Djibouti Presentation

1

• Djibouti Presentation
• Inter-Country Workshop on Public Health
  Pesticides in the Context of the Stockholm
  Convention on POPs
• Amman 7-11 December 2003
• By M.FARAH ALI AINAN
• POPs Project Coordinator
• Ministry of Habitat, Urbanism, Environment and
  Land
• Amman 7/12/03

2

• Djibouti Delegation
• M. FARAH Ali Ainan, POPs Project Coordinator,
  Ministry of Habitat, Urbanism, Environment and
  Land
• M. ABRO Mohamed Moussa, Dpt of Public Health,
  Ministry of Health
• M.RACHID Elmi Hersi, Head plant protection Dpt,
  Ministry
• of Agriculture

3

• Report prepared by
• M. FARAH Ali Ainan, POPs Project Coordinator,
  Ministry of Habitat, Urbanism, Environment and
  Land
• M. ABRO Mohamed Moussa, Dpt of Public Health,
  Ministry of Health
• Dr. Mohamed Ali Kamil, Director of Pevention and
  Public Health, Ministry of Health

4

• Djibouti Presentation
• Part I Public Health Management
• Part II Malaria Vector Control

5
Republic of Djibouti

• Djibouti is located in East Africa
• Between Eritrea Ethiopia,Somalia and Read Rea.
• Pop 600 000 inhab
• Surf.Area 23 000 Km2
• Climate Hot-Maritime Desert Humidity60 2
  seasons fresh hot

6
Public Health Pesticides Departments in Charge

• Public Health Pesticides
• Departments in Charge
• Ministry of Health ( public health)
• Ministry of Agriculture (plant animals)
• Ministry of Environment (pesticides regulations
  related to environmental preservation)

7
Public Health Pesticides

• Public Health Pesticides
• Deltametrhin
• Malathion
• Carbamate(Baygon)-Carbyne
• Temephos (Abate)
• DDT (on Mosquito coils)
• Decis(Deltamethrin)

8
Public Health Pesticides Quantities

• Public Health Pesticides
• Quantities
• 2000 600l deltamethrin100l temephos
• 2001 600l Malathion 180l deltamethrin 80l
  temephos
• 2002 480l Malathion 80l temephos
• Average 600l malathion 200l deltamethrin per
  year

9
Public Health Pesticides Crisis scope

• Public Health Pesticides
• Emergency
• 1989 1000L Malathion 450L deltametrhin
• 1990 1000L lindane( for larves elimination
  after floodings)

10
Other Pesticides Public health

• Other Pesticides
• linked with Public health
• Anti-termites in agriculture, wood conservation 
• Plant protection pesticides
• Farming  Lindane,Decis(deltametrhin) etc

11
Legislation status

• Legislation status
• no specific Legislation on POPs Pesticides  
• Existing legislation on Pesticides need to be
  updated.
• POPs ongoing project main objectives
• Ratification of Basel(done), Rotterdam,
  Stockholm(o.g) Conventions

12
Inventories Status in Djibouti

• Inventories Status in Djibouti
• - POPs project started in June 2003
• - Inventories started in September 2003
• - Will be Completed in December 2003
• - Mid Term Inventories Evalution in January 2004

13
Inventories Status Results

• Inventories Status Results
• No official trade of POPs Pesticides
• Illegal import from neighbor countries not
  quantified
• Use of mosquito coils(impregnated of DDT)
• Some Contaminated Sites identified (DPHP
  Warehouse, Douda waste disposal)
• Main challenges
• 1 Pesticides Management? institutional
  technical capacity(Legislation, Laboratories,
  Expertise)
• 2 Managing transit and transport of Pesticides
• The NIP will focus inter alias these fields

14

• Sources of pesticides 
• Legal Importation
• Some illegal importation from Ethiopia and
  Somalia
• Other important  Source 
• Transit to Ethiopia pesticides
• ( technical  DDT)
• 1999 55 Tons non POPs
• 2000 206 Tons non de POPs
• 2001 513 Tons , 347 Tons POPs Pesticides
• 2002 1078 Tons, 253 Tons POPs Pesticides

15

• vector born diseases
• Managing Status
• inter sectorial coordination in progress
• IVM inter sectorial coordination scheme
• Min. Health, Environment, Agriculture (public
  health, water sanitation Dpt)
• ToR for Institutional Structure Elaboration
• Elaboration of national strategy for water
  Sanitation
• The NIP will include this coord. Mechanism as
  part .

16

• Djibouti Proposals for EMRO Regional Project
• Regional Technical capacity for Obsoletes stocks
  and Contaminated lands for storage
• Regional Technical capacity for elimination
• Regional Collaboration Network
• Regional Technical in Analyzing
  residues(Laboratories)
• Strengthening national expertise capabilities
• Elaboration of IVM strategies in regional
  national levels

17
Part II Malaria Vector Control ITN
Alternative

• Plan of action for promotion and distribution of
  insecticide treated nets in Djibouti

18
EPIDEMIOLOGICAL SITUATION OF MALARIA IN DJIBOUTI

• Malaria inexistent in Djibouti at the beginning
  of the century
• Anopheles arabiensis mentioned between 1901 and
  1906
• From 1906 to 1962, only imported cases declared
• In 1963 14 malaria cases diagnosed in
  autochthon population
• In 1994 35 malaria cases declared
• In 1978 First malaria epidemic with 316
  malaria cases

19
EPIDEMIOLOGICAL SITUATION OF MALARIA IN DJIBOUTI
(contd)

• In 1988 and 1994 Flooding with increase
  bleeding sites
• Number of malaria cases confirmed declared each
  year 4000 7000 case
• Population at risk 360 000 (60 of the total
  population)
• Areas most affected by malaria
• - Djibouti city Ambouli and Balbala
• - Tadjurah district Sagalou, Kalaaf, Dorra et
  Weima
• - Dikhil district As-Eyla, Hanlé
• Type of parasite Plasmodum falciparum (98 )

20
MALARIA HIGH RISK AREAS
21
MALARIA VECTOR CONTROL

• Malaria vector control introduced in 70s
• consisting in insecticide spraying
• At present, different vector control methods are
  used
• - Inside and outside insecticide spraying
• with malathion
• - Bleeding sites Introduction of
• Abate

22
INSECTICIDE TREATED NETS (ITN)

• Before 1990 utilization of ITN gt individual
  initiative
• In 1990, first involvement of MOH in promotion of
  ITN with assistance from WHO
• - Training of NGOs
• - Involvement of NGOs in ITN
• distribution
• - Symbolic contribution of 0.06 cents by
• beneficiaries
• Priority were given to high risk areas, mainly to
  nomadic people in rural area were others vector
  control activities are not applicable

23
INSECTICIDE TREATED NETS (ITN) (contd)

• In 1999, MOH initiated a campaign in all
  districts to sensitize the population on ITN
• Contribution of different partners including WHO,
  USA and one NGO
• Involvement of community in ITN promotion through
  local associations, community health workers and
  the community itself
• Population sleeping under ITN in high risk areas
  
• 10 - 20
• Mosquito nets available at local market
• at the cost between US 8 to US 10

24
CONSTRAINTS

• Lack of follow-up
• Lack of collaboration and coordination with local
  businessmen importing mosquito nets
• Lack of awareness of the population
• Insufficient financial resources
• Limit access to ITN for poor population
• Quality of nets imported through private sector

25
PLAN OF ACTION FOR PROMOTION AND DISTRIBUTION OF
ITN IN DJIBOUTI

• Population targeted in ITN plan of action
• Population leaving in high risk areas (360
  000) which are
• - Ambouli and Balbala in Djibouti
• city
• - As-Eyla in Dikhil District
• - Sagalou/Karaaf and Dorra in
• Tadjourah District

26
OBJECTIVES

• General objective
• Reduction of mortality and morbidity due to
  malaria
• Specific objectives
• - 60 of the population leaving in high
  risk
• areas using ITN
• - 60 of pregnant women and children
  leaving in
• high risk areas sleeping under ITN

27
STRATEGIES

• Creating an enabling environment for the
  promotion and distribution of ITN
• Creating demand
• Supplying and distribution
• Monitoring and evaluation
• Operational research

28
CREATING AN ENVIRONMENT FOR THE PROMOTION AND
DISTRIBUTION OF ITN

• Meeting and coordination with partners
• Meeting with NGOs
• Meeting with community leaving in high risk ares
• Identification of local businessmen to be
  implicated in ITN promotion and distribution
• Decision by the Ministry of Health for 0
  taxation of nets
• Define procedure and modality of collaboration
  with NGOs

29
CREATING DEMAND

• Identification of NGOs to be involved in
  promotion and distribution of ITN
• Training of NGOs members
• Involvement of communities trough community
  health workers, local associations and NGOs
• Introducing ITN promotion in BDN sites
• Involvement of media including training of
  journalists
• Elaboration of educational materials
• Monthly publication of articles in local
  newspapers

30
Facilitating supply and distribution of ITN

• Importation of ITN by the Ministry of Health in
  collaboration with partners
• Importation of nets through private sector (local
  businessmen)
• Training members of NGOs
• Establishment of district teams in charge of ITN
  distribution
• Distribution of ITN through BDN
• Training of District team members
• Importation of insecticides for nets treatment

31
MONITORING AND EVALUATION

• Define indicators for the evaluation of ITN plan
  of action
• Survey on knowledge, attitude and practices in
  high risk areas
• Follow-up of ITN importation, distribution and
  utilization

32
OPERATIONAL RESEACH

• Study on sensibility of anopheles to insecticide
  (k-othrine)

33
Principal indicators

• Number of nets imported through public and
  private sectors
• Number of ITN distributed
• of household with one or more ITN
• of persons sleeping under ITN in high risk
  areas
• pregnant women and children under five sleeping
  under ITN in high risk areas
• Number of malaria cases confirmed and declared
  every year

34

• Thanks for your
• Attention