Roll Back Malaria in EMRcross border issues

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Roll Back Malaria in EMR-cross border issues

• Second cross border meeting Afghanistan, ,
  Pakistan, Iran
• Peshawar , Pakistan
• August 30-September 1
• Dr Hoda Atta
• Regional malaria advisor
• WHO EMRO

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Overview of Presentation

• Global Malaria Burden
• Regional malaria burden
• Roll Back Malaria
• RBM tools
• Regional strategy _Cross border collaboration

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Global Malaria Burden

• 40 of world population at risk in over 100
  malaria endemic countries
• 300-500 million cases of malaria per year
• 1 million malaria deaths per year
• gt 90 of deaths in Africa
• In Asia and the Americas Malaria is now mainly
  found in poor, marginalized rural communities

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Economic Burden
GNP per capita (1995)

• 1.3 reduced growth of national economies
• lowers GDP by 32 within 35 years
• Affects mainly agricultural productivity and
  school attendance of children

0-70
1941-2580
0
0
3
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Malaria Index
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Malaria is coming back

• Over last decade
• return of P.vivax transmission to countries where
  it had been eradicated
• Central Asian Republics
• Korean Peninsula
• increasing P.falciparum problem in parts of
  Africa, Asia and South America
• Some causes
• Wide-spread population movement, Poverty, war
• Resistance to antimalarials
• Resistance to insecticides
• Fragmented efforts to combat malaria

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Malaria burden in the Eastern Mediterranean
Region

• PUBLIC HEALTH THREAT
• 287 million live under risk (60 of EMR
  population)
• 15 million clinical cases per year
• 47 thousand deaths per year

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Estimated number of cases in EMR countries
(million/year)
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Current operational situation
Free from malaria Limited foci Mild-mod
transmission Intense transmission
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Group 1 Malaria eliminated

• Lebanon , Palestine
• Jordan, Qatar
• Libya, Bahrain
• Tunisia , Kuwait
• UAE

9 countries, 7 of the population Have Imported
cases
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Group 2 - Malaria under elimination

• Egypt
• Morocco
• Oman
• Syria

24 of the population
Cross border collaboration between Egypt and
Sudan annually Turkey Syria Iraq started in 2003
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Most Areas Freed From Malaria Are Still Receptive

• Population movement and lack or poor coordination
  of control activities at the border areas are
  common risk factors
• Threat of reintroduction to Gulf countries from
  labor force coming the Indian subcontinent
• Cross border movement e.g, between Turkey and
  Syria
• Threat of expansion of A. arabiensis Sudan to
  Egypt

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Group 3 Low/Moderate endemicity

• Pakistan
• Saudi Arabia
• Iran
• Iraq

53 of the population
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Vision to eliminate gt80 of cases in one district
in Dhouk Gov in the north Indoor residual
spraying is the mainstay of the programme
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Set a plan to eliminate Strong collaboration
with Yemen along the border Joint planning and
joint implementation teams
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Significant increase in malaria cases in 2003
Cooperation with PAK, AFG is not functional YET
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(No Transcript)
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Pakistan Access to and utilization of diagnostic
services is poor ratio of reported total
slides examined (TSE) through passive cases
detection to reported clinical malaria cases 2002
is 24
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Rough estimation of malaria burden in Pakistan
Surveillance is incomplete , incomprehensive

• The total number of confirmed cases recorded for
  2001 was 111,110.
• If the SPR of the remaining clinical cases
  treated in the public sector was 7, then this
  would account for an additional 226,125 cases, So
  the total confirmed cases should be 337,235 .
• If this represents one fifth of the total cases,
  then a conservative estimation for 2001 would be
  some 1.5 million malaria cases

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Group 4 With intense malaria transmission
16 of population 95 of the cases

• Afghanistan
• Djibouti
• Yemen
• Sudan
• Somalia

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Afghanistan
Malaria Endemic provinces/districts Border
areas at more risk
Afghanistan
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Effective Evidence-based Interventions

• Access to prompt effective treatment and
  diagnosis
• treatment with most appropriate therapy,
  switching to combination therapy as resistance
  thresholds are passed
• treatment near the home as possible ( home
  management of malaria)
• Epidemic prediction , preparedness and rapid
  response
• Multiple prevention measures
• Integrated vector management ( chemical ,
  biological environmental , insecticide-treated
  nets priority for children under 5 years old
  and pregnant women in intense transmission areas
  )
• Intermittent preventive treatment (IPT) in
  pregnancy in areas with intense P F transmission
• chemoprophylaxis for travelers

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Strengthen information system, monitoring and
evaluation system

• Strengthening routine disease surveillance with
  prioritisation on proper analysis of data, timely
  reporting and feedback of information and a
  better use of data translated into action.
• Development of laboratory-based sentinel
  surveillance
• Use of Geographical Information Systems (GIS)
  technology for risk mapping
• Support specific studies , surveys
• Encourage reporting and documentation national
  malaria report

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Sentinel sites for monitoring drug efficacy

• 8 countries with local P falciparum in EMR
• Sites established in 4 countries ( SUD , YEM,
  SOM, IRA)
• Not Yet in AFG, PAK, DJI, SAA.in process
• HANMAT a network for HOA countries was
  established
• WHO Supported therapeutic efficacy of chloroquine
  and SP study in 2003 , Khanabad, north-eastern
  Afghanistan, in Collaboration with MERLIN and
  the Institute of Malaria and Parasitic Diseases

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RBM EMR programme 2002-2005

• Targets
• Strengthen technical capacity for RBM
• Support inter-country action and inter-regional
  cooperation
• Support the countries in implementing package of
  effective interventions
• Support specific projects to show success

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Cross border activities in EMR

• In 2004
• Cross border meeting in Aleppo, Syria, 20-23
  April 2004 SYRIA, IRAQ, TURKEY
• Border meeting between Saudi Arabia and Yemen
  every 6 month ( bilateral activity )
• Border coordination between Egypt, Sudan (
  bilateral activity )
• Horn of Africa network for monitoring
  antimalarials treatment ( Cairo March, Nairobi
  July 2004) (SUD, SOM DJI, ETH, ERI, YEM)
• Before
• First border meeting IRA PAK AFG 2003
• Meetings in Baku 1999, 2000 ( AFG, Syr, IRA,
  Iraq, AZE, TUR, TAJ)
• Tunis 97 for north of Africa countries

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• Collaboration between Saudi Arabia and
• Republic of Yemen
• Border Collaboration was initiated with RBM in
  2000
• The joined Saudi-Yemeni coordination committee on
  malaria control at the border areas established ,
  Committee agreed, at the last meeting , February
  2003 on
• implementation of activities through mutual
  teams,
• Standardization of malaria drug policy in the two
  countries
• Establishment of a bilateral team to evaluate the
  implementation of control activities at the
  border areas every three months,
• preparation of periodic and special reports for
  information purposes.
• A joined team has recently conducted residual
  house spraying in border villages of the
  Republic of Yemen.

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Cross border coordinationIRA, PAK,
AFGRationale

• Frequent cross border population movement , no
  real geographic border
• High incidence of malaria and PF at the border
  with CQ treatment failure
• Shortages of diagnosis facilities and prompt
  treatment in remote areas
• Delay on detection and control of outbreaks
• Limited capacity on integrated vector
  management
• Insufficient advocacy on personal protection and
  low ITN coverage
• Information exchange, monitoring and evaluation
  is weak

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Cross border coordinationIRA, PAK, AFGFuture
vision

• Be functional
• National/district committees and joint
  implementation teams at the border
• Routine activity of the National programme
• Harmonization of policies and strategies
• Network on monitoring antimalarials treatment
• Collaboration in capacity building and training
• Joint operation research projects
• Joint proposal for fund raising