Uganda Malaria Quarterly Bulletin

Transcription

1 Uganda Malaria Quarterly Bulletin Issue 16: Oct Dec 2016 Uganda Ministry of Health National Malaria Control Program P.O. Box 7272 Kampala Uganda Editorial This is the 16th issue of the Uganda Malaria Quarterly Bulletin that focuses on the fourth quarter of the year The issue provides an update on the malaria status and progress registered during the reporting period October to Dec We hope actors in malaria control in Uganda will use this information to enhance efforts geared towards the fight against malaria in Uganda. We hope this meets your information needs to enable you make appropriate decisions Q4 Report highlights Overall, the malaria burden remained almost constant with almost the same number of cases registered in the third and fourth quarters of Variation was seen among the under fives however where there was a 10% increase between the two quarters. ACT consumption was at 1.4 times the number of malaria cases registered in the quarter. 53% of the districts experienced an in- 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 6 6. Update from Malaria Reference Centers.....pg 7 7.Special Topic: Progress on LLIN Universal Coverage Campaign and IRS implementation in eleven Northern Uganda districts.pg District, Regional & National malaria burden...pg Maps of malaria burden......pg Indicator definitions.....pg Upcoming Events....pg 18 Editorial Team National Malaria Control Program Jimmy Opigo, Program Manager Daniel Kyabayinze Joselyn Annet Atuhairwe Allen E Okullo Bosco AgabaD Damian Rutazaana Juliet Nakiganda Denis Walusimbi Henry Katamba Denis Rubahika Mathias Mulyazawo Vincent Katamba Resource Centre Eddie Mukoyo Carol Kyozira John Kissa World Health Organisation Charles Katureebe Bayo Segun Fatunmbi US President s Malaria Initiative Kassa Belay Peter Thomas Uganda Malaria Surveillance Project Ruth Kigozi 1

2 HMIS reporting rates A graph showing Completeness and Timeliness of HMIS reporting health facilities ( ) Malaria Intervention updates There was a general decline in uptake of IPTp1, IPTp2 and receipt of Long Lasting Insecticide Treated Nets (LLINs) for malaria prevention by pregnant women attending antenatal care (ANC) in quarter four 2016 compared to the same quarter in The HMIS reporting rate which is already high has continued to increase. On average, 98% of the HMIS reporting facilities reported this quarter denoting a 1.4% increase in comparison with quarter three 2016 and 2.4% increase compared to quarter four Timeliness in reporting averaged at 95% this quarter showing an increase of 1% from last quarter and 11% in quarter four A graph showing proportion of women attending ANC who received IPT1, IPT2 and ANC LLINS ( ) The proportion of women attending ANC who received IPTp1 averaged at 70% this quarter. This indicated a 1% increase compared to quarter three 2016 and 10% decrease compared to quarter four of Uptake of IPTp2 remained low with only about half (54%) of the pregnant women attending ANC receiving it in quarter four 2016; an observed 6% decline compared to the same quarter last year. 66% of the pregnant women attending ANC this quarter received LLINs. This is a deterioration by 22% in comparison to the last quarter and 12% in comparison to quarter 4 last year 2

3 Malaria Burden Out-patients 3,995,914 total malaria cases (lab confirmed and clinically diagnosed) that were registered this quarter. The number of malaria cases this quarter were 0.2% more than the cases registered the previous quarter (3,988,956) Compared to the same quarter the previous year, the number of malaria cases increased by 20% Average incidence remained at an average of 36 cases per 1000 population just like the previous quarter. When compared to the same period last year however, it increased by 5%. The under five year old total malaria cases increased by 10% from an average of 1,091,874 cases last quarter to1, 210, 332 cases this quarter. In-patients The number of admissions due to malaria decreased from 75,329 cases in Q to cases in Q hence a 14% reduction. Compared to quarter 4 in 2015 however, the number of malaria admissions increased by 14%. Graph showing in patient Malaria cases and case fatality The number of pregnant women admitted due to malaria reduced by 0.5% from an average of 6,872 last quarter from an average of 6,836 this quarter. Comparing quarter four 2016 to quarter four 2015, there was a 26% increase in the number of pregnant women admitted due to malaria. On average 1 in every one hundred cases admitted this quarter died (Case Fatality Rate (CFR) =0.9%). This has almost remained constant compared to last quarter (CFR=0.8%) and quarter 4 the previous year (CFR=1.4%). 3

4 Malaria diagnosis Comparison of reported Malaria cases with malaria laboratory tests done A graph showing Total malaria cases and Total Malaria laboratory tests done for This quarter, 5,845,711 laboratory tests were done. These were 1.5 times the number of malaria cases (2016 Q4 total malaria cases = 3,995,914) The number of the laboratory test done this quarter were 3% lower than those done the previous quarter and 37% more than those done in the same quarter the previous year. Total number of malaria cases in this quarter was almost the same as those for the previous quarter (3,995,914 3,994,377) and 20% more than the same quarter the previous year. Test Positivity Rate A graph showing TPR and Laboratory tests done for Average Test Positivity Rate (TPR) this quarter was 43% this quarter lower by a magnitude of 4% compared to both the previous quarter and same quarter in A clear inverse relationship between the total laboratory tests done and TPR. 4

5 Test Positivity Rate in the 11 Northern Epidemic districts A graph showing TPR in the 11 Northern Uganda Malaria Epidemic Districts for The eleven Northern Uganda Malaria Epidemic districts (Agago, Amuru, Apac, Gulu, Kitgum, Kole, Lamwo, Nwoya, Omoro, Oyam, Pader) had an average TPR of 64% making it 21% higher the national average. TPR remained the same compared to quarter 4 in 2015 and reduced by 2% In comparison to quarter three

6 Malaria diagnosis Proportion of laboratory confirmed cases among all malaria diagnosed cases In this quarter, an average of 61% of the reported malaria cases were laboratory confirmed. This denotes a n 8% decline in laboratory confirmation of malaria cases compared to the previous quarter which was at 69% Treatment practices ACTs consumed This quarter, an average of 4,166,000 doses of ACTs were consumed. The amount of ACTs consumed in this quarter were 1.04 times the number of reported malaria cases and were 6% lower than the ACTs that were consumed in the previous quarter. Just like the previous quarter, the average number of ACTs dispensed were sufficient to manage all the malaria cases within the reporting period 6

7 Malaria Reference Centers Malaria confirmed cases against Test Positivity Rate Aduku Health Center IV (Jan 15 Sept 16) in Apac District Kasambya Health Center IV (Jan15 Sept 16) in Mubende district Kihihi Health Center IV (Jan 15 Sept 16) in Kanungu district 7

8 Malaria Reference Centers Walukuba Health Center IV (Jan 15 Sept 16) in Jinja district Nagongera Health Center IV (Jan 15 Sept 16) in Tororo district (IRS Ongoing) Dokolo Health Center IV (Jan 15 Sept 16) in Dokolo district (IRS Ongoing) 8

9 Malaria Reference Centers Anyeke Health Center IV (Jan 15 Sept 16) in Oyam district Lalogi HCIV (Jan15-Sept 16) in Gulu district Patongo HCIV ( Jan15-Sept16) in Agago district 9

10 Progress on LLIN Universal Coverage Campaign and IRS implementation in eleven Northern Uganda districts 1. LLIN Universal Coverage Campaign 2016/17 Commendable progress has been made towards the implementation of the Universal LLIN campaign where Uganda aims to give its citizens at least one net for every two people in a household. The 35 highly competent, self motivated and well trained team of micro-planners was dispatched to Northern and Eastern Uganda. The team experienced challenges in accessing the funds for this activity that were sent to the districts though this did not hinder them from working. The challenges of micro-planning will be history with the signing of a Memorandum of Understanding between the Government of Uganda and Malaria Consortium where the later is now the official lead agency for the campaign. Recruitment and training of district and sub-county supervisors was successfully accomplished awaiting deployment ahead of the distribution exercise. Due to unavoidable circumstances, the national launch of the LLIN UCC 2016/17 that was initially slated for 8th December 2016 has been postponed to 17th February 2017 still in Apac district. 1. Indoor residual Spraying in malaria epidemic districts Indoor Residual Spraying (IRS) in the 11 Northern Uganda Malaria Epidemic districts As a step towards implementing the joint-stakeholders midterm strategy against the malaria epidemic in Northern Uganda, a team of thirteen central level staff trained in Indoor residual Spraying were dispatched to help with district-level micro-planning, needs assessment, development of district level implementation plans, advocacy, social mobilization and behavior change communication, recruitment and training of spray team members and supervisors. Movement of additional supplies and logistics for IRS is ongoing. Actual spraying will start in January

11 201 6Q4 Malaria Incidence % difference Abim District Adjumani Agago Alebtong Amolatar Amudat Amuria Amuru Apac Arua Budaka Bududa Bugiri Buhweju Buikwe Bukedea Bukomansimbi Bukwo Bulambuli Buliisa Bundibugyo Bushenyi Busia Butaleja Butambala Buvuma Buyende Dokolo Gomba Gulu Hoima Ibanda Iganga Isingiro Jinja Q Q4 2016Q4-2016Q3 2016Q4-2015Q4 2016Q4-2015Q

12 201 6Q4 Malaria Incidence % difference District 2016 Q Q4 2016Q4-2016Q3 2016Q4-2015Q4 2016Q4-2015Q4 Kaabong Kabale Kabarole Kaberamaido Kalangala Kaliro Kalungu Kampala Kamuli Kamwenge Kanungu Kapchorwa Kasese Katakwi Kayunga Kibaale Kiboga Kibuku Kiruhura Kiryandongo Kisoro Kitgum Koboko Kole Kotido Kumi Kween Kyankwanzi Kyegegwa Kyenjojo Lamwo Lira Luuka Luwero Lwengo Lyantonde Manafwa Maracha Masaka

13 201 6Q4 Malaria Incidence % difference District 2016 Q Q4 2016Q4-2016Q3 2016Q4-2015Q4 2016Q4-2015Q4 Masindi Mayuge Mbale Mbarara Mitooma Mityana Moroto Moyo Mpigi Mubende Mukono Nakapiripirit Nakaseke Nakasongola Namayingo Namutumba Napak Nebbi Ngora Ntoroko Ntungamo Nwoya Otuke Oyam Pader Pallisa Rakai Rubirizi Rukungiri Serere Sheema Sironko Soroti Ssembabule Tororo Wakiso Yumbe Zombo

14 Maps of Malaria burden by district Below are maps showing the changes in the incidence of malaria per 1000 population in quarter 4, 2016 compared to quarter 3, 2016 and quarter 4,

15 Below is a map showing the reporting rates at district level in Uganda, 2016 Quarter4 15

16 Below are maps showing the changes in Test Positivity Rates for malaria in quarter 4, 2016 compared to quarter 3, 2016 and quarter 4,

17 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. The 11 northern epidemic districts are those that currently have cases exceeding their epidemic thresholds using normal channels with previous years data. 17

18 Upcoming Events/ Activities There are a number of activities that have been planned for the next quarter, January - March, 2017, These include: 1. Launch LLIN Universal Coverage Campaign in Apac district, on 17th February, Global Fund grant writing 3. Implementation of IRS in the 11 epidemic districts 4. Implementation of iccm in 15 global funded districts, including the 11 malaria epidemic districts 5. Implementation of district level micro-planning activities for the LLIN campaign 6. Training sub-county& parish leadership and VHTs for the mass LLIN campaign 7. Training of Trainers for clinical audits 8. Rolling out a tool for NMCP with three capabilities namely: Visual dashboard GIS capability to map out implementing partners and programmes Data repository 18