FOURTH INTERCOUNTRY MEETING OF NATIONAL MALARIA PROGRAMME MANAGERS ISFAHAN ISLAMIC REPUBLIC OF IRAN

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FOURTH INTER-COUNTRY MEETING OF NATIONAL MALARIA
PROGRAMME MANAGERS ISFAHANISLAMIC REPUBLIC OF
IRAN
25 28 May 2004
Presented by Dr. Said Farah Ahmed RBM Nation
Focal Point WHO Somalia E-mail
whogarcdc_at_hotmail.com E-mail
bedenle54_at_hotmail.com

• Dr. Waqar Ahmed Butt
• RBM Coordinator WHO Somalia
• E-mail rbm_at_som.emro.who.int
• Email waqbutt54_at_hotmail.com

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Administrative Map
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Health Facility Accessibility
NWZ NEZ CS
zones Hospitals 9 Hospitals 5
Hospitals 23 MCH 53 MCH
54 MCH 70 HPs 197
HPs 98 HPs
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Malaria Microscopy Centers and Referral
Laboratories in Somalia
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SITUATION OF THE PROGRAM

• Somalia belongs to the zone of Afrotropical
  malaria .
• The deadly Plasmodium faciparum is overwhelmingly
  predominant.
• Malaria situation ranges from unstable but
  epidemic prone areas( Somaliland and Puntland )
  to stable meso-endemic in central and
  hyper-endemic in the south of the country
• Over all, all age groups are affected but
  severely children , pregnant women and nomadic
• Control measures priorities vary in different
  zones. In north, to reduce malaria transmission
  through effective anti-larval and epidemic
  preparedness is the top priority, while in South
  and central , to reduce morbidity and to prevent
  the mortality in high risk groups through early
  diagnosis and prompt treatment and personnel
  protection With ITNs are the top priorities

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Malaria Control Activities

• Laboratory services available in hospitals
  trainings for laboratory technicians on malaria
  microscopy and rapid diagnostic test for malaria
  in areas with no laboratory facility (paracheck)
• Vector control measures such as larvivorous fish,
  ITNs as personnel protection, indoor residual
  spray in outbreak prone areas.
• Surveillance, monitoring and Evaluation
• Prompt response to malaria out breaks with
  adequate AMD and Laboratory diagnostic services
  at site
• Limited activities in Larvivrous fish programme
  in NWZ

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Epidemiological Stratum in Somalia Sentinel
sites for AMD Efficacy Study
Djibouti
Hypo endemic
Burao
Ethiopia
Galcayo
Baidoa
B/hawa
Meso-endemic
Jowhar
Jannale
Kenya
Hyper-endemic
Jamaame
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DEVELOPMENT OF CHLOROQUINE RESISTANCE IN SOMALIA
1986-1997
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Table1 Therapeutic Efficacy of Chloroquine (CQ)
2003
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Table 2 Therapuetic efficacy of Sulphadoxine /
Pyrimethamine (SP) in 2003
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Achievements for Malaria Control Programin
Somalia 2003

• Effective celebration of the 3rd anniversary of
  AMD
• Assessment of malaria situation in epidemic
  malaria prone areas (NEZ NWZ)
• Establishment of malaria task force at national
  and zonal level
• Two weeks training workshop on entomology by VCP/
  scientist from EMRO
• Training on malaria microscopy for 14 lab.
  technicians from cross border areas
  (Somalia/Ethiopia)

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Achievements for Malaria Control Programin
Somaliacont.

• Prompt response to malaria outbreaks in Awdal and
  Galbeed regions and pre-positioning AMDs in te
  other zones.
• Extension of one more sentinel site for AMD
  efficacy in Somalia (B/Hawa in SZ).
• Supervisory visit to NWZ (Borama,
  Berbera,Togdher, Galbeed and AwdalRegions) and
  NEZ (Mudug,Nugal and BariRegions)

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Achievements for Malaria Control Programme in
Somalia 2004

• Response to malaria problems reported from
  coastal areas in NWZ
• Basic Malaria Microscopy training in NEZ Puntland
  for 11 Laboratory Technicians
• Basic malaria microscopy training in South
  Central zones for 9 laboratory technicians
• Basic malaria microscopy training for 9 private
  laboratory technicians in Garowe Punt and
• Indoor residual house spraying campaign completed
  in Awdal Galbeed regions (epidemic prone areas
  in NWZ)
• Four health professional staff from Galgudud were
  trained
• 6 health professional staff training on mosquito
  net impregnation in NEZ
• 28 health professional staff training on mosquito
  net impregnation in south Central zone
• 4th Africa Malaria Day celebrated in Somalia
  with theme A Malaria Free-Future with slogan
  Children for children to Roll Back Malaria

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Future activities

• AMD efficacy study for combination (AQSP) and
  Mono-therapy (AQ) in four sentinel sites of CS
  zones
• To develop malaria treatment guideline for
  Somalia
• Training of one entomologist in integrated vector
  control management

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Malaria Cases in Somalia, 2002
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Malaria Cases in Somalia, 2003
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Malaria Cases in Somalia, 20041st Quarter
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Outbreak, Notification and Response in NWZ,2003
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Outbreak, Notification .
Slide 19
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ITNs DISTRIBUTION IN SOMALIA 2003
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ITNs Distribution 4th Africa Malaria Day in
Hargeisa Orphanage Center, NWZ of Somalia
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FOURTH AFRICA MALARIA DAY CEREMONY IN THE
GAROWEMCH SCHOOL CHILDREN,TEACHERS ELDERS
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Continue
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Community Concept on ITNs (IEC)

• Community Concept
• Is the Insecticide for Impregnation of the bed
  nets Harmful to Human (Children lt5 years
  Pregnant mothers)?
• Will the ITN protect us from biting or kill the
  mosquito?
• How long can it protect us from Mosquito bites?
• Awareness!

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MAIN CONSTRAINTS

• There is no organized Malaria control program
  and activities in most of the country with
  exception of NWZ NEZ.
• Unstable and constantly changing security
  situation limiting access and operation in the S
  C zones
• Inadequate and irregular supply due to high
  operational cost
• Lack of effective central government to
  coordinate the control activities
• WHO trained health staff left the public health
  facilities due to low remuneration and
  incentives
• Self medication adapted by Somali community which
  may provoke resistance of parasite to
  anti-malarial
• No respect and compliance with the existing
  Malaria Drug Policy as the AMD is imported and
  distributed by private sector
• Security concern increases burden on programme
  budget

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RECOMMEDATIONS

• Completion of the anti- malaria drug efficacy
  study, on combination therapy to develop new
  policy for malaria treatment in the country.
• Strengthening of existing laboratory services
  and Extension of the laboratory services to the
  peripheral health facilities (malarious/ malaria
  prone areas (both by training of the staff and
  capacity buildings)
• Development of common strategy for purchasing,
  distribution, re-impregnation , utilization
  follow up and efficacy evaluation of the ITNs
  (all partners)
• Provision of IPT in MCHs for pregnant woman in
  2nd and 3rd trimester
• Training the health professionals on malaria case
  management country wide
• Consensus on development of IECB With partner and
  other organizations dealing with malaria control
  program

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Moving on 60 of Somalias population comprises
people of nomadic nature