 80% on the benefits of early diagnosis and prompt treatment
and malaria prevention measures using health promotion, advocacy and BCC intervention by 2020
4) To enhance technical and managerial capacity in planning, implementation, management and MEAL
(Monitoring, Evaluation, Accountability and Learning) of malaria prevention and control intervention
by 2016
5) To ensure availability of quality assured strategic information (epidemiological, entomological and
operational) for informed decision making and; functional, passive and active case based weekly
surveillance system in all low risk districts by 2017
6) To ensure provision of malaria prevention, treatment and control services in humanitarian crises,
emergencies and cross-border situation.
4 http://www.emro.who.int/pak/programmes/roll-back-malaria.html accessed on 24th July 2017 5 Strategic Plan Malaria Control Program Pakistan (2015-2020) 6 Pakistan Bureau of Statistics; http://www.pbscensus.gov.pk/content/distribution-districts-phases 7 Routine malaria information system 2015 8 Unit PM. Malaria Annual Report 2016.
3. COUNTRY OVERALL FINDINGS
3.1. POPULATION COVERAGE
Directorate of Malaria Control (DOMC) in collaboration with the Provincial Malaria Control Programs
of all the provinces has been providing malaria preventive and treatment services all over the country.
The interventions were carried out at primary health facilities including Basic Health Units (BHUs) and
Civil Dispensaries (CDs), secondary level health facilities including District Headquarter (DHQ) hospitals,
Tehsil Headquarter (THQ) hospitals and Rural Health Centers (RHC).
3.2. OVERALL DISEASE BURDEN IN 2017
A total of 369,615 confirmed malaria cases have been reported from all the health facilities across Pakistan
to the federal directorate. Around 6.2 million cases were screened at these facilities. Highest numbers of
the reported cases were P. Vivax (PV) 81.3% (300,426) followed by P. Falciparum (PF) 14.7% (54,405) and
Mix cases 4.0% (14,784). (Figure: 3)
The cumulative API of all the districts/agencies of Pakistan in 2017 was 1.8 with ABER of 3.04 and TPR of
5.9. Provincial breakdown indicates that during 2017 highest number of cases was reported from KP 30.0%
(110,739) followed by Sindh 26.5% (98,040), FATA 21.9% (80,924), Balochistan 20.5% (75,790) and Punjab
01.1% (4,122).
3.3. ANNUAL PARASITE INCIDENCE (API)
The overall API of country was 1.8 (using census-2017 population). Highest API was reported by FATA
(16.2) followed by Balochistan, KP and Sindh while lowest was reported by Punjab. (Figure: 5)
Figure 5 Country Annual Parasite Incidence (API) of 2017
0.02.0
3.6
6.3
16.2
1.8
0.0
5.0
10.0
15.0
20.0
Punjab Sindh KP Balochistan FATA Overall
300,426
54,40514,784
369,615
P. Vivax P. Falciparum Mix Confirmedcases
3.0
5.9
1.8
0.0
2.0
4.0
6.0
8.0
ABER TPR API
Figure 4 API, ABER and TPR in 2017 Figure 3 Total confirmed malaria cases in 2017
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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3.4. ANNUAL BLOOD EXAMINATION RATE (ABER)
The overall ABER9 for all country was 3.0. FATA (10.1) and Balochistan (5.9) reported the highest ABER.
(Figure: 6)
Figure 6 Country Annual Blood Examination Rate (ABER) for 2017
3.5. TEST POSITIVITY RATE (TPR)
The reported cumulative TPR was 5.9. FATA reported the highest TPR which was 16.1 followed by
Balochistan (12.4) as shown in Figure: 7.
Figure 7 Country Test Positivity Rate (TPR) for 2017
9 Annual Blood Examination Rate (ABER) = The number of patients receiving a parasitological test for
malaria (blood slide for microscopy or malaria rapid diagnostic test) per 100 population per year
2.42.9 3.2
5.9
10.1
3.0
0.0
2.0
4.0
6.0
8.0
10.0
12.0
Punjab Sindh KP Balochistan FATA Overall
0.2
6.3
10.712.4
16.1
5.9
0
2
4
6
8
10
12
14
16
18
Punjab Sindh KP Balochistan FATA Overall
Punjab Sindh KP Balochistan FATA Overall
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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4. THE GLOBAL FUND (TGF) GRANT SUPPORTED DISTRICTS
4.1.1. The Global Fund (TGF) Grant
TGF support has been mainly targeted for decreasing the burden of disease in the highest endemic districts
of the country through the provision of prompt diagnostic, treatment and preventive services for malaria
through providing Long Lasting Insecticidal Nets (LLINs) and Indoor Residual Spray (IRS) to the high risk
groups. Facility level services include screening of the suspects through microscopy and rapid diagnostic
test (RDT), confirmation, treatment and follow-up of the malaria cases.10
Directorate of Malaria Control Program (DOMC) is the main public sector Principal Recipient (PR) for
the Global Fund New Funding Model (NFM) grant while Indus Health Network (IHN/TIH) is the main
private sector PR. In 2017, DOMC implemented Malaria Control interventions in 48 highly endemic
districts and agencies of Pakistan (Table 1) through 8 public and private Sub-Recipients (SRs) in Balochistan
(18), FATA (10)*11, KP (7), Sindh (12) and Punjab (1). Public SRs for DOMC were Integrated Vector
Control / Malaria Control Program (IVC/MCP) Khyber Pakhtunkhwa (KP), Integrated Vector Management
Program (IVMP) FATA, Directorate of Malaria Control (DOMC) Sindh and Directorate of Vector Borne
Diseases (VBD) Balochistan. Private SRs were Association for Community Development (ACD),
Association for Social Development (ASD), National Rural Support Program (NRSP) and Pakistan Lions
Youth Council (PLYC).
Indus Health Network (IHN/TIH) is implementing similar interventions in 18 districts (Table 1) of KP (7)
and Balochistan (11) through 2 SRs namely Balochistan Rural Support Program (BRSP) and Frontier
Primary Health Care (FPHC).
4.2. TGF GRANT GOAL AND OBJECTIVES
4.2.1. Goal
By 2020, reduce the malaria burden by 60% in 66 high endemic districts/agencies (Stratum- I) of Pakistan.
4.2.2. Objectives
The key objectives of the programme are to:
1. Ensure and sustain universal coverage of multiple prevention to population at risk in target districts
by 2020
2. Ensure and sustain > 80% coverage for the provision of quality assured early diagnosis and prompt
treatment services to population at risk in target districts by 2020
3. Increase community awareness up to 80% on the benefits of early diagnosis, prompt treatment and
Malaria preventive measures using health promotion, advocacy and BCC interventions by 2020
4. Ensure availability of quality assured strategic information (epidemiological, entomological and
operational) for informed decision making
5. Enhance technical and managerial capacities of malaria control programs in planning, implementation,
management and M&E
10 The Global Fund. Pakistan - Country Overview [Internet]. [cited 2018 Mar 30]. Available from:
https://www.theglobalfund.org/en/portfolio/country/ 11 * For administrative purposes, six FRs of FATA had been merged to three; hence a total of 13 FRs and Agencies
of FATA have been taken as 10 FRs and agencies.
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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4.2.3. Total number of health facilities under the Global Fund grant
A total of 2540 public and private diagnostic centers (Microscopy + RDT) were fully functional in 2017
under DOMC covered districts and agencies. Similarly a total of 984 public and private diagnostic centers
(Microscopy+ RDT) were fully functional in IHN/TIH covered districts.
4.3. TGF DISTRICTS POPULATION COVERAGE
The population coverage in the Global Fund supported districts was enhanced from 20.6 million in 2016
to 54.4 million in 2017 in four provinces. This has resulted in an increase of population by around 33.8
million (164%). The interventions were carried out at primary health facilities including Basic Health Units
(BHUs) and Civil Dispensaries (CDs), secondary level health facilities including District Headquarter
(DHQ) hospitals, Tehsil Headquarter (THQ) hospitals and Rural Health Centers (RHC).
4.4. DISEASE BURDEN IN TGF SUPPORTED DISTRICTS
The Global Fund grant support coverage has been enhanced during the year as the number of reporting
districts are increased from 43 in 2016 to 66 in 2017. The number of reporting health facilities providing
malaria diagnostic services have also been increased from 1955 in 2016 to 3396 in 2017. Around 3 million
cases were screened at these facilities (0.8 million more than 2016).
A marked increase in the overall number of reported confirmed malaria cases is seen from 0.26 million in
2016 to 0.34 million in 2017. A total of 344,043
confirmed malaria cases were reported from
grant supported facilities in the Global Fund
districts and agencies in 2017 as compared to
260,100 cases in 2016. Highest number of the
reported cases were P. Vivax (PV) 81%
(277,713) followed by P. Falciparum (PF) 15%
(51,552) and Mix cases 4% (14,778); as shown
in Figure: 9. It has been seen that P. Vivax and P.
Falciparum cases had proportionally increased
by 03% and 02% respectively while the
proportion of mix cases has decreased by
around 05% in 2016 as compared to 2017. This
MIX, 14,778, 4%
PF, 51,552, 15%
PV, 277,713, 81%
MIX PF PV
192522
270
984
476
1755
309
2540
0
500
1000
1500
2000
2500
3000
Public Private
MS RDT Total
TIH DMC
Figure 8 Functional Health Facilities under TIH and DOMC in 2017
Figure 9 Reported confirmed malaria cases in 2017
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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may be attributed to the type of RDT kits (Pf/Pv combo) which have been used in the grant supported
health facilities during 2017. These are more specific for detection of the P. Falciparum and P. Vivax cases.
Provincial breakdown indicates that during
2017 highest number of cases were reported
from KP 31% (106,915) followed by Sindh
24% (81,216), FATA 23% (80,924),
Balochistan 21% (72,867) and Punjab 01%
(2,121). This was different than the last year
2016 where FATA had reported the highest
number of cases 32% (84,002), followed by
KP 29% (75,653), Balochistan 26% (66,032),
and Sindh 13% (34,413). The possible reason
may be that new additional districts included
in the grant were from the provinces of KP,
Sindh and Balochistan in 2017, while all
areas of FATA were already covered in the
grant even during 2016.
Regarding the trend of peak malaria season, 2017 reports highest number of cases with a peak reaching
in the month of August followed by September and October (Figure: 11). The trend is almost the same in
previous three years as well with highest number of cases reported from August to October.
Figure 11 Monthly trends of cases from 2014-2017
9,379 8,224 10,40815,756
24,30626,841
41,601
65,617
52,175
45,011
27,967
14,637
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
Jan Feb Mar April May June July Aug Sept Oct Nov Dec
2017 2016 2015 2014
KP31%
Sindh24%
Balochistan 21%
FATA23%
Punjab1%
Figure 10 Confirmed malaria cases reported by the Provinces in 2017
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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The average API of these 66 districts/agencies in 2017 was 6.3 with ABER of 5.4 and TPR of 11.6 as
compared to the reported API of 10.28, ABER of 8.4 and TPR of 12.23 in 2016 (Figure: 12). The decline
in API and ABER has majorly been contributed by the increased population of the grant supported districts
due to the inclusion of 23 new districts. Furthermore, the updated population figures have been taken
from census-2017 data. This has resulted in an increase of around 164% in the overall population in all
grant supported districts.
Figure 12 API, ABER and TPR in 2017
4.5. ANNUAL PARASITE INCIDENCE (API)
Based on the compiled reported malaria data from public and private facilities for 2017 and using census
2017 population data, the average API for TGF supported 66 districts and agencies was 6.3. Highest API
was reported by FATA (16.2) followed by Balochistan, KP and Sindh while lowest was reported by Punjab
(0.7). (Figure: 13).
Figure 13 Annual Parasite Incidence (API) of 2017
5.46.3
11.6
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
ABER API TPR
0.7
4.66.2 6.3
16.2
6.3
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
Punjab Sindh KP Balochistan FATA Overall
Under the Global Fund grant, the number of targeted districts for intervention has been varying over the
period of time. API declined from 7.82 per 1000 per year in 2012 to 5.54 in 2015. The 2016 API showed
an increase in malaria incidence which could be attributed to the increase in coverage of the malaria
diagnostic and case management services. However, API estimates for year 2017 showed a decline as
compared to 2016. This may be due to the inclusion of many new districts under the grant where the
TGF support was enhanced from 43 districts and agencies in 2016 to 66 districts and agencies in 2017.
Furthermore, the inclusion of 23 new districts in 2017 also increased the overall targeted population by
around 164% for the grant supported districts. The newly included districts and agencies were those
having relatively less disease burden as compared to earlier ones. This may have also resulted in a drop in
API in 2017 as compared to 2016. The year-wise comparison of the APIs since 2012 is shown in the graph
below: (Figure: 14)
Figure 14 Comparison of API in last six years
4.6. ANNUAL BLOOD EXAMINATION RATE (ABER)
The overall ABER12 for different provinces/regions is shown in Figure: 15. The ABER for the year 2017 for
TGF supported districts was reported to be 5.4. FATA (10.1) and Balochistan (5.8) reported the highest
ABER followed by Sindh (4.6). Punjab (0.9) reported the lowest ABER.
Figure 15 Annual Blood Examination Rate (ABER) for 2017
12 Annual Blood Examination Rate (ABER) = The number of patients receiving a parasitological test for
malaria (blood slide for microscopy or malaria rapid diagnostic test) per 100 population per year
7.8 7.97.3
5.5
10.3
6.3
0.0
2.0
4.0
6.0
8.0
10.0
12.0
2012 2013 2014 2015 2016 2017
0.9
4.65.4
5.8
10.1
5.4
0.0
2.0
4.0
6.0
8.0
10.0
12.0
Punjab Sindh KP Balochistan FATA Overall
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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The blood screening rates of 2017 (5.4) were also lower as compared to 2016 (8.4). Year wise comparison
since 2012 is shown in Figure: 16. Due to inclusion of 23 new districts in the grant in 2017 and because of
the increased population of these districts, the ABER has shown a decline from 8.4 to 5.4 in 2017 as
compared to 2016.
Figure 16 Comparison of ABER of last six years
4.7. TEST POSITIVITY RATE (TPR)
The reported cumulative TPR was 11.6 for the year 2017. FATA reported the highest TPR which was
16.1 (Figure: 17).
Figure 17 Test Positivity Rate (TPR) for 2017
5.9 6.2
7.1
6.0
8.4
5.4
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
2012 2013 2014 2015 2016 2017
8.0 8.5
10.7
13.4
16.1
11.6
0
2
4
6
8
10
12
14
16
18
Punjab Sindh KP Balochistan FATA Overall
The yearly trends show that TPR in cumulative TPR in 2017 (11.6) has slightly declined as compared to
2016 (12.2). (Figure: 18).
Figure 18 Comparison of TPR in last six years
4.8. TREND OF API, ABER AND TPR
Comparing the trends of API, ABER and TPR of last six years, slight decrease can be seen in all the three
indicators in 2017. (Figure: 19) The probable reason may be that the coverage of diagnosis and cases
management services was further expanded in 2017 as compared to 2016 in both the public and private
sector in all 66 grant supported districts. Due to the inclusion of the new districts, the total targeted
population in the grant supported districts has increased. This has decreased the API and ABER as the
newly strengthened health facilities are supposed to take much longer time for reaching the desired level
of screening for the suspected malaria cases. Due to ABER just around 6.3 in these districts, the TPR may
not be true reflective of the malaria endemicity. It may improve with the passage of time as the screening
of malaria suspects in increased in the grant supported new districts.
Figure 19 Trends of API, ABER and TPR of last six years
16.6
13.2
10.6 10.5
12.211.6
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
2012 2013 2014 2015 2016 2017
7.8 7.97.3
5.5
10.3
6.35.9 6.27.1
6.0
8.4
5.4
16.6
13.2
10.6 10.5
12.211.6
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
2012 2013 2014 2015 2016 2017
API ABER TPR
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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5. PROVINCIAL PROGRESS / ACHIEVEMENTS
5.1. KHYBER PAKHTUNKHWA (KP)
During 2017, KP reported the highest number of cases with a total 106,915 cases as compared to 75,653
cases in 2016. As discussed earlier, the main reason of increased number of reported malaria cases seems
to be the inclusion of seven new districts from KP province in the grant. The seven newly added districts
included Buner, Hangu, Karak, Kohat, Lower Dir, Shangla, and Swat. Earlier KP had only seven grant
support districts. After addition of seven new districts, the total number of grant supported districts has
now doubled from seven to fourteen in KP province. A total of 101,854 cases of PV (95%) were reported
followed by PF 3992 (4%) and mix 1069 cases (1%).
Figure 20 Malaria confirmed cases distribution in KP
In 2017, KP reported API of 6.2, ABER of 4.6 and TPR of 13.4 as compared to API of 8.27, ABER of 6.27
and TPR of 13.2 in 2016. The decrease in API and ABER may be attributed to the increase in population
due to the inclusion of seven new districts during 2017.
Considering district wise situation, during 2017 highest number of cases were reported from DI Khan
(13182) followed by Charsadda (12715) and Bannu (12539). Last year in 2016, Bannu had reported the
highest number of malaria cases (16,161). (Figure: 21)
Figure 21 District wise distribution of cases in KP 2017
1,069 3,992
101,854106,915
0
20,000
40,000
60,000
80,000
100,000
120,000
Mix PF PV Total
1,5102,665 3,018 3,068
4,5535,535
7,919 8,078 8,317
11,824 11,99212,539 12,715 13,182
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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The highest API was reported from district Tank of 20.6 followed by Lakki (13.5) and Bannu (10.7). (Figure:
22).
Figure 22 BER, API and TPR comparison district wise of KP 2017
Monthly trend of the number of cases reported indicates a highest rise of cases in August reaching a peak
of 10698 cases to 8771 cases in October. Minimal cases have been reported from January to March.
(Figure: 23)
Figure 23 Monthly trend of cases reported in KP in 2017
1.3 2.04.3 4.6 5.1 5.1 5.5 5.5 6.2
7.9 8.1
10.7
13.5
20.6
0
5
10
15
20
25
ABER API TPR
2348 20442403
3351
47825129
6603
1069810295
8771
6306
3986
0
2000
4000
6000
8000
10000
12000
Jan Feb Mar April May June July Aug Sept Oct Nov Dec
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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A yearly comparison of the cases reported from 2014-2017 also indicates a peak season of August –
October followed by a decline (Figure: 24).
Figure 24 Year wise monthly trend of cases in KP from 2014-2017
5.2. SINDH
The number of malaria cases reported from Sindh in 2017 was 81,216 as compared to 34,413 cases
reported during 2016. During 2017, seven new districts were included in the grant namely Badin, Kambar
Shahdadkot, Larkana, Naushahro Feroz, Sukkur, Tando Muhammad Khan, and Umerkot; while Thatta was
divided into one additional district namely Sujawal. Earlier in 2016, only five districts had reported while
during 2017 the number of reporting districts has increased to 13 now. It seems that the addition of these
seven new districts to the grant during 2017 has contributed in reporting higher number of cases from
the Sindh province.
A total of 57,549 cases of PV (71%) were reported followed by PF 20,626 (25%) and mix 1069 cases
(4%). (Figure: 25)
Figure 25 Malaria confirmed cases distribution in Sindh
In 2017, Sindh reported API of 4.6, ABER of 5.4 and TPR of 8.5 as compared to the reported API of
5.67, ABER of 8.42 and TPR of 6.74 in 2016. The decrease in API and ABER may be attributed to the
increase in population due to the inclusion of seven new districts during 2017.
2227 1797 24073737
67818205
12771
19274
15891
12844
8347
4317
0
5000
10000
15000
20000
25000
Jan Feb Mar April May June July Aug Sept Oct Nov Dec
2017 2016 2015 2014
3,041
20,626
57,549
81,216
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
Mix PF PV Total
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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Considering district wise situation, highest number of cases were reported from Thatta (15,515) followed
by Mirpur Khas (9597) and Khairpur (8920). (Figure: 26) During 2016, Khairpur (10,550) had reported
the highest number of malaria cases.
Figure 26 District wise distribution of cases in Sindh 2017
Highest API was reported of district Thatta (15.8) followed by Sujawal (7.9) and Umerkot (6.8). (Figure:
27).
Figure 27 BER, API and TPR comparison district wise of Sindh 2017
1,814 2,056 2,127
3,673 3,684
5,0836,157
6,782 7,2928,516 8,920
9,597
15,515
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
18,000
1.2 1.62.3
3.0 3.3 3.7 4.1 4.4 4.7
6.4 6.87.9
15.8
0
2
4
6
8
10
12
14
16
18
ABER API TPR
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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Monthly trend of the number of cases reported indicates a highest rise of cases in August reaching a peak
of 7902 cases to 5596 cases in October. Minimal cases have been reported from January to March. (Figure:
28)
Figure 28 Monthly trend of cases reported in Sindh in 2017
A yearly comparison of the cases reported from 2014-2017 also indicates a peak season of August –
October followed by a decline (Figure: 29).
Figure 29 Year wise monthly trend of cases in Sindh from 2014-2017
5.3. KP-Tribal Districts (FATA)
The number of malaria cases reported from FATA in 2017 were 80,924 as compared to 84,002 cases
reported during 2016; hence a decline of around 04% (3078) cases. There was no change in the number
of reporting agencies and FRs during 2017 as compared to 2016. However, due to the updated population
figures of census-2017, an increase in the population of FATA has been seen. Earlier the population used
in 2016 for estimation of API was 4,761,021 based on EPI population estimates; the revised census
population for FATA is 4,996,556 (an increase of around 5%).
1555 1383 15152185
2664 2652
3750
7902
62295596
3704
2519
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
Jan Feb Mar April May June July Aug Sept Oct Nov Dec
1834 1290 15002783
4358 4288
8782
21023
1347512328
6062
3493
0
5000
10000
15000
20000
25000
Jan Feb Mar April May June July Aug Sept Oct Nov Dec
2017 2016 2015 2014
A total of 72,392 cases of PV (89%) were reported followed by PF 6653 (8%) and mix 1879 cases (2%).
Figure 30 Case distribution in FATA
In 2017, FATA reported API of 16.2, ABER of 10.1 and TPR of 16.1 as compared to the API of 17.54,
ABER of 10.37 and TPR of 17.01 reported during 2016. The decrease in API may be contributed by the
increased population of FATA as reported by censuse-2017.
Considering district wise situation, highest number of cases were reported from Khyber (21068) followed
by SWA (12556) and Mohmand (7946). (Figure: 31). During 2016, highest number of confirmed malaria
cases was reported from same agency, i.e. Khyber (23,492).
Figure 31 Agency wise distribution of cases in FATA 2017
1,8796,653
72,392
80,924
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
90,000
Mix PF PV Total
2305 2887 3190 3356 3712 37334740
62177250 7946
12556
21068
0
5000
10000
15000
20000
25000
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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The highest API was reported by FR Lakki of 121.0 followed by FR Bannu (86.6) and FR Tank (79.3)
(Figure: 32).
Figure 32 BER, API and TPR comparison agency wise of FATA 2017
Monthly trend of the number of cases reported indicates a highest rise of cases in August reaching a peak
of 8204 cases to 7158 cases in October. Minimal cases have been reported from January to March. (Refer
to Figure: 33)
Figure 33 Monthly trend of cases reported in FATA in 2017
5.7 7.7 9.1 13.3 17.0 18.6 21.330.4 31.3
49.0
79.386.6
121.0
0.0
20.0
40.0
60.0
80.0
100.0
120.0
140.0
160.0
Bajaur Kurram Orakzai NWA Mohmand SWA Khyber FRPeshawar
FR Kohat FRD.I.Khan
FR Tank FR Bannu FR Lakki
BER API TPR
18121549
1838
2876
47505294
6461
8204
7274 7158
5352
3200
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
Jan Feb Mar April May June July Aug Sept Oct Nov Dec
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
Page | 29
A yearly comparison of the cases reported from 2014-2017 also indicates a peak season of August –
October followed by a decline (Figure: 34).
Figure 34 Year wise monthly trend of cases from 2014-2017
5.4. BALOCHISTAN
Balochistan reported a total 72,867 cases in 2017 as compared to 66,032 cases reported during 2016.
During 2017, eight new districts were included in the grant namely Awaran, Barkhan, Khuzdar, Killa
Abdullah, Kohlu, Lasbella, Quetta, and Ziarat. Earlier in 2016, 21 grant supported districts had reported
while during 2017 the number of reporting districts has increased to 29.
A total of 44,655 cases of PV (61%) were reported followed by PF 19,666 (27%) and mix 8546 (12%) cases.
(Figure: 35).
Figure 35 Malaria confirmed cases distribution in Balochistan
In 2017, Balochistan reported API of 6.3, ABER of 5.8 and TPR of 10.7 as compared to reported API of
12.39, ABER of 10.30 and TPR of 12.03 during 2016. The decrease in API and ABER may be attributed to
the increase in population due to the inclusion of eight new districts during 2017.
2485 22292881
4376
69227840
11056
13834
10592
9086
6169
3454
0
2000
4000
6000
8000
10000
12000
14000
16000
Jan Feb Mar April May June July Aug Sept Oct Nov Dec
2017 2016 2015 2014
8,546
19,666
44,655
72,867
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
80,000
Mix PF PV Total
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
Page | 30
Considering district wise situation, highest number of cases were reported from district Jaffarabad (7912)
followed by Zhob (7182) and Musakhel (6300). (Figure: 36). During 2016, same Jaffarabad district had
reported the highest number of cases but with very high magnitude (13,678).
Figure 36 District wise distribution of cases in Balochistan 2017
The highest API was reported of district Musa Khel of 37.7 followed by Sherani (25.9) and Zhob (23.1).
(Figure: 37).
Figure 37 BER, API and TPR comparison district wise of Balochistan 2017
131 183 271 307 326 404 404 711 773 831 931 1,2481,6861,7061,7532,059
2,4302,4852,8293,1463,4863,6013,9603,982
5,8126,0186,3007,182
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0.1 0.2 0.5 1.1 1.3 1.4 1.5 1.93.1 4.0 4.7 5.0
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ABER API TPR
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
Page | 31
Monthly trend of the number of cases reported indicates a highest rise of cases in September reaching a
peak of 6370 cases to 6032 cases in October. Minimal cases have been reported from January to March.
(Figure: 38)
Figure 38 Monthly trend of cases reported in Balochistan in 2017
A yearly comparison of the cases reported from 2014-2017 also indicates a peak season of August –
October followed by a decline (Figure: 39).
Figure 39 Year wise monthly trend of cases from 2014-2017
1676 18772286
3261
4110
3343
4257
59696370
6032
4704
2541
0
1000
2000
3000
4000
5000
6000
7000
Jan Feb Mar April May June July Aug Sept Oct Nov Dec
2684 27753423
4587
5704 5888
7895
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9656
6749
3099
0
2000
4000
6000
8000
10000
12000
Jan Feb Mar April May June July Aug Sept Oct Nov Dec
2017 2016 2015 2014
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
Page | 32
6. MALARIA CONTROL INTERVENTIONS
Various interventions for malaria control in Pakistan include:
a. Malaria case management: Early diagnosis, treatment as per national guidelines
b. Long Lasting Insecticidal Nets (LLINs)/Mosquito nets distribution
c. Capacity building / trainings of healthcare providers on:
i. Malaria case management,
ii. Malaria diagnosis through microscopy and RDT,
iii. Malaria microscopy quality assurance, and
iv. Malaria information system (MIS)
d. Behavior Change Communication (BCC), and
e. Malaria surveillance and outbreak response.
A review of malaria control activities that took place in 2017 is discussed below:
6.1. LLINS/MOSQUITO NETS DISTRIBTION
Long lasting insecticidal nets (LLINs) or simply mosquito nets have been one of the major key interventions
for prevention of malaria under the Global Grant since 2012. Under TGF grant, LLINs distribution strategy
includes mass distribution and continuous distribution to pregnant women during their Antenatal care
(ANC) visits.
6.1.1. Mass distribution of LLINs
The mass distribution of LLINs is shown in Figure: 37. Around 1.19 million LLINs were distributed in TGF
covered districts in 2017. The LLINs distributed through mass distribution during last year (2016) were
around 2.4 million. Highest number of LLINs (0.6 million) distributed through mass distribution was seen
in the Balochistan province as shown in the figure below:
Figure 40 Mass distribution of LLINs in Provinces/Regions in 2017
619,435
275,263
64,024
228,544
1,187,266
Balochistan FATA KP Sindh Total
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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Highest number of LLINs distributed through mass distribution was seen in South Waziristan (145,152)
followed by Dera Bugti (126,576). District wise LLINs distribution in ascending order is shown in the
figure 41:
Figure 41 District wise mass distribution of LLINS in 2017
6.1.2. Continuous distribution of LLINs through Antenatal Care (ANC) Clinics
Distribution of LLINs to pregnant women during ANC visits was more as compared to last year. A total
of 233,398 LLINs were distributed in 2017 as compared to 195,754 LLINs distributed in 2016. Highest
distribution through ANC clinics took place in Sindh province as shown in the graph below:
Figure 42 LLINs ANC distribution in 2017
6.2. CAPACITY BUILDING
6.2.1. Malaria case management
The target for 2017 was to train a total of 2,951 health care providers on malaria case management. A
total of 3,319 HCPs were trained thus achieving the target by 112%.
6.2.2. Malaria Diagnosis
The target was to train 2,463 technicians on malaria diagnosis. In 2017, a total of 2,946 malaria technicians
were trained thus achieving the target by 120%.
-
20,000
40,000
60,000
80,000
100,000
120,000
140,000
160,000
5,000 19,393
58,454 70,093
85,343
106,829 121,715
145,152
65,479 39,448 42,615
85,856
233,398
Balochistan FATA KP Sindh Total
6.2.3. Malaria information system (MIS) and outbreak response
The target was to train 3,017 HCPs on MIS and outbreak response. A total of 3,878 HCPs were trained
in 2017 from various districts under TGF grant. This resulted in achieving the target by 129%.
The details of DOMC, IHN/TIH and total achievements vs the targets is shown in the graph below:
Figure 43 Malaria trainings conducted in 2017
6.2.4. Behavior Change Communication (BCC) activities
BCC activities include ‘advocacy sessions’ with community based activists including Lady Health Workers
(LHWs), Community Based Organizations (CBOs), Non-Governmental Organizations (NGOs), religious
leaders, local elders and elected representatives for community awareness to enhance preventive and
curative services utilization in the districts. These trained LHWs, CBOs/NGOs and community
representatives then conduct the awareness sessions at community and health facility level.
In 2017, 52,888 personnel participated in the ‘advocacy sessions’ regarding preventive and curative services
pertinent to malaria. These participants then conducted community awareness sessions and a total of
around 1,442,302 members from the communities were reached.
Figure 44 BCC (Advocacy and awareness session conducted in 2017
2,3
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C A S E M A N A G E M E N T H C P M A L A R I A D I A G N O S I S M I S & O U T B R E A K R E S P O N S E H C P
DOMC-Target DOMC-Ach: IHN-Target IHN-Ach: Total-Target Total-Ach:
53360
1212134
51794
1160772
1068
279000
1094
281530
54428
1491134
52888
1442302
Advocacy sessions Awareness sessions
DOMC-Target DOMC-Ach: IHN-Target IHN-Ach: Total-Target Total-Achieved
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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6.2.5. Development of guidelines and training manuals
During 2017, DOMC developed guidelines and training manuals for malaria case management, G6PD
screening, diagnosis & quality assurance.
a. Malaria Case Management training manuals
b. Guidelines for Malaria Microscopy
c. Guidelines for Malaria diagnosis through RDT
d. Guidelines for Quality Assurance (of Malaria Microscopy)
e. Guidelines for G6PD deficiency testing
6.2.6. Surveys conducted during 2017
The long pending surveys (quality of anti-malaria drugs in private sector, therapeutic efficacy survey, and
Insecticide resistance monitoring) were conducted by DOMC during 2017. The brief details are as under:
a. Insecticide resistance monitoring of malaria vector mosquitoes in 5 provinces of Pakistan
b. Monitoring Antimalarial drug efficacy at two sentinel sites
c. Survey on Quality of Anti-Malarial Drugs (AMDs) in private sector
All these surveys and guidelines were endorsed by the Technical Working Group (TWG) members in the
TWG meeting held on 27th Dec, 2018.
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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7. ISSUES AND CHALLENGES
The main challenges faced during the implementation of grant activities during 2017 are as under:
7.1. Delays in establishment and functionality of new health facilities
Around 23 new districts were added under the Global Fund grant. SRs had to establish new malaria
diagnostic centers in these new districts. Along with this, SRs also had to establish new diagnostic centers
in old 43 districts where there was a gap in services provision and more centers were identified by the
district health authorities to enhance the coverage. There was a delay in establishment and functionality
of the new centers mainly due to the delayed trainings of the facility focal persons.
7.2. Delays in reporting from the new districts
Due to the delays in training of the new facility focal persons and establishment of the new malaria
diagnostic centers, the reporting from the 23 new districts was also delayed. Many districts started
reporting on the malaria information systems during after June 2016 so no surveillance information was
received in the first half of the year.
7.3. Increased number of yearly malaria cases
The number of malaria cases like the last year has shown an increase in the current year as well. This
increase can be attributed to the increased number of reporting health facilities, increased number of
grant supported districts, and better screening rates of malaria suspects. However, the yearly increase in
malaria cases is still an area of concern regarding the effectiveness of malaria control interventions in
Pakistan.
7.4. Fragmented health system and parallel reporting system
Malaria screening and confirmed cases data at the health facilities level is recorded and reported through
two parallel reporting and surveillance systems namely the District Health Information System (DHIS) and
Malaria Information System (MIS). The start of donor support for malaria control interventions in the
country had brought with it an additional reporting system to the DHIS, i.e., the MIS which is more
comprehensive and has many additional indicators as per the donor requirement. The MIS has its own
data recording and reporting tools at the health facility level in parallel to already existing tools for DHIS.
When there are parallel reporting systems and different recording and reporting tools from same health
facilities, the data quality is usually compromised as entering the data into separate platforms will result in
more errors. An integrated disease reporting system and use of the update online DHIS-2 are the potential
options for better integrity and coherence of reported data.
7.5. Lack of compliance to the national malaria treatment guidelines
Compliance to the national malaria treatment guidelines remained low mainly in few old and many new
grant supported districts. The old districts included Gwadar while new included districts from Balochistan,
KP and Sindh. Major reason was that specialists/experienced doctors prefer to prescribe medicines based
on their own clinical experience and knowledge, sign and symptoms of the patients and complications with
the other diseases with the result that they do not comply to the treatment guidelines. Continuous efforts
were made by DOMC and partners to improve the compliance to the national malaria treatment
guidelines so as to assure proper radical cure for malaria cases as per guidelines.
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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7.6. Lower coverage of malaria trainings
Although the trainings have been planned for a high number of service providers working at facility level
in the targeted districts, still a big gap has been mainly at the Rural Health Centers (RHC), Tehsil
Headquarter (THQ) and the District Headquarter (DHQ) hospitals. DOMC and IHN have been training
additional number of staff in the targeted districts, still due to budgetary constraints the overall coverage
of trainings in these hospitals is far low than the desired levels.
7.7. Challenges related to the LLINs distribution
LLINs distribution in the remote and security prone areas of Balochistan and FATA during the year has
been challenging. Issues were mainly seen in the districts of Dera Bugti, Musakhel, Jhal Magsi and Jaffarabad
in Balochistan while FR regions in FATA. These challenges resulted in delayed distribution of LLINs in
these remote districts.
7.8. Unregulated private sector
Both DOMC and IHN/TIH have scaled up the involvement of the private sector GPs (approx. 15 per
district) for the free of cost malaria diagnosis and treatment services, however their regulation as per
program requirement remains a challenge.
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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8. IMPORTANT EVENTS DURING 2017
8.1. Online District Health Information System (DHIS-2) malaria module
DMC is determined to have a robust surveillance system (third pillar of Global Technical Strategy) for
ensuring accurate and timely reporting of malaria cases from the targeted health facilities. For reporting
from TGF funded districts DMC and TIH have strategically planned to shift to an online malaria information
system with the support from TGF and technical guidance from WHO. In this regard, an online DHIS-2
malaria module has been developed for reporting of malaria cases and other programmatic achievement.
A number of consultative meetings with WHO mission, National TB control Program (NTP) and Ministry
of National Health Services Regulation and Coordination (NHSR&C) were held.
8.1.1. WHO mission to Pakistan for DHIS-2
WHO mission consisting of Dr. Ghasem Zamani (Regional
Advisor WHO) and Ryan Williams (DHIS-2 Focal Person
WHO) visited Pakistan in July 2017. The purpose of the mission
was the assessment of malaria situation in Pakistan in post
devolution scenario. Ryan gave an orientation of DHIS-2. Dr.
Zamani and Dr. Qutbuddin Kakar (NPO-WHO) visited health
facilities in Balochistan, KP, Punjab and Sindh provinces and had
meetings with DHOs and other important Government
officials.
8.1.2. Inception session for the provincial programs
An inception session for the Provincial Program Managers, DMC and TIH team was held on 12th Dec,
2018 at Hill View Hotel, Islamabad. This was followed by the
Provincial level trainings and hands-on practices at Peshawar-
KP, Hyderabad-Sindh and Quetta-Balochistan for the Data
Management Units (DMUs) and SRs’ district and provincial MIS
staff. It was planned that the period of Jan-June 2018 will be a
transition period where both manual and online systems will
run in parallel. Later on, the malaria cases reporting will be done
only through the online DHIS-2 system.
8.1.3. Training of trainers (TOT) and the data entry operators on DHIS-2 malaria
module
A series of trainings was conducted in December 2017 for the
implementation of DHIS-2 malaria module. The TOT was held in
Islamabad followed by the training of data entry operators for
DHIS-2 at the provincial level. The trainings was mainly facilitated
by the consultants namely the Pace Tech who were hired for the
development and trainings of the malaria information system
based on the DHIS-2 module.
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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8.2. WHO regional training workshop on M&E and surveillance (Muscat-Oman; Oct-2017)
The WHO Global Technical Strategy encompass ‘Transform malaria surveillance into a core intervention’
as the 3rd major pillar. Keeping in view the importance of surveillance, World Health Organization
(WHO) in collaboration with the Ministry of Health (MOH) organized a three days regional training
workshop on malaria M&E and surveillance. It aimed at training the malaria surveillance focal points in the
participated countries on the updated methods of collecting, analyzing, and evaluating data. From Pakistan
six participants attended this important training workshop including DMC Manager M&E, Provincial
Coordinators from KP-FATA and Balochistan and WHO Provincial Consultants.
8.3. WHO 9th Inter-country meeting of national malaria program managers from HANMAT
and PIAM-Net countries (Cairo-Egypt; Oct-2017)
WHO Regional Office for the Eastern Mediterranean convened the ninth inter country meeting of national
malaria program managers from countries in the Horn of Africa Network for Monitoring Antimalarial
Treatment (HANMAT) and Pakistan–Islamic Republic of Iran–Afghanistan Malaria Network (PIAM-Net),
two networks for monitoring antimalarial treatment efficacy, from 24 to 26 October 2017 in Cairo, Egypt.
8.4. WHO and University of Oslo mission visit to Pakistan for DHIS-2 (Dec-2017)
National TB Control Programme and DoMC under the auspices of MNHSR&C and in collaboration with
WHO, Global fund, University of Oslo, and NACP organized a technical assistance mission for integrated
management information system for HIV, TB and Malaria (HTM) using the DHIS-2 platform from 4-8 Dec,
2017. The mission presented the field findings and next planning in the debriefing meeting involving all the
key stakeholders.
8.5. Procurement & supply Chain
Directorate of Malaria control Pakistan is responsible for the procurement of Pharmaceuticals and Health
products. The pharmaceutical and health products are procured internationally with the help of Pooled
Procurement Mechanism of The Global Fund. The pharmaceutical products are delivered by air and stored
at the central warehouse in Islamabad for onward distribution. The health products based on the volume
are delivered via sea and stored at central level in Islamabad except LLINs. LLINs are stored at regional
level warehouse of DOMC.
DOMC is managing warehouses at central level for the storage of AMDs and HP. Regional level
warehouses are maintained for storage of LLINS. Two provincial level warehouses One at Peshawar and
second in Quetta is managed by DOMC. Two regional level warehouses were established in 2017 at
Thatta and Mirpurkhas for storage of LLINs.
9. ANNEXURES
9.1. List of the Global Fund grant supported districts
Names and details of the grant supported districts with PRs and SRs is given in the table below:
The Global Fund grant supported districts of Pakistan during 2017
S# Districts
(alphabetically)
Province Principal Recipient
(PR)
Sub-Recipient
(SR)
1. Awaran Balochistan DOMC NRSP
2. Badin Sindh DOMC NRSP
3. Bajaur KP-TD DOMC ACD
4. Bannu KP IHN/TIH FPHC
5. Barkhan Balochistan DOMC BRSP-DOMC
6. Buner KP DOMC ACD
7. Chagai Balochistan DOMC BRSP-DOMC
8. Charsadda KP IHN/TIH FPHC
9. Dera Bugti Balochistan DOMC BRSP-DOMC
10. Dera Ghazi Khan Punjab DOMC PLYC
11. Dera Ismail Khan KP IHN/TIH FPHC
12. FR Bannu/Lakki Marwat KP-TD DOMC ACD
13. FR D.I.Khan/ Tank KP-TD DOMC ACD
14. FR Kohat/Peshawar KP-TD DOMC ACD
15. Gwadar Balochistan DOMC NRSP
16. Hangu KP DOMC ACD
17. Harnai Balochistan IHN/TIH BRSP-TIH
18. Jaffarabad Balochistan DOMC BRSP-DOMC
19. Jhal Magsi Balochistan DOMC BRSP-DOMC
20. Kachhi/Bolan Balochistan DOMC BRSP-DOMC
21. Kambar Shahdad Kot Sindh DOMC PLYC
22. Karak KP DOMC ACD
23. Kech Balochistan DOMC NRSP
24. Khairpur Sindh DOMC PLYC
25. Kharan Balochistan DOMC BRSP-DOMC
26. Khuzdar Balochistan DOMC BRSP-DOMC
27. Khyber KP-TD DOMC ACD
28. Killa Abdullah Balochistan DOMC BRSP-DOMC
29. Killa Saifullah Balochistan IHN/TIH BRSP-TIH
30. Kohat KP DOMC ACD
31. Kohlu Balochistan DOMC BRSP-DOMC
32. Kurram KP-TD DOMC ACD
33. Lakki Marwat KP IHN/TIH FPHC
34. Larkana Sindh DOMC PLYC
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Page | 41
35. Lasbela Balochistan DOMC NRSP
36. Loralai Balochistan IHN/TIH BRSP-TIH
37. Lower Dir KP DOMC ACD
38. Mastung Balochistan IHN/TIH BRSP-TIH
39. Mardan KP IHN/TIH FPHC
40. Mirpur Khas Sindh DOMC PLYC
41. Mohmand KP-TD DOMC ACD
42. Musa Khal Balochistan IHN/TIH BRSP-TIH
43. Nasirabad Balochistan IHN/TIH BRSP-TIH
44. Naushahro Feroze Sindh DOMC PLYC
45. North Waziristan KP-TD DOMC ACD
46. Nushki Balochistan IHN/TIH BRSP-TIH
47. Nowshera KP IHN/TIH IHN/TIH
48. Orakzai KP-TD DOMC ACD
49. Panjgur Balochistan DOMC NRSP
50. Pishin Balochistan IHN/TIH BRSP-TIH
51. Quetta Balochistan DOMC BRSP-DOMC
52. Shangla KP DOMC ACD
53. Sherani Balochistan IHN/TIH BRSP-TIH
54. Sibi Balochistan IHN/TIH BRSP-TIH
55. South Waziristan KP-TD DOMC ACD
56. Sujawal Sindh DOMC NRSP
57. Sukkur Sindh DOMC PLYC
58. Swat KP DOMC ACD
59. Tando Allahyar Sindh DOMC PLYC
60. Tando Mohammad Khan Sindh DOMC NRSP
61. Tank KP IHN/TIH FPHC
62. Tharparkar Sindh DOMC PLYC
Thatta Sindh DOMC NRSP
63. Umer Kot Sindh DOMC NRSP
64. Washuk Balochistan DOMC BRSP-DOMC
65. Zhob Balochistan IHN/TIH BRSP-TIH
66. Ziarat Balochistan DOMC BRSP-DOMC
MALARIA ANNUAL REPORT 2018 l DIRECTORATE OF MALARIA CONTROL ISLAMABAD
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9.2. DOMC procured AMDs and HP during 2017 (for both PRs)
S# Description Unit Quantity
1
Artesunate+Sulfadoxine/Pyrimethamine 50mg+500/25mg, tablets,
Blister 25 x 6+2 Tabs Doses 33,675.0
2
Artesunate+Sulfadoxine/Pyrimethamine 100mg+500/25mg, tablets,
Blister 25 x 6+3 Tabs Doses 42,800.0
3 Artemether/Lumefantrine 20/120mg, tablets, Blister 30 x 12 Tabs Doses 6,210.0
4 Artemether/Lumefantrine 20/120mg, tablets, Blister 30 x 18 Tabs Doses 14,730.0
5 Artemether/Lumefantrine 20/120mg, tablets, Blister 30 x 24 Tabs Doses 38,490.0
6
Chloroquine 250mg (phosphate) (155 mg base), Blister 10 x 10
Tabs Tablets 2,500,000.0
7 Primaquine 7.5mg, tablets, Blister 10 x 10 Tabs Tablets 10,657,400.0
8
Artesunate 60mg, powder for injection, 1 vial co-packed with 1
ampule of sodium bicarbonate injection (1ml:50mg) and 1 ampule
of sodium chloride injection (5ml:45mg). Vial 5,000.0
9 Quinine sulphate 300mg, coated tablets, Blister 10 x 10 Tabs Tablets 400,000.0
10 Malaria Antigen P.f / P.v, HRP2, pLDH, Kit, 25 Tests Kit 1,632,125.0
11 Microscope 179.0
13 LLINS (DOMC+ IHN) 4,244,667.0