APMEN III Annual Business and Technical meeting Kota Kinabalu Malaysia

Transcription

1 APMEN III Annual Business and Technical meeting Kota Kinabalu Malaysia May , 2011

2 MALARIA ELIMINATION IN MALAYSIA APMEN III MEETING, 9 11 May 2011 KOTA KINABALU, SABAH, MALAYSIA DR. CHRISTINA RUNDI MINISTRY OF HEALTH MALAYSIA

3 OUTLINE Epidemiology National Strategic Plan Indicators Challenges

4 INTRODUCTION 14,000 Total number and incidence of malaria (all cases and locally acquired cases) in Malaysia, ,000 10,000 8,000 6,000 4,000 2, Malaria (All) cases Malaria (Locally Acquired) cases Incidence rate (All) per 1,000 Incidence rate (Locally Acquired) per 1, Incidence of malaria was 0.5 per 1000 population in 2000, reduced to 0.2 per 1000 population since More than 73% of all cases are locally acquired.

5 Number of cases by states in Malaysia, 2010 No locally acquired malaria cases in 3 states, 2 Federal Territories 0 10 cases cases cases cases > 1000 cases

6 1000 Imported cases, Number of imported cases in Malaysia, Number of imported cases on 800 the rise (except for 2009) No of imported cases 70 Percentage of imported cases by region in Malaysia, Percentage of imported cases higher in West Malaysia than East Malaysia. Perc centage WEST MSIA SARAWAK SABAH

7 MALARIA PARASITES SPECIES, Percentage of malaria species in Sabah, P. falciparum P. vivax P. malariae P. knowlesi Mixed Percentage of malaria species in West M'sia, P. falciparum P. vivax P. malariae P. knowlesi Mixed Percentage of malaria species in Sarawak, P. falciparum P. vivax P. malariae P. knowlesi Mixed

8 NATIONAL STRATEGIC PLANNING FOR THE ELIMINATION OF MALARIA Elimination of locally acquired malaria in Malaysia by % pop. at risk 04% 0.4% pop. 19.7% Sabah and at risk pop. at risk Sarawak: elimination by West Malaysia: elimination by AREA RED YELLOW GREEN CRITERIA Incidence (2010) Incidence > 1 / 1000 population -West Malaysia: 0.02 per 1000 Incidence < 1 / 1000 population population; -Sabah: 0.78/1000 population No local transmission -Sarawak: 0.87/1000 population ** 10% - red, 19% - yellow * Based on 2008 stratification

9 NATIONAL STRATEGIC PLANNING FOR THE ELIMINATION OF MALARIA Surveillance system 7. Operational Research 2. Intergrated Vector Management 6. Capacity Building NSP Malaria 3. Early detection and prompt treatment 5. Communication and Social Mobilisation 4. Preparedness and outbreak response

10 Strategy 1: Malaria Surveillance System a. National malaria case registry - ongoing E-notis: all notifiable diseases VEKPRO: Vector borne diseases

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12 Strategy 1: Malaria Surveillance System 1. Components: a. Case registry b. Laboratory Registry - ongoing c. Foci registry FORMS Contents: a. Case registry b. Case Investigation i c. Follow-up cases d. Investigation on malaria death e. Vector Control: - basic data (localities), vector control activities (spraying, ITN) Foci Registry e. Laboratory: no of slides and results

13 Strategy 1: Malaria Surveillance System 1. Components: c. Foci registry DIVISION DISTRICT SECTOR No. of locality No of houses Pop Inc 2006 Inc 2007 Inc Kuching 0110 Lundu Sematan Merah 0100 Kuching 0110 Lundu Lundu Merah 0300 Sibu 0310 Kanowit Kanowit Merah 0300 Sibu 0310 Kanowit Ngemah Merah 0400 Miri 0410 Marudi Bario Merah 0400 Miri 0410 Marudi Mulu Merah 0400 Miri 0410 Marudi Loyang Merah 0500 Limbang 0510 Limbang Mendamit Merah 0500 Limbang 0520 Lawas Ba Kelalan Merah 0600 Sarikei 0610 Julau Julau Merah 0600 Sarikei 0640 Pakan Pakan Merah Stratification

14 Strategy 1: Malaria Surveillance System 1. Components: d. Vector surveillance Vectors 1. An balabacencis 2. An sundaicus 3. An flavirostris Vectors 1. An maculatus 2. An sundaicus 3. An letifer 4. An campestris 5. An. dirus Vectors 1. An latens 2. An sundaicus 3. An donaldi

15 Strategy 1: Malaria Surveillance System 1. Component e. Parasite bank and genotyping ongoing 2. Time to notification - CDC Act Notification within 7 days after diagnosis 24 hours (West M sia) and within 3 days (East M sia) Msia) 3. Supervision 4. Malaria death - national indicator (Standard is zero death)

16 Strategy 2: Integrated Vector Management 1. Increased coverage of IRS and treated bednets 2. Used of LLINs 3. Other control measures such as environmental manipulation, larvaciding, use of repellents 4. Vector surveillance 5. Multi-agency collaboration

17 Strategy 2: Integrated Vector Management 1. Strengthened residual spraying activities FOCI (when there are cases and receptive) AKTIVITI SEMBURAN Regular residual spraying 100% Every 6 months 8 cycles Focal spraying 100% Every 6 months At least 2 cycles until no more cases for one year b. In receptive and vulnerable areas, special spraying permanent structure: 100% coverage every 6 months semi-permanent structure, every 3 months (until no longer vulnerable) c. Monitor coverage d. Monitor insecticide resistance

18 IRS COVERAGE % IRS coverage for population at risk in Sabah, % IRS coverage % IRS coverage for population at risk in Sarawak, % IRS coverage Sabah: 100% coverage by 2016 Sarawak: 100% coverage by 2015 WM: 100% coverage by

19 Strategy 2: Integrated Vector Management 2. Increase coverage of ITN FOCI (when there are cases and receptive) AKTIVITI KELAMBU BERUBAT Coverage 100% Retreatment every 6 months 8 cycles Ratio net:pop 1:2 Coverage 100% Retreatment every 6 months At least 2 cycles until no more cases for one year Ratio net:pop 1:2 b. Use of different insecticidei id c. Monitor insecticide resistance d. Use of LLINs

20 ITN COVERAGE Sabah: 100% coverage by 2014 Sarawak: 100% coverage by 2015 WM: 100% coverage by % ITN coverage of population at risk in Sabah, % ITN coverage % ITN coverage for population at risk in Sarawak, % ITN coverage 19

21 Strategy 2: Integrated Vector Management 3. Other strategies Environmental management, chemical larvaciding and biological control Project manipulation such as automatic siphon, subsoil drainage and control drains Use of repellents 4. Vector surveillance At least 1 sentinel station in every region (West Malaysia, Sabah and Sarawak) In areas with high risk groups (foreign workers, indigenous groups in West Malaysia) 5. Optimise interagency collaboration within the country and with bordering countries.

22 Strategy 3: Early detection and prompt treatment Criteria for screening (control programme) Malarious areas Incidence > 10 cases per 10,000 population a) 10% of outpatient attendees with fever/anemia/history of fever b) Pregnant women: BFMP during every ante-natal t visit it to the clinic i and during home visit Malaria Prone Areas Incidence 1 10/10,000 population 5% of outpatient attendees including pregnant women with fever, history of fever past 3 months, past history of malaria, anemia Malaria Free Areas Incidence < 1/10,000 population 5% of outpatient attendees including pregnant women with symptoms suggestive of malaria, travel history to malarious area, known foci nearby

23 Strategy 3: Early detection and prompt treatment 1. Criteria for screening at health facilities: Area Target groups Out-patient attendees with fever (including non Malaysians) Non Malaysians from malaria endemic countries (all non-documented) Pregnant mothers at first visit (100%) and if has any of the followings during subsequent visits it or home visits; it fever, anemia or IUGR Out-patient attendees with fever and symptoms suggestive of malaria (include non Malaysians) Out-patient attendees with fever and risk factors (travel history, forest related activities) All non Malaysians from malaria endemic countries (including pregnant mothers) Pregnant mother with fever and risk factors

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25 Strategy 3: Early detection and prompt treatment 2. Early diagnosis: microscopy equipped health facilities with microscopy trained microscopists examination of slides (OPD) within the same day recehecking of slides (100% positive slides and 10% negative ones) EQA and competency testing 3. Rapid diagnostic test? 4. PCR 5. PCD post and Sub-sector offices in Sabah and Sarawak. 6. Treatment Review treatment guideline: Use of ACT. Completion of treatment 7. Drug resistance 8. Follow up of cases according to species 9. Surveillance among high risk groups (foreign workers)

26 Diagnosis : microscopy

27 Strategy 4: Preparedness and outbreak response Early detection of outbreak surveillance system (number of cases) information on the opening up of new areas foreign workers from endemic areas Control of outbreak within 6 weeks Case investigation Vector control activities acceptability, coverage Strategy 5: Social Mobilisation and Communication Improved knowledge and awareness among population at risk. Community mobilisation to control malaria.

28 Strategy 6: Capacity Building Staff Training microscopy vector control activities IVM Management of malaria (Medical Officers and Assistant t Medical Officers) re-orientation programme Assets: vehicles, microscope, spray cans etc Operational research Strategy 7: Research

29 KEY PERFORMANCE INDICATORS No Indicator Target 1 Annual reduction of cases 20% 2 Case fatality 0 3 Coverage of treated nets for population at risk 100% 4 Coverage of indoor residual spraying for population 100% at risk 5 Number of cases investigated 100% 6 Number of cases completed treatment 100% 7 BSMP slides with inaccurate reading (error rate) < 1% 8 BFMP slides examined within the same day (health 100% clinics) 9 Control of outbreak within 6 weeks 85% 10 Increased health education activities for population at risk Note: 47 indicators 10%

30 CHALLENGES 1. High risk groups: mobile population, p migrant workers from endemic areas, plantation workers, rubber tappers, loggers, travelers to endemic countries, those involved with forest related activities 2. Inaccessible areas, logistics problems especially in Sabah and Sarawak 3. Control activities at the border areas.

31 TERIMA KASIH