Malaria control program

Malaria control programGROUP 2OVERVIEW:To cite the worldwide impact, prevalence and social and economic effects of MalariaTo review the etiology, mode of transmission, symptoms, and pathogenesis of the diseaseTo discuss the methods of diagnosing Malaria To describe the geographical distribution of Malaria in the Philippines and categorize the different provinces based on the malaria cases/ year

OVERVIEW:To discuss the national situation of the control of malaria in the Philippines To give updates and developments on the Malaria Control Program 2002-2009To explain the transition from malaria control to malaria elimination as set by the WHO To present and discuss the 2011-2016 Malaria Program Medium-Term Development Plan: vision, goal, objectives

OVERVIEW:To enumerate the different different strategies of MP-MTDPTo discuss the different indicators and activities for each strategiesTo give the roles and responsibilities of various groups

OBJECTIVE 1To cite the worldwide impact, prevalence and social and economic effects of Malaria

Worldwide Impactit is transmitted in 108 countries containing 3 billion people and causes nearly 1 million deaths each yearamalaria has been eliminated from the United States, Canada, Europe, and Russiain the late twentieth and early twenty-first centuries, however, its prevalence rose in many parts of the tropicsa Harrisons Internal Medicine. 18th ed.Worldwide Impact35 countries (30 in sub-Saharan Africa and 5 in Asia) account for 98% of global malaria deathsin 2008, malaria caused an estimated 190 311 million clinical episodes, and 708,000 - 1,003,000 deaths89% of the malaria deaths worldwide occur in Africa

5th cause of death from infectious diseases worldwide (after respiratory infections, HIV/AIDS, diarrheal diseases, and tuberculosis) in low-income countries2nd leading cause of death from infectious diseases in Africa, after HIV/AIDSin Africa a child dies every 45 seconds, the disease accounts for 20% of all childhood deathsWHO 2005 Data- 9th leading cause of death

Malaria-endemic countries in the Americas (bottom) and in Africa, the Middle East, Asia, and the South Pacific (top), 2007. CAR, Central African Republic; DROC, Democratic Republic of the Congo; UAE, United Arab Emirates.Social and Economic EffectsIn addition to its death toll, malaria also places a heavy burden on the perpetuated the continuing cycle of poverty among the people affected and their familieseconomic well-being of population in endemic countries as a disease, the poorest countries experience the greatest burden for malariain 2002, almost 60% of malaria deaths are concentrated in the worlds poorest population; also holds true when the burden is measured in disability adjusted life-years (DALYs)on the other hand, the richest 20% of the worlds population in 2002 only carried 0.2% of the malaria burden in terms of deaths and DALYsa countrys per capita GDP inverse relation to the countrys malaria burden

OBJECTIVE 2To review the etiology, mode of transmission, symptoms, and pathogenesis of the diseasePlasmodium sp.Anopheles sp.Anopheles gambiaeInfected female mosquito bite which sucks blood from the human host

Life Cycle

Clinical ManifestationCLASSICAL MALARIA PAROXYSMCold StageHot StageSweating StageCold StageSudden inappropriate feeling of coldness and apprehensionMild shiveringIntense peripheral vasoconstrictionVomitFebrile convulsions

15-60 minutesClinical ManifestationCLASSICAL MALARIA PAROXYSMCold StageHot StageSweating StageHot / Flush StageHot (40-41 C)HeadachePalpitationsTachypneaEpigastric discomfortThirstNausea and VomitingConfused and delirious

1-6 hoursClinical ManifestationCLASSICAL MALARIA PAROXYSMCold StageHot StageSweating StageSweating StageProfuse sweatingTemperature lowers over the next 2-4 hours

Symptoms diminishaSymptoms of severe P. falciparum malariaUnarousable coma (cerebral malaria)Generalized convulsionsSevere normocytic anemiaHypoglycemiaMetabolic acidosis with respiratory distressFluid and electrolyte disturbancesAcute renal failure

Acute pulmonary edemaAcute respiratory distress syndrome (ARDS)Algid malaria (circulatory collapse, shock, septicemia)Abnormal bleedingJaundiceHemoglobinuriaHigh feverHyperparasitemiaOBJECTIVE 3To discuss the different diagnostic procedures for malariadirect diagnosis -direct demonstration of the parasite whole cell or of parasites nucleic acid or products in the blood

indirect diagnosis or immunodiagnosis-demonstration of the patients immune response to the infectionBlood Smears(Thick & Thin Smears)Three thick and thin smears 12-24 hours apart should be obtained. The highest yield of peripheral parasites occurs during or soon after a fever spike.

Thick smears are 20 times more sensitive than thin smears. The parasitemia can be calculated based on the number of infected RBCs. This is a quantitative test.

Thin smears are less sensitive than thick smears, but they allow identification of the different species. This should be considered a qualitative test.

Rapid diagnostic tests (RDT)an alternate way of quickly establishing the diagnosis of malaria infection by detecting specific malaria antigens in a person's blood.

Rapid diagnostic tests (RDT)A blood specimen collected from the patient is applied to the sample pad on the test card along with certain reagents.

After 15 minutes, the presence of specific bands in the test card window indicate whether the patient is infected withPlasmodium falciparumor one of the other 3 species of human malaria.Immunological tests to detect Plasmodia specific antibodiesIndirect Immunofluorescence (IFAT) Indirect haemoagglutination (IHA) Enzyme-linked immunosorbent assay (ELISA) Radioimmunoassay (RIA) OBJECTIVE 4To describe the geographical distribution of Malaria in the PhilippinesCategories of the Different Provinces Based on the Malaria Cases/Year

Category Aaverage of >1000 cases

Cagayan PalawanIsabela Sulu Tawi-tawi

Category Baverage of 100 - < 1000 cases

Sarangani Kalinga Davao del Norte Mindoro Occ. Agusan del Norte Zambales Quirino Surigao del Sur Compostela Valley Basilan Davao Oriental Mt. Province Bukidnon Misamis Oriental Quezon ApayaoNueva VizcayaAuroraMindoro Or.

Category Caverage of < 100 cases

Ifugao Zamboanga Sigubay Abra Ilocos NorteTarlac Zamboanga del Norte Bulacan Pangasinan Nueva Ecija Camarines Norte Negros Oriental Antique Ilocos Sur Batangas Misamis Occidental Batanes Negros Occidental Pampanga La Union Zamboanga del SurRomblon Bataan Lanao del NorteLanao del Sur Laguna Camarines Sur

Benguet Cavite Masbate Cebu Bohol Catanduanes Aklan Capiz Guimaras Siquijor Biliran IloiloNorthern Leyte Southern Leyte Northern SamarCamiguin

Category Dabsence of indigenous malaria casea case acquired from local vector, not from somewhere elseacquired cases from travel not includedMicrostratification by Risk and Endemicity (2010)

Purpose:better tracking of malaria cases prioritization of endemic areas to be assisted to ensure more focused interventions.

High: >1000 casesModerate: 100- 80% of the 39 provinces and 9 chartered cities with stable and unstable transmission.Develop guidelines on 7 pop groups at risk Document good practices in each pop group Conduct consultations with concerned agencies/ stakeholders Orient pilot areas on the policy/guide Pilot the implementation of the package of intervention and approaches Evaluate pilot and enhance policies and guides Expand to other areas starting 2013 in 25 provinces/ cities and another roll out in 2014 to the other 25 provinces/ cities OBJECTIVE 1Strategy 1.1 Level-up focal anti-malaria interventions in stable and unstable risk areasStrategy 1.2 Sustain provision of anti-malaria diagnostic, treatment and preventive measures in epidemic risk and malaria-free areasStrategy 1.3 Design and implement responsive interventions to identified high risk groupsStrategy 1.4 Increase demand and support for anti-malaria services. Performance IndicatorsActivitiesPerformance Indicator 1.4.1Awareness of the population and participation of various groups of stakeholders in anti-malaria prevention and elimination efforts improved as evidenced by:% of population with correct knowledge on malaria signs and symptoms, mode of transmission and prevention measures% of identified groups of stakeholders at the national, regional and local levels participating in anti-malaria prevention and elimination effortsConduct pre-KABP and post-KABP Survey Develop MP-HPC Plan to enhance behaviour change by area of stratification Develop CHD and LGU MPHPC Plans Develop and produce IEC materialsDisseminate info through quad-media and innovative communication schemesAdvocate to LGUs to support MP elimination implementation Train staff on social mobilization, advocacy and communication skillsConduct special eventsEvaluate health promotion and communication activities and outcome Disseminate results of evaluation/studiesOBJECTIVE 2Strategy 2.1 Institutionalize area stratification, zoning and planning towards elimination of the disease. Strategy 2.2 Enhance malaria surveillance and response, monitoring and evaluation. Strategy 2.3 Strengthen organizational support and coordination mechanism for malaria operations at all levels. Performance IndicatorsActivitiesPerformance Indicator 2.1.1 Malaria transmission-based stratification per barangay completed and regularly updated every 3 years in all malaria endemic provinces and chartered cities.Orient/re-orient local health staff and program/project officers on stratification guide and analysisUpdate micro-stratification in 2013 and 2016Performance IndicatorsActivitiesPerformance Indicator 2.1.2100% of malaria endemic provinces and chartered cities formed into Malaria Disease Elimination Zones (MDEZ).Develop criteria and guide on macro-stratification of malaria-endemic areas into malaria disease elimination zones Map-out and establish malaria disease elimination zones based on criteria Undertake joint zonal activities Performance IndicatorsActivitiesPerformance Indicator 2.1.3Overall assessment and validation criteria and process in declaring malaria-free areas and malaria-eliminated zones developed and applied accordingly to candidate provinces, chartered cities and zones respectively.Enhance protocol and guide in assessing and declaring malaria-free areas Validate potential malaria free areas Develop criteria and guide in declaring malaria disease elimination zones Develop serologic testing capability of 4 regional collaborating centers Actual validation of malaria-free areas in a given zone through serologic test Design and implement incentive/ reward program for provinces/cities declared MFA and malaria eliminated zones Orient provinces/cities on guide/ criteria in assessing awards/ recognition scheme Provide corresponding incentive/ awards Performance IndicatorsActivitiesPerformance Indicator 2.1.4 2012-2016 LGU Malaria Program Strategic Plans formulated in sync with the national program policy direction, strategic thrusts and funding priorities and integrated into their P/CIPHDevelop guidelines and design for 2012-2016 Regional and Local Malaria Program Plans Conduct Strategic Planning Workshop in all endemic provinces and cities OBJECTIVE 2Strategy 2.1 Institutionalize area stratification, zoning and planning towards elimination of the disease. Strategy 2.2 Enhance malaria surveillance and response, monitoring and evaluation. Strategy 2.3 Strengthen organizational support and coordination mechanism for malaria operations at all levels. Performance IndicatorsActivitiesPerformance Indicator 2.2.1 Malaria Program Monitoring and Evaluation Plan, Guide and Tool developed and disseminated.Organize M and E Task Force and conduct regular meeting Formulate Malaria Program M and E Plan Develop M and E Guideline and Tools Orient LGUs and other offices concerned on Malaria M and E Plan Organize annual technical conference to disseminate M and E results Performance IndicatorsActivitiesPerformance Indicator 2.2.2 Malaria Program status tracked through the routine malaria information system at the national level and in all regions and malaria-endemic provinces and cities.Assess and enhance PhilMIS Orient areas with existing PhilMIS, new areas and the 11 chartered cities Consultative meeting malaria free and epidemic-risk and malaria-free provinces mplement revised forms, SOG and software to include data entry Train staff on data management Document best practices on data management Performance IndicatorsActivitiesPerformance Indicator 2.2.3 Periodic special surveys designed and completed with results disseminated and utilized.Design and undertake special surveys Midterm and End Term Evaluation Institutionalize GIS Organize periodic dissemination forum to share results of completed researches/studies Conduct Spacial Distribution Net Mapping Conduct PCR (for treatment failures) Performance IndicatorsActivitiesPerformance Indicator 2.2.4 Each region, province and chartered city monitored at least once a year.Consultative meeting to review/assess current M and E field monitoring scheme and develop field monitoring guide TOT on the M and E Tools and Guide Roll out trainingConduct monitoring by National DOHConduct monitoring by Regional DOH Conduct monitoring by PHO/CHOConduct PIROBJECTIVE 2Strategy 2.1 Institutionalize area stratification, zoning and planning towards elimination of the disease. Strategy 2.2 Enhance malaria surveillance and response, monitoring and evaluation. Strategy 2.3 Strengthen organizational support and coordination mechanism for malaria operations at all levels. Performance IndicatorsActivitiesPerformance Indicator 2.3.1 At > 80% of provinces and chartered cities with program policy issuance, designated staff and budget allocation in support to malaria prevention and/or eliminationDevelop phase-in/phase-out (transition) plan for LGU-led MP implementation Advocate among LGUs to adopt staff transition plan Conduct actual advocacy/consultation and joint transition planning with concerned regions and :LGUs Train/Retool of LGU personnel involved in malaria program implementation. Performance IndicatorsActivitiesPerformance Indicator 2.3.2 Supervisory guide adopted and implemented in at least 80% of the malaria service health facilitiesDevelop post-training supervision guideline and tool for facility staff on diagnosis, treatment and vector control Pilot implementation of supervisory guideline and tool Expand supervision initiative to other areas Develop /enhance staff incentive scheme and recognize staff performance Performance IndicatorsActivitiesPerformance Indicator 2.3.3 Coordination mechanism of program and project efforts and resources established and functional at the national and regional levels and in > 80% of LGUs levels.Establish and regular meetings of Task Forces Strengthen regional coordination of malaria-related efforts Conduct regular provincial/city/municipal coordination meetings Performance IndicatorsActivitiesPerformance Indicator 2.3.4 Multi-sectoral stakeholders involvement in malaria program expanded at the national and regional levels and in at > LGUsStrengthen performance of PhilMAM Conduct inventory of LGU and Region-based NGOs and institutions Advocate for participation/support Conduct regular meetings of CHDs with NGOs and other development partners OBJECTIVE 3Performance IndicatorsActivitiesPerformance Indicator 3.1.1 Capability of National and local governments to mobilize and manage malaria program resources improvedPrepare overall Financial Investment Plan to support elimination of the disease. Orient LGUs on the overall Financing Investment Plan Advocate for approval of financing plan/ scheme by local officials Develop cost-sharing scheme between national and local governments in the elimination efforts Orient development partners to adopt the cost-sharing mechanism. Conduct joint planning workshop for GF, RBM DOH and LGUs Train LGUs on project proposal development Performance IndicatorsActivitiesPerformance Indicator 3.1.2 National and local government funds to support and sustain malaria operations increasedFormulate policy and guide for provision of DOH Malaria grant assistance and orient epidemic-risk, MPA and MFA on the guide Advocate among LGUs to increase budget allocation for malaria prevention/elimination Advocate among oversight agencies to increase if not sustain national government allocation for malaria program Promote PhilHealth enrolment and facility accreditation to Malaria Outpatient Benefit Package in stable/unstable provinces/cities Develop financing mechanism to sustain operations of 4 Zonal Giemsa Centers Performance IndicatorsActivitiesPerformance Indicator 3.1.3 External funds (Non-governmental funds) to finance investment requirements for malaria elimination mobilizedPrepare proposals for GF, RBM, other donors Advocacy among local-based NGOs, development partners and corporations Conduct donors meeting Explore and establish local financing schemes OBJECTIVE 4Strategy 4.1 Strengthen QAS for anti-malaria diagnostic and treatment facilities Strategy 4.2 Improve quality of vector control measures Strategy 4.2Improve quality of vector control measuresPerformance IndicatorsActivitiesPerformance Indicator 4.1.1 All facilities providing anti-malaria diagnostic services are covered and ariticipationg in the QASMonitor functionality of malaria laboratory units including quality of RDT under storage. Orient and advocate all malaria microscopy centers to participate in the QAS Procure additional panel of slides for validation Submit slides for validation Conduct validation visits at various levels Train medtechs/ microscopists as QAS validators External Competency Certification Training for National Core Trainers Performance IndicatorsActivitiesPerformance Indicator 4.1.2 All facilities are using DOH-recommended anti-malarial drugs and suppliesConduct therapeutic efficacy studies in designated sentinel sites every 2 years Update malaria treatment guide based on result of efficacy studies Establish reporting system of any deviations/ violation at local level re procurement or use of DOH-recommended anti-malaria drugs Orient FDA personnel on acceptable list of malarial drugs and advocate integration in their regular monitoring at the local level Orient local authorities on acceptable anti-malaria drugs and other commodities Advocate among local health personnel re participation in adoption and involvement in enforcing quality anti-malarial drugs and other commodities Conduct PCR in selected MDR areas OBJECTIVE 4Strategy 4.1 Strengthen QAS for anti-malaria diagnostic and treatment facilities Strategy 4.2 Improve quality of vector control measures Strategy 4.2Improve quality of vector control measuresPerformance IndicatorsActivitiesPerformance Indicator 4.2.1 Quality of ITN/LLIN and house spraying in stable and unstable risk areas trackedConduct bioassay tests on used ITN/LLIN Conduct bioassay test on IRS Operations research-LLIN Durability Performance IndicatorsActivitiesPerformance Indicator 4.2.2 Susceptibility tests using WHO standard test kit conducted every 2 years in all designated sentinel sites.Conduct insecticide susceptibility testing Perform Insecticide Quality Protein Test Promote list of WHOPES approved-FDA recommended insecticide to LGUs. Orient FDA personnel on WHOPES-approved and FDA- recommended insecticides and sound management of pesticides of public health importance Establish reporting system of any deviation/ violation found at local level relative to procurement and use of non-WHOPES-approved and DOH-FDA recommended insecticide products Monitor IRS application in selected areas OBJECTIVE 11To give the roles and responsibilities of various groupsRoles and Responsibilities of Various GroupsDOH-National Center for Disease Prevention and Control (NCDPC)

Centers for Health and Development (CHD)

Local Government Units

DOH-National Center for Disease Prevention and Control (NCDPC)primarily responsible: overall execution of the revised policy and guidelines on the diagnosis and treatment of malaria

tasked to lead in the dissemination of the policy and advocate for its adaptation and implementation among concerned stakeholders

responsible in the coordination of the design, implementation and/or advocacy pertinent to the installation of essential management systems DOH-National Center for Disease Prevention and Control (NCDPC)conduct orientation and/or training of concerned CHD officials and staff coordinate the timely procurement and distribution of quality anti-malarial drugs

Note: Procurement Division/Material Management DivisionNational Epidemiology Center (NEC)Philhealth

Centers for Health and Development (CHD)Local levelto ensure the dissemination, orientation and/or training of the CHD staff mobilization of additional resources formulation and implementation of advocacy plans to generate stakeholders supportensuring timely reporting and surveillancemonitoring of the implementation of the revised policy and guide by both public and private providers in different localities in their respective regions

Local Government UnitsProvincial/City Health Office (P/CHO)

Rural Health Units

Barangay Health Workers (BHWs)/Barangay Microscopists and Other Volunteers

Thank you