recent developments and achievements in malaria …...recent developments and achievements in...
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![Page 1: Recent Developments and Achievements in Malaria …...Recent Developments and Achievements in Malaria Control in Tanzania (Mainland) Dr. RenataMandike Deputy ProgrammeManager National](https://reader030.vdocuments.net/reader030/viewer/2022040403/5e8da8fce33c9d125a61ccb8/html5/thumbnails/1.jpg)
Recent Developments and
Achievements in Malaria Control in
Tanzania (Mainland)
Dr. Renata Mandike
Deputy Programme Manager
National Malaria Control Programme
Ministry of Health and Social Welfare
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Malaria Continues to Cause Disability
and Death in Africa• Complicates pregnancies (maternal anemia)
• Leads to poor birth outcomes (low birth weight)
• Each year…– 300–500 million cases– 300–500 million cases
– Millions progress to severe malaria disease
– 900,000 ultimately die
• Accounts for 40% of public health expenditures
But several interventions are immediately available to prevent and treat malaria!
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The burden in Tanzania Mainland
• Over 93% of the Tanzania mainland population lives in areas where malaria is transmitted
• Stable and intense transmission- coastal fringe, southern lowlands and regions bordering Lake Victoria -(70 – 75% of the country)
• Reported malaria cases 10-12 million annually• Reported malaria cases 10-12 million annually
• Leading cause of Outpatient , Inpatient and Hospital deaths in underfive children
• 30-40% of health facility attendance
• Estimated deaths: 60-80,000 mainly in children
• The poorest bear the brunt of the burden
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NMCP’s Ongoing Four-pronged Strategy
• Prompt diagnosis & treatment
• Intermittent preventive treatment in pregnancy (IPTp)
• Insecticide-treated nets (ITNs)
• Indoor residual spraying (IRS)
• Larviciding
Plus…• Monitoring & evaluation• Surveillance&• Behavior Change Communication
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Malaria Control Financial Inputs for
Mainland Tanzania, 2000-10
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Allocation of Malaria Control Funding
for Mainland Tanzania, 2000-10
8%
6%
5%
1%
2%ITN
Diagnosis & Treatment
IRS
48%
30%
IRS
Bevahioral change
M&E
IPTp
Other
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Update 1:
Intervention Scale-upIntervention Scale-up
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ITNs
• Tanzania National Voucher Scheme (TNVS ongoing)– Net vouchers issued at health facilities for later redemption at retail shops
– Launched in 2004 (preg women) & 2006 (infants)
– LLIN voucher with fixed top-up 500/= Tsh since Oct 2009
– Over 7 million vouchers redeemed to date, with redemptions increasing
• Under-5 Coverage Campaign (completed May ‘10)• Under-5 Coverage Campaign (completed May ‘10)– Jointly funded by GFATM, World Bank, PMI, UNICEF, GoT and Swiss
Development
– Completed May 2010
– 8.7 million LLINs distributed at total cost of $64 million
• Universal Coverage Campaign (est. completion Jun ‘11)– Majority funded by GFATM
– 5 Zones completed & 12 million LLINs distributed to date
– 18.5 million LLINs to be distributed at total cost of $91 million
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IRS
• Kagera selective application since 2007 (outbreak prevention)– 100,000 households targeted (0.5 million people)
• Expansion to all districts of Kagera in 2009 (high transmission)– 450,000 households targeted (2.2 million people)
• Further expansion to Mwanza/Mara Regions in 2010– 1,250,000 households targeted (6.5 million people)
• All households sprayed with lambda-cyhalothrin (ICON®)
6.5 million population now protected by IRS
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IPTp
• Introduced in 2003
• First dose sulfadoxine-pyramethamine (SP) starting at second trimester, then 2nd dose at least 4 weeks later
• Success is highly dependent upon early access to antenatal care
• Uptake impeded by periodic stock-outs of SP since ’08
• Significant variation in uptake across regions
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Case Management
• Rapid diagnostic tests (mRDTs)– Now implemented in 11 Regions
– Rollout completion by end-2011
• Artemisinin-based combination therapy (ACT)• Artemisinin-based combination therapy (ACT)– First-line treatment at all public facilities since 2007
– 60 million+ treatments delivered in 4 yrs
• Recurrent national stock-outs of RDTs and ACTs impede continuous service delivery
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Affordable Medicine Facility for
Malaria(AMFm)
• It’s a pilot aimed at increasing access to recommended ACTs through private outlets at an affordable price
• Drugs are procured by the private sector and • Drugs are procured by the private sector and distributed through the private distribution system
• The Government role: awareness creation, monitoring and evaluation
• Drugs are already available
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Update 2:
Achievements in Achievements in
Intervention Coverage
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Trends in Core Coverage Indicators:
Tanzania Mainland, 2004–10
63.4 64.157.160
80
100
Po
pu
lati
on
Co
ve
rag
e (
%)
2004/05 DHS
Target
0
20
40
Own 1
ITN
Use ITN Use ITN IPTp Tx within
24h
Po
pu
lati
on
Co
ve
rag
e (
%)
2004/05 DHS
2007/08 THMIS
2009/10 DHS
Malaria intervention
Age <5y Pregnantper Home
2 doses
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IRS Achievements, Lake Zone 2010-11
43
48
Ma
lari
a P
osi
riv
ity
Ra
te %
25
17
12 119
6
Mu
leb
a
Ka
rag
we
Ch
ato
Misse
nyi
Ma
lari
a P
osi
riv
ity
Ra
te %
Year before IRS
Year after IRS
# of house structures sprayed
(1,120,092) coverage (94%) and
impact (70% reduction malaria
test positivity rate)
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Update 3:
ImpactImpact
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P. falciparum Prevalence in Tanzania,
2007/08
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16
18
11 111112
1010
15
20
Pre
vale
nce (
%)
2004/05
2007/08
Reductions in Severe Anemia,
Mainland Tanzania, 2004–10
8
4
8
5
3
87
5 5
3
6
0
5
10
6--11 12--23 24--35 36--47 48--59 All
Months of Age
Pre
vale
nce (
%)
2007/08
2009/102
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Reductions in All-cause Mortality in
Tanzania Mainland, 1999–2009/10
99
147
112
100
120
140
160
De
ath
s p
er
10
00
liv
e b
irth
s
45-50% reductions between 1999 and 2009/10
99
68
51
81
0
20
40
60
80
100
Infants Children < 5 yrs
De
ath
s p
er
10
00
liv
e b
irth
s
1999
2004/05
2009/10
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Looking Ahead at NMCP
• Affordable Medicines Facility – malaria (AMFm)– Subsidized ACT (< $0.05 per treatment)
– Pilot program highly dependent upon performance
• Continued rollout of RDTs nationwide• Continued rollout of RDTs nationwide
• Mechanisms for ITN “keep-up”
• Increased integrated vector control initiatives– Including Larviciding
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Larviciding
• Implemented in collaboration with the Cuban Government
• Target in Urban areas
• Builds up on the Urban Malaria Control Project which focused in 15 wards 2006-2010which focused in 15 wards 2006-2010
• Roll out in all wards in DSM
• last four years
• Construction of larvicides production industry in Kibaha – Coast Region
• Implementation at preliminary stage
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Surveillance, Monitoring & Evaluation
Health facilities:
• Strengthening Integrated Disease Surveillance and Response (IDSR) for NMCP needs
• Surveillance in new Sentinel Panel of Districts
• NMCP collaborating with HMIS strengthening initiative
Household surveys:
• 2011-12 Tanzania HIV/AIDS and Malaria Indicator Survey (THMIS)
Analysis:
• Malaria Impact Evaluation
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NMCP’s Careful Vigilance for Monitoring
Insecticide and Antimalarial Drug Resistance*
*In collaboration with NIMR, IHI, WHO, PMI, and others
Antimalarial efficacy
Insecticide susceptibility
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Need for Cross-border Collaboration with
other NMCPs
Mainland:
• 41 million
• 900,000 km2
Shared borders with 8 countries, plus Zanzibar!
Zanzibar:
• 1.2 million
• 2,500 km2
Pemba
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Asanteni sana.
Questions?Questions?
Contact info:
Dr. Renata Mandike
mobile: 0754 295 323