Uganda Malaria Quarterly Bulletin

Transcription

1 Uganda Malaria Quarterly Bulletin Issue 11: July Sept 2015 Uganda Ministry of Health National Malaria Control Program P.O. Box 7272 Kampala Uganda Editorial This is the 11th issue of the Uganda Malaria Quarterly Bulletin that focuses on the third quarter of In this issue, we pay tribute to the former Acting Program Manager, National Malaria Control Program, Dr. Albert Peter Okui (RIP). He served as Ag. Program Manager from March 2012 and passed on while in service on 12 November He will be remembered for his hard work, brilliance, humility, dedication and above all, his passion to eliminate malaria in Uganda. 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 The malaria epidemic in Northern Uganda with a special focus on the trend of the epidemic, presented graphically and the interventions. This, as in the previous issue, follows the most significant malaria related event in this quarter, which was the confirmation of an Epidemic in the ten districts of Northern Uganda which ended Indoor Residual Spraying in It will be a pleasure to hear from you regarding this publication. Thank you and we hope this will be an informative reading for you. Contents 1. Editorial and report highlights.....page 1 2. Tribute to Dr. Albert Peter Okui (RIP)...page2 3. Malaria Interventions...page 3 4. Malaria Burden......page 4 5. Laboratory diagnosis.....page 5 6. Treatment practices....page 6 7. Uganda Malaria Surveillance Project....page 7 8. Special Topic: The Malaria Epidemic....page 9 9. District malaria burden. page Maps of malaria burden...page Indicator definitions.....page Q3 Report highlights Tribute to the late Dr. Albert Peter Okui. There has been a drop in the malaria burden, both the out-patient and in-patient, from the peak in June the previous quarter to September The malaria epidemic which was confirmed in June 2015 is still above the epidemic alert thresh hold in 10 Northern districts. The number of ACTs consumed country-wide averaged at more than twice the number of malaria cases diagnosed at health facilities. Editorial Team National Malaria Control Program Bosco Agaba Henry Katamba Denis Rubahika Mathias Mulyazawo Vincent Katamba Humphrey Wanzira Allen E Okullo Resource Centre Mukoyo Eddie Kyozira Carol Kissa John World Health Organisation Katureebe Charles US President s Malaria Initiative Kassa Belay BK Kapella Uganda Malaria Surveillance Project Ruth Kigozi African Leaders Malaria Alliance Gasasira Anne 1

2 Tribute to Dr. Albert Peter Okui this short period in the world. 2. He worked with PMI to ensure smooth operations during Indoor Residual Spraying of the 10 districts in northern Uganda. He oversaw the exit of IRS activities in the 10 districts of northern Uganda and the expansion to 14 more districts at the end of 2014 through the support of PMI. 3. Community distribution of ACTS and laboratory testing before treatment has been scaled up to a substantial country proportion under his leadership. 4. The Malaria Indicator Survey was conducted successfully under his leadership in November The Late Dr. Albert Peter Okui The malaria fraternity pays tribute to Dr. Albert Peter Okui (RIP), who passed away on 12 November 2015 and was laid to rest on November 15, 2015 at his home district in Bukedea. Post mortem results confirmed that he died of a heart attack on November 12, at the end of a Roll Back Malaria meeting at the Lake Victoria Serena Hotel in Entebbe, Uganda, that he was chairing. He died in the line of duty. At the time of his death, Dr. Okui was the Acting Program Manager, National Malaria Control Program, a position he had held for the last three and a half years since June He was very kind, humble, jolly and is specially remembered for his immense passion and hard work to end the malaria scourge in Uganda. As such, scores of friends, family, colleagues and implementing Partners flocked his funeral and burial to pay tribute him. Most notably was his ability to bring people together to fight for the common cause, malaria. He inspired staff at the National Malaria Control Program to work hard as a team to hit the set program targets by making everyone feel that they had a valuable contribution to make. He also had the amazing ability to bring together implementing partners to fill gaps for support in the control of malaria in Uganda by fostering strong relationships with them. He is remembered for making remarkable achievements during his tenure as Ag Program Manager at the NMCP, notably: 1. He led the first ever Long Lasting Insecticide treated mosquito Nets (LLINs) universal distribution campaign in Uganda and harnessed Malaria partners who supported NMCP in this activity which started in May 2013 and lasted till August More than 21million Nets were distributed in total. This was the first ever universal net distribution mass campaign of its magnitude to be successfully completed within 5. The highest impact on malaria was achieved under his leadership as PM where malaria in our country reduced by more than 50% from 2009 to date as per the results of the recent disseminated results of the Malaria Indicator Survey 2014/ Under his leadership, a comprehensive Uganda Malaria Reduction strategic plan was developed by Ministry of Health and all Roll Back Malaria partners. This strategy has a vision of making a malaria free Uganda. 7. As a basis of this strategic plan, a concept note to global fund was written and approved. A total of191 million dollars from Global fund is being released from Global fund to NMCP in a phased manner towards implementation of malaria activities. 8. On the wake of the malaria epidemic that was confirmed in 10 districts of Northern Uganda in July 2015, he served as the Incident Commander for the Incident Management Committee and Chairman of the National Task Force on the malaria epidemic to bring together implementing partners, donors and technical expertise to control the epidemic. 9. He led the revival of the Uganda National Quarterly Malaria bulletin with technical staff at the NMCP. 10. He harnessed stake holders commitment to malaria reduction in Uganda by maintaining a good relationship with all the stakeholders and working closely and passionately. Prior to joining the Ministry of Health, he served as the District Director of Health Services, Kasese district; Medical Superintendent Fort Portal Regional Referral Hospital; and Medical Superintendent of Abim Hospital, Kotido district and Kapchorwa Hospital, Kapchorwa district. We as the National Malaria Control Program have lost our Commander in Chief, a great comrade and dear friend. This loss is felt by the Ministry of Health, and the Nation as a whole. We will continue to keep the fire and passion burning to fight to eliminate malaria in Uganda and carry his legacy on. May the Almighty God grant his soul rest in eternal peace. 2

3 HMIS reporting rates Of the facilities that report on the HMIS, 91% completed reporting last quarter. A decline from the previous quarter at 96%. 59% of facilities reported in time in July, a very significant drop from 91% in June. This improved in August and September to give an average of 72% for the quarter. Malaria Intervention updates The core malaria interventions focusing on pregnant mothers are: the provision of intermittent preventive treatment in pregnancy (IPTp) with Fansidar and LLIN distribution through routine ante natal (ANC). The proportion of pregnant mothers attending their first ANC visit and receiving the first dose of IPTp was 78% in this quarter, a slight decline from the proportion of those that received it the previous quarter (80%) and those that received it the same quarter the previous year(81%). Those receiving the second dose of IPTp was 19% lower than IPTp 1 this quarter. However, in this quarter, IPTp 2 coverage rose by 4% from the previous quarter. There was an exponential increase in the proportion of mothers receiving LLINs in the first ANC visit, from 45% in July, to 85% in September Integrated Community Case Management (iccm) was launched in Sheema district on 25 August /15 districts scheduled for iccm this year, started implementation activities this quarter. This includes supervision at the district level, training of master trainers, VHTs and supply of commodities. 3

4 Malaria Burden Out-patients This quarter, there was a significant drop by 45%, in the total number of monthly malaria cases diagnosed (lab confirmed and clinical) from a peak of 1,629,237 in June the previous quarter, to 903,469 in September The incidence had a similar pattern, almost halving from 47 cases per 1000 in June to 26 cases per 1000 population in September Similarly, the under 5 malaria cases decreased by about 46% from 481, 867 in June to 258,120 in September The peak in June was largely due to the malaria epidemic declared in June 2015, in 10 districts of northern Uganda. Interventions to control the epidemic were put in place, starting in June. The extent to which this facilitated the decline in incidence remains to be assessed. In-patients In the third quarter, as seen in the total number of cases, there was a sharp decline in the number of cases admitted. Numbers dropped from 95,005 in June to 46,503, almost pre epidemic levels in September. The number of pregnant women admitted to hospital declined in the third quarter by 34% from 6784 in July to 4498 in September The case fatality rate for all admitted malaria cases increased from less than 1% to 1% in this quarter. 4

5 Malaria diagnosis Comparison of reported Malaria cases with laboratory tests done Test positivity rate From July to September 2015, there was a drop in the number of reported malaria cases and a similar decline in the total laboratory tests done. However, the number of tests done was higher than the reported malaria cases. There was a drop in the overall positivity rate from a peak this year, of 52% in June to 43% in August, followed by a rise to 48% in September Surveillance should be intensified to closely monitor the TPR countrywide and put in place control measures given the current malaria season. Test positivity rate in the 10 Northern Epidemic districts The positivity rate in the ten epidemic districts of northern Uganda this quarter has maintained a high average of 69% peaking in July and September at 70%. In the same quarter in 2014, the positivity rate was 26%. 5

6 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sept Number(Thousands) Malaria diagnosis Proportion of laboratory confirmed cases among all malaria diagnosed cases The proportion of reported cases that are laboratory confirmed increased from 60% in July to 64% in September 2015 as the trend in reported cases declined. On average, the proportion of reported cases that were confirmed this quarter was 60% compared to 53% in the previous quarter. Treatment practices ACTs consumed All Malaria ACTs Consumed The number of ACT doses consumed dropped from 3,054,325 in June to ,848,313 in July This followed a similar pattern in the drop of malaria cases from 1,629,237 to 1,192,933 in the same months The consumption of ACTs increased to 2,412,455 doses in August, about twice the Month of Year number of malaria cases reported. There was further increase in September to 2,899,903 doses, more than thrice the malaria cases reported. 6

7 Malaria Reference Centers Test Positivity Rate observed at various Malaria Reference Centers Reference Centers where IRS stopped in

8 Malaria Reference Centers Reference Centers where IRS Ongoing Inpatient data: Apac Hospital Proportion of admitted children under 5 years of age who died and had a positive malaria test result 8

9 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 W34 W35 W36 W37 W38 W39 Weekly Malaria Cases Special Topic: The Malaria Epidemic in Northern Uganda A malaria epidemic was declared in the 10 former IRS districts of Northern Uganda in June A review of the HMIS weekly surveillance data revealed that the upsurge in the malaria cases beyond the normal threshold started in April 2015, reaching its peak in July The graph below shows the trend in all 10 districts i.e. Gulu, Nwoya, Amuru, Pader, Kitgum, Lamwo, Amuru, Apac, Oyam and Kole, from the start of the epidemic to the end of the third quarter (September) Mean Mean+1STD 2015 Start of Epidemic Week of Year HMIS could only provide two complete years of weekly data for 2013 and 2014 The malaria epidemic started in April, Epi week 16 as shown. The malaria cases in the epidemic districts dropped from 42,603 in week 31 to 25,533 week 36. This could have been due to a number of interventions put in place by the Ministry of Health and a number of implementing partners. However, as per this quarter, the epidemic is not yet over. There was an increase in the number of cases in week 39 from week 38. This calls for continued intensified surveillance and vigilance in reporting from all the districts to inform the Ministry of Health for action. Interventions put in place for control The National Malaria Control Program is working with a number of implementing partners to ensure that the epidemic is controlled. Interventions in place include: 1. Activation of the district epidemic management task force with the surveillance, logistics and BCC sub-committees. 2. Intensifying surveillance in the 10 epidemic districts. 3. Training of VHTs in the most affected sub counties in Mass Fever Treatment 4. The provision of ACTs to 72 most affected sub counties in the 10 districts through Mass Fever Treatment being implemented by VHTS. This is being provided for all age groups. 5. Intensified Behavioural Change Communication in all the 10 districts through various media channels and local leaders within the community. 6. Emergency stock up of supply of anti-malarials (ACTs and Artesunate) within the facilities for rapid treatment to reduce disease burden and reduce mortality. 7. Provision of 34,000 LLINs to the most affected sub counties. 8. Comprehensive support to Kole district by MSF 9. Reactivation of the community village health teams stocked with anti-malarials 9

10 District Malaria burden 2011 DHS regions District Malaria Incidence % difference 2014 Q Q Q Q Q Q Q3 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 2014 Q Q Q Q Q Q Q3 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 2014 Q Q Q Q Q Q Q3 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

13 Maps of Malaria burden by district Below are maps showing the changes in the incidence of malaria per 1000 population in quarter 3, 2015 compared to quarter 2, 2015 and 3,

14 Below is a map showing the reporting rates at district level in Uganda, 2015 Quarter3 14

15 Below are maps showing the changes in Test Positivity Rates for malaria in quarter 3, 2015 compared to quarter 2, 2015 and 3,

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