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Malaria Burden and Strategies for Control and Elimination.

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Presentation on theme: "Malaria Burden and Strategies for Control and Elimination."— Presentation transcript:

1 Malaria Burden and Strategies for Control and Elimination

2 Outline Global situation of malaria elimination in 2011 Lessons on malaria elimination – WHO regions by region Recent WHO activities on malaria elimination Major challenges/opportunities ahead Conclusions

3 Current classification of 193 countries and 2 territories by the malaria programme that is implemented in the worst affected part of the country

4 Malaria Elimination: 2011

5 Progress with malaria elimination in the WHO European Region Ten out of 53 countries in the European Region were affected by malaria in 2000 As of 2011, locally acquired malaria cases were reported in only four countries: Azerbaijan, Greece, Tajikistan and 1 case in Georgia Turkmenistan was certified malaria-free by WHO in 2010, Armenia – in 2011

6 Progress with malaria elimination in WHO European Region

7 Number of autochthonous cases of malaria in EURO,


9 Similarities & Differences between North Afghanistan and South Tajikistan SIMILARITIES: P. vivax malaria is predominant Areas susceptible to P. falciparum outbreaks/epidemics The same malariogenic landscapes with the same malaria vectors High level of commitment to control and eliminate malaria DIFFERENCES: Malaria is more prevalent in Afghanistan Health infrastructure is in the process of being rebuilt in Afghanistan Malaria control and elimination policies are uniform in Tajikistan but they are variable in Afghanistan Quality control and assurance of anti-malaria measures are absent in Afghanistan but present to some extent in Tajikistan Insecure, but relatively safe in North Afghanistan and safe in South Tajikistan

10 Progress with malaria elimination in WHO Eastern Mediterranean Region Twelve out of 22 countries in the Eastern Mediterranean Region reported local malaria transmission in 2000 During subsequent decade, six countries embarked on nationwide elimination programmes (Islamic Republic of Iran, Iraq, Morocco, Oman, Saudi Arabia and Syria), resulting in 10-fold reduction in malaria cases Three others (Pakistan, Sudan and Yemen) developed sub-national malaria-elimination initiatives The United Arab Emirates and Morocco were certified malaria-free in 2007 and 2010, respectively

11 Elimination in Morocco 11 Malaria has been eliminated in Morocco Total cases (log scale) 100,000 10,000 1, Total cases Local cases Monitoring & surveillance remain high priority Map of entomological surveillance sites in Morocco today Permanent breeding sites for entomological surveillance

12 Elimination in Iraq 12 Cases of vivax malaria - Iraq Sulaimania was the last region with malaria in Iraq Local cases in Iraq, Last Local cases in 2008 Local cases Imported cases Local cases 100,000 40,000 20, ,860 9,684 49,836 98,222 Total cases

13 Iran - gradual reduction of malaria cases (1710 cases in 2011 compared to in 2005) Close to falciparum elimination only 463 local cases in 2011 Saudi Arabia reported 29 local cases in 2010 ( 99% decrease compared to 2000) However, local cases have increased to 79 in 2011 Elimination in Saudi Arabia and IR Iran

14 Bilateral coordination - Border units for screening, diagnosis and treatment قائم الصياب المكندرات سمسرة المجدعة العرة بتول المظبر السودة القرقاعي الخوبة المصفق Border units Border screening clinics between Saudi Arabia and Yemen Saudi-Yemen border Saudi Arabia Yemen

15 Challenges in malaria elimination/free countries Increased Vulnerability Considerable increase in population movement (legal and illegal) Increase in imported malaria esp. in Gulf countries Several outbreaks in Oman Increase in local cases in KSA 69 in 2011compared to 69 in 2010 Mostly imported cases from India and Pakistan Majority P. vivax Challenges: Decrease political support Border problems Relaxation More attention to non-CDs Country NameImportedlocal % increase of imported compared to 2010 Bahrain Kuwait Oman Qatar Saudi Arabia UAE Total Source of importation Imported cases % PV Pakistan India Unknown Yemen Afghanistan714 91

16 Progress with malaria elimination in WHO Region of the Americas (PAHO) Local malaria transmission in 23 out of 47 countries in 2000 Four have since progressed to the pre- elimination phase (Argentina, El Salvador, Paraguay and Mexico) Two have initiated an elimination programme at sub-national level (Dominican Republic and Haiti) Two other countries (Bahamas and Jamaica) suffered a temporary reintroduction of malaria transmission in 2006 that has since been controlled

17 Progress with malaria elimination in WHO Southeast Asia Region (SEARO) With exception of the Maldives, which is preventing reintroduction following its successful elimination efforts in the 1980s, all 11 countries affected by malaria during last decade Two countries progressing with nationwide elimination (Sri Lanka and Democratic Peoples Republic of Korea) Indonesia has adopted a sub-national elimination strategy for Java and Bali Bhutan and Thailand, where large areas with no malaria transmission are found, have expressed their intention to proceed with elimination

18 Progress with malaria elimination in WHO Western Pacific Region (WPRO) Malaria is still endemic in 10 of 37 countries Malaysia and Republic of Korea implementing nationwide malaria elimination programmes Sub-national elimination on-going in Philippines, Solomon Islands, and Vanuatu Cambodia, China, Viet Nam and Lao Peoples Democratic Republic have included elimination in their national strategies. In 2010, China made a government commitment to eliminate malaria

19 Progress with malaria elimination in WHO African Region (AFRO) All but four of 46 countries have on-going transmission Lesotho, Mauritius, and the Seychelles not endemic for malaria Algeria is in the elimination phase; Cape Verde entered the pre-elimination phase in 2010 Four countries of southern Africa (Botswana, Namibia, South Africa and Swaziland) share a common goal of eliminating malaria by 2015; joined by four northern neighbours (Angola, Mozambique, Zambia and Zimbabwe) in 2009, to form sub- regional malaria elimination initiative known as Elimination Eight (E8) Another four countries in Africa (Gambia, Rwanda, Sao Tome and Principe, and Madagascar) have secured grants to prepare for elimination

20 Recent WHO activities on malaria elimination Community Based Reduction of Malaria Transmission (with malERA) Eliminating Malaria: Learning from the Past and Looking Ahead Malaria Elimination Case Studies Series (together with UCSF Global Health Group) Elimination Scenario Planning (ESP) tool (together with Clinton Health Access Initiative) Launch of Disease Surveillance for Malaria Elimination Launch of T3: Test. Treat. Track.

21 Major challenges ahead Political commitment Financial resources Procurement and supply chain management Health system capacity Delivering quality case management in the private sector Human resource capacity Antimalarial drug resistance Insecticide resistance Inadequate surveillance and controversies over burden estimation Delivering results in highest burden countries

22 Challenge: Global political commitment Context Major shift towards non-communicable diseases Sense that malaria has already made significant progress, therefore needs less support going forward Fatigue (this is a long fight) Potential solutions Consistent evidence-based policy setting (WHO Malaria Policy Advisory Committee) Careful and consistent documenting of impact Link to wider health & development efforts Resolutions from major organizations (e.g. UN, WHO) Organizational support (e.g. ALMA) Helping countries cross the finish line (malaria elimination) Risks Advocacy sometimes out ahead of reality: a fine line

23 Continued global political commitment Creation of African Leaders Malaria Alliance (ALMA): 2009 United Nations General Assembly resolution on malaria: April 2011 World Health Assembly (WHA) resolution on malaria: May 2011 Roll Back Malaria (RBM) Partnership revised objectives, targets, and priorities: June 2011 malERA ( ) & MESA (2012 & beyond)

24 Challenge: Financial Context Well short of estimated 6 billion USD per year required Concerning data to suggest that funds could decline by 2015 Global financial crisis and competing priorities with potential to worsen the situation Global Fund Continuity of Services policy does not include malaria Potential solutions Increased efficiency and value for money Increased domestic funding for malaria Innovative financing mechanisms Risks Worsening financial crisis; continued financial challenges at Global Fund

25 Major opportunities ahead Malaria elimination: crossing the finish line Trans-border collaboration New uses for existing tools. Example: Seasonal Malaria Chemoprevention (WHO policy for Sahel sub-Region as of 2012) New tools: malaria vaccine in 2015? Integrated community case management (iCCM) Improving efficiency and value for money. Example: a 5-year LLIN Universal diagnostic testing, improved case management, and strengthened surveillance (T3: Test, Treat, Track) Stratification: Using data for decision making Determining the optimal intervention mix for different epidemiological settings

26 Malaria Surveillance Manuals – Worldwide launch: Namibia, 24 April 2012

27 Objective To provide guidance to malaria-endemic countries on the operation of malaria surveillance systems for malaria control and elimination Rationale Updated malaria surveillance guidance has not been issued by WHO since the Global Malaria Eradication Programme era Scale-up of malaria interventions increases need for timely and accurate information on malaria occurrence for program management Increasing availability of malaria diagnostic tests allows for tracking confirmed malaria cases and better targeting of resources New manuals focus on program implementation and complement other existing guidance on malaria indicators Surveillance Manuals: Objective and Rationale

28 Surveillance Manual Content Developed by WHO with help from members of the Roll Back Malaria Monitoring and Evaluation Reference Group and other partners in global malaria community Focus on routine information systems, decentralized analysis, interpretation and use of surveillance data Structure: two volumes: (i) programs in control phase; (ii) programs in elimination phase 1.Overview of Malaria Surveillance in Different Phases of Malaria Control 2.Key Concepts in Malaria Surveillance 3.Data Recording, Reporting, Analysis and Use 4.Establishing Surveillance Systems Annexes Diagnostic tests/ quality assurance Core surveillance indicators Registers, case investigation forms, report forms, sample analyses

29 Three WHO Manuals as pillars of T3 TestTreatTrack

30 T3: Test. Treat. Track. Worldwide Launch: Namibia, World Malaria Day 2012




34 Conclusions Experiences in countries of EMR – provide important lessons for Rwanda i.e. cross-border and vulnerability Complacency and lack of political commitment Tendency to withdraw resources for malaria following successful elimination. There is a need to strengthen: Capacity on surveillance so that cases are picked up, treated and reported rapidly (T3) Capacity for entomological and insecticide resistance monitoring Capacity to respond to malaria outbreaks through appropriate vector control interventions

35 I thank you for your attention

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