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Malaria Elimination

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Prevention and Control of Re-introduced Malaria ... Diagnosis and treatment of introduced cases. Emergency preparedness. Training of personnel ... – PowerPoint PPT presentation

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Title: Malaria Elimination


1
Malaria Elimination
  • Dr A.Kondrachine

2
Development of Concept of Disease/Infection
Elimination
3
WHO Concepts of Disease/InfectionEliminati
on
4
Elimination as Public Health Problem
5
Elimination as a Public Health Problem and
Interruption of Transmission
  • Chagas disease (1998)- in all endemic countries
    of Latin America
  • Lymphatic filariasis (1997)
  • Onchocerciasis in the Americas (1991)- in 6
    countries
  • Dracunculiasis (2002 2005) eradication
    country-by-country certification of elimination
    of transmission by International Commission

6
Concept of Malaria Elimination
  • Practical eradication of malaria malaria
    incidence reached in NMCP the level of less 0.1
    per 100 000 population (USSR, China, North
    Vietnam during 1960s)
  • In the NMEPs, malaria elimination status roughly
    corresponded to the last year(s) of consolidation
    phase
  • In Europe, USA, Australia, malaria eradication
    was achieved in the course of implementation of
    malaria control in a staged manner, initially by
    elimination malaria as a public health problem
    and then by interruption of malaria transmission

7
Concepts by Agencies outside WHO
  • Elimination of communicable disease connotes the
    reduction of case transmission to a predetermined
    very low level (Last, JM 2001)
  • Elimination of disease is a reduction to zero of
    the incidence of a specified disease in a defined
    geographical area as a result of deliberate
    efforts. Continued intervention measures are
    required (ITFDE, cited by Molyneux et al, 2004)
  • Elimination is a local reduction to zero of the
    incidence of infection because infection can be
    imported from other areas that are still endemic,
    permanent intervention is required to maintain
    elimination as a stable state of the trivial
    equilibrium (Duerr et al,2005)

8
CONCLUSION
  • WHO concept of disease/infection elimination
    applicable to malaria
  • Elimination of malaria is a logical transition
    from effective control to malaria eradication
  • The eventual goal of malaria eradication may be
    achieved firstly through the elimination of
    disease as public health problem with subsequent
    interruption of local transmission
  • Concept of malaria eradication needs
    re-assessment by WHO

9
Malaria Elimination in WHO EMROTargets
  • Elimination of Local Transmission Egypt, Syria,
    Morocco
  • Elimination as Public Health Problem and
    Interruption of Local Transmission Islamic
    Republic of Iran, Saudi Arabia
  • Maintenance of Malaria Free Status- Jordan,
    Qatar, Bahrein, Kuweit, Oman, United Arab
    Emirates, Lebanon

10
  • Strategies for Elimination of Residual Malaria
    Foci

11
Concept of Malaria Focus
  • Malaria focus a defined and circumscribed
    locality situated in a currently or formerly
    malarious area and containing the continuous or
    intermittent epidemiological factors necessary
    for malaria transmission (WHO, 1963)
  • A focus of infection is an integration of the
    interactive populations of the parasite,hosts and
    vectors that support its existence (Beklemishev,
    1970)

12
Commitments
  • Political Commitment
  • Resource Allocation
  • RBM Partnership

13
Preparatory Stage
  • Needs assessment exercise
  • Meeting of requirements
  • Training of personnel (specialized service,
  • Basic health service, private sector)
  • Collection and analysis of information on malaria
    foci
  • General information

14
Preparatory stage (cont.)
  • Physiography
  • Entomology and related information
  • GIS, GPS
  • Meteorology
  • Population characteristics
  • Malaria season, details of malaria transmission
  • Assessment of feasibility of malaria elimination

15
Preparatory stage (cont.)
  • Epidemiological investigation and classification
    of cases
  • - induced case by contaminated blood
  • - imported case contracted outside
  • - relapsing case
  • - introduced case contracted locally
  • from imported
  • - indigenous case- contracted locally from
  • any other case

16
Preparatory stage (cont.)
  • Operational classification of foci
  • - Duration of existence residual or
  • new
  • - Current malaria transmission non-
  • active, active, potential

17
Types of Malaria Foci
  • Residual foci
  • - non-active (transmission interrupted no
    indigenous
  • possible occurrence of relapsing cases)
  • - active ( transmission not interrupted)
  • New foci
  • - potential (presence of imported cases no
    evidence of transmission, but renewal possible)
  • - active ( renewed transmission)

18
Attack Stage
  • Selection of anti-malaria measures
  • Plan of Action developed
  • Detection, diagnosis and treatment
  • Mass fever and mass drug administration
  • Chemoprophylaxis

19
Vector Control
  • Integrated Vector Control
  • Anti-larval measures
  • Indoor residual spraying
  • Space spraying
  • Personal protection measures
  • Bio-environmental management

20
Role of Different Partners
  • General Health Services
  • Specialized Health Services
  • Private sector
  • Intersectoral cooperation
  • International cooperation
  • Cooperation in border areas

21
Evaluation and Monitoring
  • Integrated Information system
  • Integrated Surveillance system
  • Use of Indicators
  • Exchange of Information
  • Verification of Interruption of Transmission

22
Prevention of Malaria Reintroduction
23
CHALLENGES
  • Inadequate availability of international
    information on malaria status in different areas
  • Inadequate cooperation between malaria countries,
    especially in border areas
  • Risk of introduction of multi-resistant
    P.falciparum
  • Difficulties to trace imported cases
  • Inadequacies in malaria vigilance
  • Lack of awareness of malaria re-introduction into
    malaria free areas among GHS staff
  • Inadequacies in malaria training

24
Role of Malaria Surveillance
  • Malaria surveillance as a part of General
    Surveillance
  • Information collection, analysis, exchange,
    dissemination
  • Epidemiological investigation of foci, cases,
    analysis of malariogenic potential
  • Monitoring and assessment of preventive measures

25
Prevention and Control of Re-introduced Malaria
  • Sustained surveillance of fever cases by various
    diagnostic measures
  • Availability of reagents, antimalarials,
    materials, equipment
  • Training and re-training of personnel
  • Epidemiological Malaria Early Warning System
  • - forecasts average seasons weather
  • - increase in mosquitoes density and
    survival
  • - Vector dynamics (entomological
    inoculation
  • rate)

26
Prevention (cont.)
  • Monitoring and use of indicators
  • Diagnosis and treatment of introduced cases
  • Emergency preparedness
  • Training of personnel
  • Operational research
  • Role of different health services
  • Role of Ministry of Health
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