Uganda Malaria Quarterly Bulletin

Transcription

1 Uganda Malaria Quarterly Bulletin Issue 13: Jan Mar 2016 Uganda Ministry of Health National Malaria Control Program P.O. Box 7272 Kampala Uganda Editorial This is the 13th issue of the Uganda Malaria Quarterly Bulletin that focuses on the first quarter of The aim of this bulletin is to inform district, national, and global stakeholders on progress achieved and challenges encountered in malaria control in Uganda. Most importantly, it is to encourage use of this information at all levels in order to foster improvement of our efforts and to highlight achievements and create awareness for increased resource mobilization& allocation in order to maintain the gains we have achieved. We present, in this issue, HMIS and UMSP data representing coverage of malaria interventions, malaria burden, laboratory and treatment practices. We present a special topic on Proceedings from the malaria epidemic expert review meeting and the current reported ACT stock outs in a number of districts. This issue also presents upcoming malaria activities for the next quarter. We welcome your thoughts and contributions regarding this publication. We look forward to hearing from you. Thank you and we hope this will be an informative reading for you. Contents 1. Editorial and report highlights......pg 1 2. HMIS reporting rates... pg2 2. Malaria Interventions....pg 2 3. Malaria Burden pg3 4. Laboratory diagnosis.....pg 4 5. Treatment practices.....pg 5 6. Update from Malaria Reference Centers.....pg 6 7. Special Topic: Expert review meeting on the malaria epidemic & current ACT stock outs...pg 9 8. District, Regional & National malaria burden...pg Maps of malaria burden......pg Indicator definitions.....pg Upcoming Events....pg Q1 Report highlights There has been a significant decease in the malaria burden, both the out-patient and inpatient, from January to March There is a reduction in the Test Positivity Rate in the 10 Epidemic districts, though still above that for the previous three years. Provision of LLINs in the ANC department has declined significantly from the previous quarter. Editorial Team National Malaria Control Program Jimmy Opigo Allen E Okullo Bosco Agaba Henry Katamba Denis Rubahika Mathias Mulyazawo Vincent Katamba Humphrey Wanzira Resource Centre Eddie Mukoyo Carol Kyozira John Kissa World Health Organisation Charles Katureebe US President s Malaria Initiative Kassa Belay BK Kapella Uganda Malaria Surveillance Project Ruth Kigozi African Leaders Malaria Alliance Anne Gasasira 1

2 HMIS reporting rates This quarter, an average of 95% of the facilities that report on the HMIS, reported. This is similar to the reporting rate last quarter. Facilities that submitted their reports on time declined from 86% in Jan to 78% in Feb, then rose to 89% making an average of 85%, a slight improvement from last quarter (84%). Malaria Intervention updates This quarter, 80% of pregnant mothers attending their first ANC visit received the first dose of IPTp. This is similar to the previous quarter. Reasons for the decline in LLIN provision in ANC departments needs to be assessed and addressed with immediate effect given the critical importance of this intervention The proportion of pregnant mothers receiving IPTp2 averaged at 57%, which was a 5% decrease from the previous quarter. This was 23% lower than IPTp1 this quarter. The proportion of pregnant mothers receiving LLINs decreased significantly from an average of 78% last quarter to 55% this quarter with as low as 49% in March. A team of over 300 health care practitioners consisting of doctors and nurses were dispatched to the 10 epidemic districts in Jan/Feb with the aim of providing much needed support to case management at the health facilities. This is reported to have reduced the case load for the health workers in this region, improving efficiency in case management. In the scale up of Integrated Community Case Management (iccm) to 15 districts, TASO has received the VHT registers, the remaining supplies required to flag off this programme. The roll out within the communities is expected to occur between April and June

3 Malaria Burden Out-patients This quarter, there was a 30% decline in the total number of monthly malaria cases diagnosed (lab confirmed and clinical) from 1,486,251 in January to 1,037,680 in March Similarly, the incidence decreased from 42 cases per 1000 in January to 29 cases per 1000 population in March The under 5 malaria cases had a similar trend with a 32% decrease from 364,418 in January to 248,180 in March. The decrease in malaria cases this quarter follows the seasonal trend as expected prior to the rains in April. In-patients This quarter the number of admissions due to malaria decreased by 42%. This was from 81,082 in January to 46,601 in March The number of pregnant women admitted due to malaria in hospital decreased from 731 cases in January to 537 in March giving a 27% decline. The case fatality rate for all admitted malaria cases increased from 0.8% in January to 1.3% in February, followed by a decline to 1.1% in March. This needs to be closely monitored despite the apparent improvement as compared to a case fatality of 1.7% in December

4 Malaria diagnosis Comparison of reported Malaria cases with malaria laboratory tests done From January to March 2016, there was a 18% reduction in the number of total malaria laboratory tests done, in line with the 30% reduction in the malaria cases. The total tests are above the reported malaria cases since some of the tests turn out negative. Test Positivity Rate Test Positivity Rate in the 10 Northern Epidemic districts The Test Positivity Rate averaged at 47% this quarter with a 9% drop from 53% in January to 44% in March This follows the trend in reduction of malaria cases. This should continue to be closely monitored countrywide given the fact that the rainy season is approaching. There was a 10% decrease in the TPR of the 10 epidemic districts from 67% in January to 52% in March 2016, averaging at 59%. This is twice the TPR in same quarter of 2015 which was 29%. This is 12% higher than the country TPR average for the same quarter. 4

5 Malaria diagnosis Proportion of laboratory confirmed cases among all malaria diagnosed cases The proportion of reported malaria cases that are laboratory confirmed was more or less stable from January to March, averaging at 56% despite the decline in the number of reported cases. On average, the proportion of reported cases that were confirmed this quarter was 3% lower than the that the previous quarter. Treatment practices ACTs consumed The number of ACT doses consumed decreased by 30% from January to February This however, increased from Feb to March by another 30% giving a total of 5,635,374 doses consumed in March, a 12% increase from what was consumed in December A study by CHAI and NMCP has been conducted to unveil the reasons for the abnormally high ACT consumption compared to the malaria cases, the findings and analysis of which will be presented in the next bulletin issue The number of ACT doses consumed this quarter was four times the number of malaria cases, similar to last quarter. A total of 14,649,170 ACT doses were reported to have been consumed compared to 3,593,029 malaria cases. 5

6 Malaria Reference Centers Malaria confirmed cases against Test Positivity Rate Aduku Health Center IV (Jan 09 Mar 16) in Apac District Patongo Health Center IV (Aug 14 Mar 16) in Agago district Padibe Health Center IV (Sep 14 Mar 16) in Lamwo district 6

7 Malaria Reference Centers Dokolo Health Center IV (Feb 14 Mar 16) in Dokolo district Amolatar Health Center IV (Feb 14 Mar 16) in Amolatar district Walukuba Health Center IV (Jan 14 Mar 16) in Jinja district 7

8 Malaria Reference Centers Kihihi Health Center IV (Jan 14 Mar 16) in Kanungu district As expected given the seasonality, there was a general decline in both the test positivity rate (TPR) and the number of cases seen at most of the malaria reference centers from January to March

9 Special Topic: Excerpts from the Expert review meeting on the malaria epidemic In June 2015, a malaria epidemic was declared in 10 former IRS districts in Northern Uganda. Since then, the NMCP along with a wide range of partners have responded by supporting interventions such as provision of anti malarials and other supplies for case management, LLINs, BCC and technical support to case management in the affected districts. Despite this, cases are still above the epidemic threshold. A roll back malaria meeting was thus set up in which international experts on malaria gathered in Kampala to discuss the protracted epidemic and forge a way forward to see an end to it. We present to you, in this issue, the key deliberations made at this meeting: It was noted that the more we succeed in controlling malaria, the more we will experience outbreaks. The northern Uganda epidemic thus presents us with a huge challenge as well as a great experience. There was no consensus as to whether the situation in the north is a resurgence or an epidemic. There is need to perform further analysis to ascertain this, however, it was noted that focus should be on control. The increase in malaria cases above epidemic threshold occurred six to twelve months after the last IRS activities. LLINs had been provided for all households as a safety net during IRS exit. It remains unclear as to whether the community in this region used the LLINs inconsistently, thus predisposing them to malaria. The El Nino rains and temperatures are thought to have had a hand in sustaining the epidemic. Response to controlling the epidemic was slow initially, however, it brought down cases to a degree. Way forward: 1. Perform targeted interventions including IRS in the epidemic districts to bring down malaria cases 2. Strengthen epidemiological and entomological surveillance in the affected districts as well as countrywide 3. The NMCP should strengthen partner coordination and information sharing 4. There is a need for partners to standardize response activities and work hand in hand with the districts 5. Lessons should be learnt to adequately prepare the 14 districts that currently have IRS prior to exit Increase in ACT stock outs ahead of rainy season The NMCP has observed a marked increase in ACT stock outs from a number of districts as reported in the weekly Mtrac reports as of week 19, It is crucial that the Ministry of Health as well as partners are aware of this, and take action given that the rainy season is upon us and cases are expected to increase. A prompt and effective response to this in form of provision of ACTs could avert any possible outbreaks and save a lot of costs. In total, 82 (73%) districts reported ACT stock outs in atleast one facility during week 19, Twenty one districts reported above 20% stock outs; and seven of these reported above 30% stock outs. Districts with stock outs above 30% are: Amudat, Bukedea, Buliisa, Kampala, Ntoroko, Sironko and Zombo. Districts with stock outs from 20 29% are : Bulambuli, Buvuma, Buyende, Kaabong, Kabale, Kabarole, Kaliro, Kamuli, Kapchorwa, Kayunga, Kyegegwa, Lira, Masindi, and Rakai. 9

10 District Malaria burden 2011 DHS regions District Malaria Incidence % difference 2015Q1 2015Q4 2016Q Q Q Q Q1 Central 1 Bukomansimbi Central 1 Butambala Central 1 Gomba Central 1 Kalangala Central 1 Kalungu Central 1 Lwengo Central 1 Lyantonde Central 1 Masaka Central 1 Mpigi Central 1 Rakai Central 1 Sembabule Central 1 Wakiso Central 2 Buikwe Central 2 Buvuma Central 2 Kayunga Central 2 Kiboga Central 2 Kyankwanzi Central 2 Luwero Central 2 Mityana Central 2 Mubende Central 2 Mukono Central 2 Nakaseke Central 2 Nakasongola East Central Bugiri East Central Busia East central Buyende East Central Iganga East Central Jinja East Central Kaliro East Central Kamuli East Central Luuka East Central Mayuge East Central Namayingo East Central Namutumba Eastern Amuria Eastern Budaka Eastern Bududa Eastern Bukedea Eastern Bukwo Eastern Bulambuli Eastern Butaleja Eastern Kaberamaido Eastern Kapchorwa Eastern Katakwi

11 2011 DHS regions District Malaria Incidence % difference 2015Q1 2015Q4 2016Q Q Q Q Q1 Eastern Kibuku Eastern Kumi Eastern Kween Eastern Manafwa Eastern Mbale Eastern Ngora Eastern Pallisa Eastern Serere Eastern Sironko Eastern Soroti Eastern Tororo Kampala Kampala Karamoja Abim Karamoja Amudat Karamoja Kaabong Karamoja Kotido Karamoja Moroto Karamoja Nakapiripirit Karamoja Napak North Agago North Alebtong North Amolatar North Amuru North Apac North Dokolo North Gulu North Kitgum North Kole North Lamwo North Lira North Nwoya North Otuke North Oyam North Pader South West Buhweju South West Bushenyi South West Ibanda South West Isingiro South West Kabale South West Kanungu South West Kiruhura South West Kisoro South West Mbarara South West Mitooma

12 2011 DHS regions District Malaria Incidence % difference 2015Q1 2015Q4 2016Q Q Q Q Q1 South West Ntungamo South West Rubirizi South West Rukungiri South West Sheema West Nile Adjumani West Nile Arua West Nile Koboko West Nile Maracha West Nile Moyo West Nile Nebbi West Nile Yumbe West Nile Zombo Westen Bundibugyo Western Buliisa Western Hoima Western Kabarole Western Kamwenge Western Kasese Western Kibaale Western Kiryandongo Western Kyegegwa Western Kyenjojo Western Masindi Western Ntoroko DHS regions Malaria Incidence % difference 2015Q1 2015Q4 2016Q Q Q Q Q1 Central Central East Central Eastern Kampala Karamoja North South West West Nile Western National Data Malaria Incidence % difference 2015Q1 2015Q4 2016Q Q Q Q Q

13 Maps of Malaria burden by district Below are maps showing the changes in the incidence of malaria per 1000 population in quarter 1, 2016 compared to quarter 4, 2015 and quarter 1,

14 Below is a map showing the reporting rates at district level in Uganda, 2016 Quarter1 14

15 Below are maps showing the changes in Test Positivity Rates for malaria in quarter 1, 2016 compared to quarter 4, 2015 and 1,

16 Indicator definitions Malaria cases reported/diagnosed comprises both laboratory confirmed and clinically diagnosed cases Absolute number of malaria cases (OPD and IPD) and number of laboratory diagnostic tests done (Microscopy and Rapid diagnostic tests) during the month Malaria incidence : Number of malaria cases diagnosed per 1000 population per month( in graphs) and quarter( in tables) Case fatality: Percentage of deaths among all malaria related admissions Comparison of reported malaria cases with laboratory tests done : Total laboratory tests done divided by the total malaria reported cases. Test positivity rate: Percentage of malaria positive laboratory tests among all tests done (Microscopy and RDTs) Proportion of diagnosed cases with a positive laboratory test IPTp1, IPTp2 and ANC coverage: Percentage of pregnant mothers attending their first Ante natal visit who receive IPTp1, IPTp2 and ANC LLINs Reporting completeness: Percentage of monthly reports received from health facilities in relation to the expected Reporting timeliness: Percentage of monthly reports received from the health facilities within two weeks of end of month. Malaria prevalence by microscopy among children 0-59 months is the proportion of children in the community in that age range with a positive blood slide result for malaria. 16

17 Upcoming Events There are a number of events that have been planned for the next quarter, April to June, These include: 1. Writing of the concept note to Global Fund 2. Planning and initial steps in creating a tool for NMCP with three capabilities namely: Visual dashboard GIS capability to map out implementing partners and programmes Data repository 3. Preparation for the LLINs mass campaign 4. IRS in the current 14 districts 5. Preparations for IRS in the 10 Northern epidemic districts 6. Dissemination of updated IPT guidelines 7. The next Technical Working Group meeting is scheduled to take place on June 8, The next RBM meeting is scheduled to take place in mid June,