26/06/ NIMR 2018 Conference - Malaria - a reality

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1 Malaria Elimination: Reality or Myth? Wellington A. Oyibo ANDI CENTRE OF EXCELLENCE FOR MALARIA DIAGNOSIS WHO/FIND Malaria Specimen Collection Site The International Center for Malaria Microscopy and Malaria RDT Quality Assurance Center, College of Medicine University of Lagos, Lagos Nigeria www

2 Global malaria situation - 1 In 2017, 97 countries and territories had ongoing malaria transmission: 3.2 billion people at risk of malaria Approx. 40% of world s population live in malaria-endemic areas 1.2 billion at high risk Most global cases in Africa (88%), followed by the South- East Asia Region (10%) and the Eastern Mediterranean Region (2%) (WHO, 2015) Between 2000 and 2015, malaria incidence rates (new malaria cases) fell by 37% globally, and by 42% in Africa Estimated malaria deaths (range ) worldwide 90% of all malaria deaths NIMR 2018 Conference occurred - Malaria - in a Africa 584,000 deaths 2

3 Global malaria situation - 2 Mortality rates decreased by an estimated 47% worldwide and by 54% in Africa 64 countries on track to reverse the incidence of malaria nationally by countries on track to reducing malaria incidence by 75% by 2015 (WHO, 2017) US$ 5.1 billion that is required to achieve global targets for malaria control and elimination 3

4 Malaria in Nigeria - 1 Evidence of changing epidemiology of malaria ( 37% in children < 5yrs in facilities and 42% and now 27% in communities nationally; lower prevalence in urban rural areas/facilities in Lagos State) Malaria still a public health disease Malaria is preventable and curable Well-defined low malaria prevalence in urban settings of Nigeria 4

5 Malaria in Nigeria 5

6 Malaria in Nigeria (2) 6

7 2015 Malaria Indicator Survey Data Draft Report 7

8 2015 Malaria Prevalence by State 8

9 National Malaria Malaria Prevalence in 2010 and % 42% 40% 35% 30% 27% 25% 20% 15% 10% 5% 0% Malaria Prevalence in 2010 Malaria Prevalence in

10 Milestones and phases to malaria elimination from a country with low to moderate endemicity Malaria control: reducing the disease burden to a level at which it is no longer a public health problem Malaria elimination: interrupting local mosquito-borne malaria transmission in a defined geographical, i.e. zero incidence of locally contracted cases, although imported cases will continue to occur. Continued intervention measures are required Malaria eradication: permanent reduction to zero of the worldwide incidence 10 of malaria infection

11 Change in malaria incidence rates by country,

12 Main Strategies to Prevent and Treat Malaria 12

13 Nigeria malaria Strategic Plan Strategies for malaria pre-elimination outlined in national malaria strategic plan ( ) through effective: Prevention and integrated vector and environmental management Case management [diagnosis and treatment] new tools [vaccine, diagnostics, medicines etc] monitoring and evaluation procurement supply management etc Increased intervention with funding Hope for success but could be slow if momentum not sustained 13

14 Strategic Plan for Malaria pre-elimination phase Vision: To have a MALARIA FREE NIGERIA Mission: To provide equitable, comprehensive, cost effective, efficient and quality malaria control services ensuring transparency, accountability, client satisfaction, community ownership and partnership Goal: To reduce malaria burden to pre-elimination levels and bring malaria-related mortality to zero 14

15 National Malaria Strategic Plan Objectives (1) At least 80% of targeted population utilizes appropriate preventive measures by 2020: expanding universal access to insecticide treated materials sustained mass distribution of Long Lasting Insecticidal Nets (LLINs) significantly scaling up Indoor Residual Spraying (IRS) expanding larviciding. support for Intermittent Preventive Therapy (IPTp) in pregnant women Seasonal Malaria Chemoprevention (SMC) in the Sahel region 15

16 National Malaria Strategic Plan Objectives (2) All persons with suspected malaria who seek care are tested with RDT or microscopy by 2020: massive scale-up quality-assured malaria diagnosis to confirm cases confirmation (RDT and/or Microscopy) at all levels private sector and the community Malaria rapid test provided free Challenges All fevers taken as malaria Poor testing ( less than 35%) Need for testing to be promoted 16

17 National Malaria Strategic Plan Objectives (3) All persons with malaria seen in private, public health facilities or community agents receive prompt treatment with an effective anti-malarial drug by 2020:. promoting use and availability of antimalarial medicines (ACTs) Delivery of Malaria Management through the community Strengthen secondary and tertiary level health facilities to treat and manage severe malaria while the community level intervention will focus in pre-referral treatment and improved referral systems Challenges: continued use of Chloroquine, sulphadoxine pyremethamine, and other monotherapies, unequipped secondary and tertiary hospitals to handle likely emergencies from severe malaria etc 17

18 National Malaria Strategic Plan Objectives (5) System in place for timely availability of appropriate antimalarial medicines and commodities required for prevention and treatment of malaria in Nigeria by 2018: Forecasting and quantification will be strengthened, while efforts are made to ensure effective and efficient distribution system that rides on completeness of the logistic management information systems Partnerships with key government agencies to strengthen and update malaria related regulatory policies and in the conduct of pharmacovigilance and postmarketing surveillance to ensure quality of all malaria products: LLINs, diagnostics, medicines etc 18

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20 Premise of my conviction (1) Malaria a medical condition but strongly socio-cultural and economic Unexplored opportunities for innovation social entrepreneurship to galvanize all interventional strategies: Integrated vector management Case management Intermittent preventive treatment of malaria in pregnancy (IPTp), Seasonal preventive NIMR 2018 Conference chemotherapy - Malaria - a etc. 20

21 Premise of my conviction (2) Opportunities for multi-prong approaches in different zones and peculiarities we can crash malaria prevalence and parasitaemia in the north In-inroads in private sector involvement in malaria pre-elimination plans Contributory effect of the RTSS malaria vaccine New interventions Drugs for Mass drug administration, diagnostics etc The upward, positive Malaria Eradication Group is in the right direction 26/06/G015 21

22 Closing Messages Malaria is preventable and curable Reducing prevalence gives us hope our strategies must not stick to the medical or biological considerations Malaria is a medical condition but anchored on a strong socio-cultural rubrics Innovation through social entrepreneurship is an unexplored opportunity aligns with our expectations on the fourth industrial revolution Success is planned for what you plan is what you get Commitment of all is critical in making malaria elimination a 22

23 Possibilities of Change? Malaria Elimination? Reality Old Oshodi, Lagos Rail line New Oshodi, Lagos Rail 23

24 Acknowledgement WHO/TDR (Geneva) WHO/AFRO/Nigeria Foundation for Innovative New Diagnostics (FIND), Geneva, Switzerland NMCP (Nigeria) Society for Family Health; SuNMAP NIMR LagMoH EQA programmes in South Africa & Oman WHO (Western Pacific) & Philippines MoH Dedicated staff College of Medicine University of Lagos/LUTH Malaria Consortium/DFID, UK USAID/MAPS 24

25 Thanks for your attention! 25