Post on 18-Jan-2016
transcript
Proposed Malaria Surveillance System & Malaria Elimination Feasibility Study: Philippines
Lipa City, Batangas, Philippines10 – 18 February 2014
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
5,00010,00015,00020,00025,00030,00035,00040,00045,00050,000
34,96837,469
44,60539,946
46,342
35,40536,235
23,65519,95519,106
9,583 8,086
Figure 1. Annual Number of Malaria Cases in the Philippines, 2001-2012
Year
Num
ber
of M
alar
ia C
ases
Cases were reduced by 83% within a period of seven years, from 46,342 in 2005 to 8,086 in 2012.
Global Fund started
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120
20
40
60
80
100
120
140
160
76
6254
150
122
73
56
2430
12 16
Figure 2. Annual Number of Malaria Deaths in the Philippines, 2002-2012
Year
Nu
mb
er o
f M
alar
ia D
eath
s
Global Fund started
Within the same period, deaths caused by malaria also declined by 89% from 150 in 2005 to 16 in 2012.
Programmatic Challenges
Palawan
Tawi-tawi
In 2012, 15 out of 80 provinces contributed to 99% of the reported 8,086 malaria cases; two provinces accounted for 85% - Palawan (51%) and Tawi-tawi (34%).
Progress in some provinces in the Mindanao (Southern) Region was erratic, most likely due to political and social instablity.
Enhanced Malaria Strategic Plan 2014 - 2020
Strategic Objectives1. To ensure universal access to reliable diagnosis, highly
effective and appropriate treatment and preventive measures.
2. To strengthen the capacity at all levels towards malaria elimination
3. To sustain financing of anti-malaria efforts at all levels of operations
4. To ascertain quality malaria services, timely detection of infection and immediate response and evidence-based enhancement of malaria elimination measures
2. Existing Malaria Surveillance
a. Phil. Integrated Disease Surveillance & Response (PIDSR)
Flow of Reporting
2. Existing Malaria Surveillanceb. Phil. Malaria Information System (PhilMIS)• An electronic information system that aims to
capture Malaria cases, deaths and vector control data;
• To be implemented across different health reporting units (BMMC/RDT sites, Hospitals, MHO, PHO/Ch-CHO, CHD);
• Allows analysis and use of data at different levels to effectively manage the Malaria Program.
Every 12th
day of thesucceedingmonth
Every 10th
day of thesucceedingmonth
Every 5th
day of thesucceedingmonth
Every 8th
day of thesucceedingmonth
Modified PhilMIS Reporting Flow
CHD
CH-CHOPHO DOH HOSPITAL
RHU/CHO HOSPITAL*
BRGY. FACILITIES
BRGY. FACILITIES
HOSPITAL**
CENTRAL OFFICE
PSFI-PO
PSFI-CH
*Municipal Hospital, District Hospital, Provincial Hospital, Private Hospital** Private Hospital, Clinics, Laboratories
Feedback MechanismReport Flow
What will be the role of the facilities?
• Fill-out Modified PhilMIS forms;• Consolidate and validate data;• Encode into the software of workstation;• Analyze data of workstation;• Provide feedback; and• Submit to next level
Modified PhilMIS FormsCASE REGISTRY FORMS VECTOR CONTROL FORMS
F1 Malaria Patient Registry Form
F6 Mosquito Net Distribution Form
F2 Monthly Malaria Report Form
F7 Mosquito Net Distribution Summary Form
F3 Malaria In-Patient Registry Form
F8 Indoor Residual Spraying Form
F4A Hospital Out-Patient Monthly Malaria Report Form
F9 Indoor Residual Spraying Summary Form
F4B Hospital In-Patient Monthly Malaria Report Form
F10 Mosquito Net Retreatment Form
F5 Active Case Detection / Mass Blood Survey Form
F11 Mosquito Net Retreatment Summary Form
Data can also be viewed in the website by implementers and
managers in the form of tables and graphical summaries.
Reports can also be sent to the implementers via email
During health emergencies (outbreak)
and special concerns (stock-out), System
Administrator of MTRS can contact local Implementers to
facilitate and coordinate activities.
A trained health
worker sends a Malaria
case report through SMS
Flow of Information in Malaria TXT Report System
Implementing partners/managers
at various levels
Malaria Diagnostic Facility
Malaria TXT Report System
5
The SMS is processed by the
MTRS software and the data is stored in a dedicated server.
2
The MTRS software sends
confirmatory SMS within minutes. It
can also send message for
announcements and special concerns
4
3
1
Framework of ESR
2. Exisiting Malaria Surveillance• Case Definition:
- case with fever/history of fever and manifest any of the following sign and symptoms: chills, sweating, headache, enlarge spleen and confirmed positive for malaria.• Laboratory Confirmation:– Microscopy– RDT
Barangay Microscopists
CHD/PHO ValidatorsRITM-NRL
RHU/CHO/hospital/laboratory
Microscopists
Slides for validation
Feedback, supervisionand remedial intervention
LEVEL 2 LEVEL 3
Proficiency Assessment
Slides for validation
Feedback, supervision and remedial intervention
National Core Group
of Trainers/ Validators (NCGT)
(composed of NRL staff and
CHD/PHO validators)
Training
Certification
National/ Regional
Slide Bank
World Health Organization
(WHO) Regional Slide Bank
Regional Accreditation and
EQA Program
LEVEL 1
RHU/CHOhospital/
laboratory/ BMMC microscopists
Basic Malaria Microscopy Training
Quality Control and Quality Assessment of Malaria Microscopy
• Validation of blood films- selection of blood films for validationControl Phase
Scheme 1
240 blood films – 30 blood films/quarter Scheme 2
200-240 blood films – submit all in a quarter Scheme 3
< 200 blood films – submit all blood films and validator sends panel of slide every year
Pre-Elim All positive slides and 10% of negatives
Elim PhaseAll positive slides, RDT positive to be confirmed by microscopy
- validation schedule and frequency
- feedback and reporting
Cross- checking
2. Existing Malaria Surveillance2.3. Personnel for case detection: a. Bgy/Village: Volunteer Bgy Microscopist,
Rural Health Midwives b. Municipality: Med. Techs., Rural Physicians,
Nurses, Malaria Personnel c. Hospitals: Med. Techs, Physicians (mun., district, prov, Cities) d. Private/NGOs, FBOs e. Provincial Health Teams (still existing in some provinces)
2. Existing Malaria Surveillance
• Laboratory Methods1. Microscopy2. RDT3. PCR - RITM
2. Existing Malaria Surveillance
• Methods of Reporting1. Submission of reports (hard and/or soft copy2. Program Implementation Reviews3. Field monitoring4. SMS (limited)
2. Existing Malaria Surveillance• Reports & Feedback Produced by Central Level– Quarterly, Semestral and Annual National Reports– Submits report to WHO - World Malaria Report– Program Implementation Review (twice a year)
3. Proposed Changes- Review of Malaria MOP and inclusion of the Elimination Chaptera. Case Classification– Local• Indigenous case• Introduced case
– Imported• Internal Imported• External Imported
– Induced cases
3. Proposed Changesb. Focus Classification- Stable Transmission – Endemic- Unstable - Active focus, Residual Active- Sporadic - New Potential- - Residual Non-Active- Malaria Free - Cleared - up
4. Proposed National Guidelines for Malaria Surveillancea. Case Definition:
- a case regardless of the presence or absence of clinical symptoms, malaria parasite have been confirmed by quality controlled laboratory diagnosis.b. Case Classification:
- Local: Indigenous, Introduced- Imported: Internal, External- Induced
c. Case Investigation: more active role in case investigation
4. Proposed National Guidelines for Malaria Surveillancec. Case Investigation: - Pre-Elimination/Elimination Areas: Immediate
case investigation- Investigation Teams: PHT, Provincial Malaria
Person, RHUs and Bgy. Health Worker- ACD/Focal Investigation
4. Proposed National Guidelines for Malaria Surveillanceb. Methods of Focus Identification, Delimitation & Classification:- Focus Investigation:
- Team: Trained Staff (Prov/Mun), Bgy Health Workers
- Map: breeding areas, houses, malaria case, Malaria Interventions
- Use of Malaria Focus Investigation Form
4. Proposed National Guidelines for Malaria Surveillance
c. Operational Implications of Different Types of Foci.
1. Foci maybe located in 2 or more boundaries:
human resourcesAllocation of commoditiessupervisionaccountability
Geographic Distribution Malaria Vector (2007-13)Source: RITM Entomology
Feasibility StudyA. Technical Feasibility1. Vectorial Capacity/ Receptivity– A. flavirostris- zoophilic but females can feed on both man
& animals– Breeds in man-made and natural breeding areas– Susceptible to current insecticides used– Generally dwellings with sprayable walls except in some IP
communities – Year round vs. seasonal transmission– Terrain: archipelago but generally good access to health
care services– Late evening activites
Feasibility Study
2. Duration of Infectivity:- P. falciparum (60 – 70%)- No drugs resistance reported, TES with RITM- Improved health seeking behaviour- Free health services - Expansion of health services to military, OFWs- Private Sector involvement in dx & tx
Feasibility Study3. Vulnerability- Significant population movement: OFWs, in-
country- Risk from neighboring countries is low except
to Students from endemic countries
-
Feasibility StudyB. Operational Feasibility- Political & social stability except in ARMM- Support from Executive Committee – DOH- Devolved Health Services – LGUs highly
accepts malaria elimination initiatives- MCP : Trained health workers but insufficient- Excellent Microscopy Services with functional
QAS- External Support: WHO, GF & Private Sector
Feasibility Study
Conclusion:- Malaria Elimination is Feasible in the
Philippines.- More work in Palawan & ARMM
Thank you!
Sample Report Generated (website view)
Sample Report Generated (website view)