malaria control program (hard copy)

7/23/2019 Malaria Control Program (Hard Copy)

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MALARIA CONTROL

PROGRAMCOMMUNITY HEALTH MEDICINE

Bicol Christian College of Medicine

Medicine II (Group 7 – Team ocGenes)

Abayon, Ronell Andrew

Ayyappan Nair, Akhil

Chereddy, Sairam Reddy

Del Rosario, Paolo Dominique

Henry, Sydney Hoper

Shrestha, Sagun

Viñas, Mark TitusSacil, Janelle Eve

Tapit, Ma.Francia

Tolentino, Gerly

Tolosa, Jonnahvee D.

Villanueva, Mary Angeline

Vitualla, Jean Louise

Zoleta, Dawn



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INTRODUCTION

The Philippines is a heavily populated archipelago of more than seven thousand islands in

Southeast Asia. Malaria is produced by intraethrocytic parasites of the genus Plasmodium. Four

plasmodia produce malaria in humans: Plasmodium falciparum, P. vivax, P. ovale and P. malariae. In

2010, approximately 72 percent of cases were due to Plasmodium falciparum and 25 percent were due

to P. vivax. Transmission occurs year-round but is typically higher during the rainy season, which runs

from June to December. The primary vector is Anopheles flavirostris, which breeds in clear, slow-flowing

streams near foothills and forests.

Malaria can be transmitted in the following ways: (1) blood transfusion from an infected

individual; (2) sharing of IV needles; and (3) trans placenta (transfer of malaria parasites from an

infected mother to its unborn child). Signs and symptoms include: recurrent chills, fever, profuse

sweating, anemia, malaise, hepatomegaly and splenomegaly.

It is mainly associated with poverty and poses significant impediments to the socio-economic

development of affected communities. The nature of malaria as a public health problem requires

sustained and systemic efforts toward two major strategies, namely prevention of transmission through

vector control and the detection and early treatment of cases to reduce morbidity and prevent

mortality.

BRIEF HISTORY OF MALARIA CONTROL PROGRAM IN THE PHILIPPINES

Prior to 1900 - Malaria was documented with high mortality rates

1906 - Philippines Bureau of Health conducted malaria education and distributed free quinine

1955 - launch of nationwide malaria control program

1966 - Malaria Eradication Act assisted by WHO

1986 - Vector Control program at the provincial level

1987 - Department Circular No. 167 s. semi vertical malaria program

VISION

Malaria-free Philippines

MISSION

To empower health workers, the population at risk and all others concerned to eliminate

malaria in the country.

GOAL

To significantly reduce malaria burden so that it will no longer affect the socio-economic

development of individuals and families in endemic areas.



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OBJECTIVES

Based on the 2011-2016 Malaria Program Medium Term Plan, it aims to:

1. Ensure universal access to reliable diagnosis, highly effective, and appropriate treatment and

preventive measures;

2. Capacitate local government units (LGUs) to own, manage, and sustain the Malaria Program

in their respective localities;

3. Sustain financing of anti-malaria efforts at all levels of operation; and

4. Ensure a functioning quality assurance system for malaria operations.

BENIFICIARIES

The Malaria Control Program targets

Meagre-resourced municipalities in endemic provinces

Rural poor residing near breeding areas

Farmers relying on forest products

Indigenous people with limited access to quality health care services

Communities affected by armed conflict

Pregnant women and children aged five years old and below.

PROGRAM STRATEGIES

EARLY DIAGNOSIS & PROMPT TREATMENT

Early diagnosis and prompt treatment is a core strategy for malaria control and is central to the

implementation of all the Global Fund Malaria Projects. The aim is to provide prompt diagnosis and

adequate treatment within 24 to 48 hours after consultation of the patient with fever in endemic

communities to prevent progression of uncomplicated malaria to severe cases and to avoid death.

Diagnosis

Microscopy (gold standard)

RDT (far -flung, hard-to- reach areas)

Treatment :

Malaria can be treated effectively early in the course of the disease, but delay of therapy can have

serious or even fatal consequences.

Treatment depends on the species..

P. falciparum:

Uncomplicated:

- Artemisinin – Based Combination Therapy (Artemether-Lumefantrine) + Primaquine

Severe:

- Parenteral Quinine + Tetracycline/Doxycycline/Clindamycin



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P. vivax/ovale/malariae:

Chloroquine + Primaquine

Mixed infection:

Pf plus other species: AL + PQ

Pv + Pm: CQ + PQ

Chemoprophylaxis Drugs

Atovaquone/Prognanil (Malarone)- good choice for shorter travel trips

Chloroquine- good choice for long trips; can be used in all trimesters of pregnancy

Doxycycline- least expensive antimalarial

Mefloquine (Lariam)- long trips & pregnancy

Primaquine- most effective medicine

VECTOR CONTROL

Sustainable preventive and vector control measures refer to the adaptation of measures for the

prevention and control against the malaria parasite and the mosquito vector. Such measures being

affordable, applicable, and appropriate are under our local conditions so that these measures can be

sustained throughout the duration of malaria control operations.

Objective of this measure is to reduce the source of infection in the human population; man–

vectorcontact, and the density of the mosquito vector population.

Long-Lasting Insecticidal Nets (LLIN)

o

Insecticide – treatment of mosquito netThis involves the soaking of the mosquito net in an insecticide solution and allowed to dry. Such

treated net is used as a protective measure against the vector mosquito during sleeping time at night.

Insecticide – treated curtains may be used in areas where they are more culturally acceptable

than mosquito nets.

House spraying - this is the application of insecticide on the indoor surfaces of thehouse through spraying.

On stream seeding - this involves the construction of bio-ponds for fish propagation

which shall be the responsibility of the LGUs and their corresponding communities. The

number of bio-ponds to be constructed as sources of larvivorous fish, for each malaria-

endemic municipality, will depend on the number of streams to be seeded with the



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propagated larvivorous fish. To be effective, about 2-4 fish per sq.m. is needed for an

immediate impact and about 200-400 fish per ha. Is needed for a delayed effect.

On steaming clearing – this is the cutting of the vegetation overhanging along stream

banks to expose the breeding stream to sunlight, rendering it unsuitable for mosquito

vector habituation.

Other preventive measures

•Wearing of clothing that covers arms and legs in the evening.

•Avoiding outdoor night activities, particularly during the vector’s peak biting hours from 9pm to 3am

•Using mosquito repellents such as mosquito coils, soap lotion or other personal protection measures

advocated by the DOH/MCS – Malaria Control Service.

•Planting of Neem tree or other herbal plants which are (potential) mosquito repellents as advocated by

the DOH/MCS – Malaria Control Service.

•Zooprophylaxis - typing of domestic animals like the carabao, cow, etc., near human dwelling to

deviate mosquito bites from man to these animals.

ENHANCEMENT OF LOCAL CAPACITY/ ADVOCACY

LGUs are capacitated to manage and implement community-based malaria control through social

mobilization.

Building a healthy public policy

Creation of a supportive environment

Strengthening community action (behavior-change activities)

Development health personnel communication skills (capacity-building activities)

Development and adaptation of key messages conveyed through appropriate channels and

fitting to target audiences.

ENHANCED SURVEILLANCE & EPIDEMIC MANAGEMENT

Philippine Malaria Information System (PhilMIS)

Aims to provide information in a computerized form needed for planning,

implementation, monitoring and evaluation of malaria control program. Philippine Integrated Disease Surveillance and Response (PIDSR)

Established to improve the current disease surveillance systems in the Philippines and

to comply with the 2005 IHR call for an urgent need to adopt an integrated approach for



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strengthening the epidemiologic surveillance and response system of each member

nation.

Field Health Services Information System (FHSIS)

To update indicators based on the current needs of the health program managers

and all local government units.

Updates in surveillance:

Harmonized PhilMIS-PIDSR System (HARPPS)

Malaria Text Report System (MTRS)

QUALITY ASSURANCE SYSTEMS IN PLACE

For diagnosis:

Microscopy – validation of slides

For treatment:

Therapeutic Efficacy Surveillance (RITM)

Vector control:

Insecticide resistance monitoring through bioassay and susceptibility tests (RITM)

EARLY RECOGNITION PREVENTION AND CONTROL OF MALARIA EPIDEMICS

Early Recognition Prevention and Control of Malaria Epidemics refer to the establishment of a

system that will immediately recognize an impending malaria epidemic

Malaria Epidemic is a situation where there is an incidence of new malaria cases in excess of the

expected. The application of such definition of actual situation is not always straight-forward.

Any transmission in a previously malaria-free are is obviously in excess of the excepted and

constitutes and epidemic by the above definition, with the premise that, traditionally, small

epidemics are usually called outbreaks

Epidemic potential is a situation where in an area is vulnerable to malaria case upsurge due to

causal factors such as climatic changes, ecological changes or socio-economic changes.

PREVENTION OF THE EPIDEMIC

1. The following should be done in the event that an imminent epidemic occurs:

Mass blood smear (MBS) collection

Immediate confirmation and follow –up cases

Insecticide – treatment of mosquito nets

Focal spraying

Stream clearing

Intensive IEC campaign

2. All cases should be given drug treatment and followed-up until clinically and/or microscopically

found negative.

3. Continuous surveillance measures should be implemented for three years.

4.

The Local Government Units in collaboration with the Nongovernment Organization and with

the technical assistance from the Provincial Malaria Coordinator should contribute in terms of

IEC campaign and logistics support.



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PUBLIC HEALTH CARE RESPONSIBILITIES

1. Participates in the implementation of the following:

Treatment policies

Provision of drugs

Laboratory confirmation of diagnosis Training of Barangay Health workers and volunteers on the diagnosis and treatment of

malaria

Supervision of malaria control activities of all health personnel in the area

Collection, analysis and submission of required reports

2. Recognition of early signs and symptoms for management and further referrals

3. Educate the individual/families/community of the importance of the following:

Taking of chemoprophylaxis

Wearing of long-sleeved clothing and trousers when going out at night.

Application of insect repellant to skin

Use of mosquito nets

Use of screen in doors and windows. If no screen, close windows and doors during nighttime.

Use of insecticide aerosols and pyrethroid mosquito coils

Clearing of hanging branches of trees along the stream

4. Availability of anti-malarial drugs and chemoprophylaxis drugs

PROGRAM ACCOMPLISHMENTS:

Malaria cases in the country declined since the mid-2000s, and have resulted in an 83%

reduction from 2005 to 2013.

There was a 92% reduction in the number of deaths within the same period.

Deaths were 150 in 2005 to 12 in 2013. The Philippines has achieved the MillenniumDevelopment Goal target for 2015 as early as 2008.

Of 53 known provinces that are endemic for the disease, 27 have already been declared

malaria-free. These were:

Cavite

MArinduque

Albay

Sorsogon

Iloilo

Capiz

Bohol

Siqujior Eastern Samar

Northern Leyte

Biliran

Batangas

Catanduanes

Masbate

Camarines Sur

Alkan

Guimaras

Cebu

Western Samar

Nortern Samar

Southern Leyte Camiguin

Surigao Del Norte

Benguet



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The top five provinces having the highest number of malaria cases are:

Palawan

Tawi-tawi

Sulu

Maguindanao

Zambales



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PARTNER ORGANIZATION/AGENCIES:

The following organizations/agencies take part in achieving the goals of Malaria Control Program:

Pilipinas Shell Foundation, Inc, (PSFI)

Roll Back Malaria (RBM)

World Health Organization (WHO)

Act Malaria Foundation, Inc

Field Epidemiology Training Program Alumni Foundation, Inc. (FETPAFI)

Research Institute of Tropical Medicine (RITM)

University of the Philippines-College of Public Health (UP-CPH)

Philippine Malaria Network

Australian Agency for International Development (AusAID)

Asia Pacific Malaria Elimination Network (APMEN)

Malaria Elimination Group (MEG)

Local Government Units (LGUs)

WORLD MALARIA DAY

April 25

OUTLOOK FOR THE FUTURE

“Malaria elimination program in progress for a malaria-free Philippines by 2020.”

CONCLUSION

The malaria control program is one of the priorities for the Philippines Department of Health;

however, malaria is no longer a leading cause of morbidity and mortality.

Factors behind malaria reduction since mid-2000; the malaria stratification system at the

barangay level facilitates a targeted and focused approach for interventions; early detection and prompt

treatment of cases; strengthened vector control, surveillance and epidemic management; quality

assurance systems for interventions in place; sustained social mobilization and advocacy; building local

capacities to manage and sustain the program; public-private partnerships; and intra- and inter-

sectorial collaborations

Mainstreaming the Malaria Control Program (MCP) through the formal health structure of the

LGU, RHU, and BLGU has been the backbone of the community based malaria control program since the

beginning of the project.

In 2010, all existing Global Fund malaria grants were consolidated into a single grant covering 40

malaria-endemic provinces. In 2012, US$24 million was earmarked for phase two of the grant to sustain



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the Philippines’ malaria control and elimination efforts through 2014 and improve its chances of moving

closer to its 2020 elimination goal.

The Philippines has successfully controlled malaria over the past two decades, and malaria there

is currently at its lowest level in more than 40 years.

REFERENCES

Department of Health-National Center for Disease Prevention and Control (DOH-NCDPC)

pinoymalaria.press.wordcom/cases/

cprmfm.com/malaria-to-be-eradicated-in-the-philippines-by-2015/

www.gov.ph/2014/03/11/philippines-on-verge-of-attaining-malaria-free-status/

www.mb.com.ph/malaria-free-philippines-eyed-in-2020/

static1.1.sqspcdn.com/static/CP+UpdatePhilippines

Book of Communicable Diseases

The Global Fund Program: Malaria: Annual Report Eliminating Malaria in the Philippines, August 2013 report

nec.doh.gov.ph/index.php

www.cdc.gov.ph

malaria control program (hard copy)

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