Prompt and Effective Treatment of Malaria through Integrated Services Dr G.N Ntadom Case Management Branch, NMEP
Case Management Branch of the NMEP Introduction Case Management Branch under the NMEP is responsible for : Formulation of relevant policy and guidelines to direct the management of malaria in Nigeria Carry out tests / trials to determine the efficacy of recommended antimalarial medicines for the treatment of uncomplicated malaria Collaborate with NAFDAC and other relevant authorities to monitor possible ADRs of deployed ACTs Collaborate with institutions and researchers to carry out implementation etc Promote innovative strategies that will improve diagnostic and treatment service deliveries Support institutional strengthening in providing diagnostics and other antimalarial commodities
Boundaries of Malaria Transmission -1900 Buxton Line Wallace Line 1900 No malaria transmission Malaria transmission
Elimination progress over the years - 1945 1945 No malaria transmission Malaria transmission
Boundaries of Malaria Transmission 1970 1970 No malaria No malaria transmission transmission Malaria Malaria transmission transmission
Elimination progress by 2011 14 Cape Verde São Tomé & Príncipe Maldives Seychelles Comoros Mauritius Réunion Solomon Islands Vanuatu 2011-2014 No malaria transmission Malaria transmission Planning for elimination or eliminating
Malaria Burden World Malaria Report (2014) shows a decline from 985,000 deaths in 2000 to 584,000 in 2013. It also showed that Nigeria has moved from a high mortality of about 300,000 in 2000 to a point where it now shares 39% i.e. 227,760 of the deaths with DRC The most vulnerable populations are children and pregnant women Local research evidences have shown significant reduction in malaria morbidity and mortality evidenced by the ever decreasing Slide Positivity Rate (SPR) Malaria got the highest political commitment to any disease in Africa when President Obasanjo hosted the African Malaria Summit in 2000 The meeting was described as a convergence of political momentum, institutional synergy and technical consensus on malaria. Another major global commitment was the Global Fund by Dr Kofi Annan, the then UN Sec Gen
Disease Control using Integrated Strategies Africa still bears over 80% of the global burden and over 90% of malaria deaths Malaria deaths may be contributing between 20 30% to childhood mortality in the country. Other cause of deaths are easily preventable diseases and easy to treat conditions. Commonly, the following other diseases have been found to contribute significantly to mortality in the country: Pneumonia, Septicaemia, Diarrhoea and dehydration, Anaemia and Malnutrition, Ear infection and mastoiditis, Immunizabe diseases such as measles, Diptheria, Pertusis, Tetanus, Tuberculosis, and several other HIV related infections Co-morbidities are not uncommon with malaria infection and children with other underlying infections such as pneumonia, diarrhoea are most likely to suffer from severe consequences of the disease
Integrated Strategies to Prevent All cause Morbidity and Mortality The National and State Malaria Programmes now collaborate with other intervention areas to control diseases in the vulnerable populations while also adopting some specific strategies to address localized issues: Integrated Community Case Management (iccm) Seasonal Malaria Chemoprevention (SMC) and SMC Plus pmip using Focused Antenatal Care platform Strengthening Diagnosis, both at public and private sectors
INTRODUCTION 2: Seasonal Malaria Chemoprevention (SMC) Overview Definition SMC is the intermittent administration of full treatment courses of antimalarial medicines during the malaria season to prevent malarial illness (WHO 2013) The main objective of this intervention is to maintain therapeutic antimalarial drug concentrations in the blood of the recipient, throughout the period of greatest malaria risk WHO Policy Recommendation In 2011, the WHO provided a policy guidance for the deployment of SMC in areas of highly seasonal malaria transmission in the Sahel & sub-sahelian regions of sub-saharan Africa (WHO 2013) Predicated on evidence that effective malaria chemoprevention during the peak transmission periods can prevent illness and avert death from malaria in children (WHO 2013) Evidence that SMC reduces incidence of both simple and severe malaria disease and associated anemia in children (WHO 2013) It is efficacious, cost effective and feasible for the prevention of malaria among children in areas with not more than 4 months of malaria transmission season (WHO 2013)
Nigeria Experience: 1 The area highlighted in yellow depicts states that fall into the sahel region of the country SMC was implemented in only 5 out of 227 eligible LGAs Nine (9) States are eligible for SMC: Kebbi, Sokoto, Zamfara, Yobe, Katsina, Kano, Jigawa, Bauchi and Borno A significant number of deaths due to P. falciparum malaria occur in these places during the short rainy season, which coincides with the peak transmission season The peak malaria transmission season in these areas is usually between June and September (Voll and Pant 1966) The estimated population of children under the age of five in this region is 10.9 million, according to 2015 Nigeria population projection The total cost required to deliver SMC to the 9 states and achieve at least a 40% coverage between 2015 and 2017 is US $48,874,736 (It costs approximately NGN650 [US$4.33] to deliver SMC per child per year)
Impact of Intervention Preliminary report in Katsina state indicate a dip in malaria incidence as a result of the introduction of SMC in children under the age of five years 1000 Total monthly malaria cases by year, in LGAs that received 2 SMC Rounds (2013/14) 900 Total monthly malaria cases by year, in LGAs that did NOT receive any SMC 900 800 2012 800 700 2012 700 600 500 400 2013 2014 600 500 400 2013 2014 300 300 200 200 100 100 0 0 Month Month SOURCE: Support for the Nigerian Malaria Programme SuNMaP, DFID 2014.
Integrated Community Case Management Thrust of iccm strategy To increase access to effective life-saving and cost-effective treatments for childhood illness, especially in hard to reach and underserved areas Ensure that the medicines for treatment of malaria, pneumonia, diarrhea and malnutrition in children underfive are available at all times These include antimalarial medicines (ACTs), antibiotics (Amoxicillin), ORS etc Presently, iccm is being implemented in only 4 states. The low scale up has been due to lack of other components
Malaria During Pregnancy: The Four Components 1.Antenatal Care & Health Education 2. Intermittent Preventive Treatment (IPT) 4. Early detection & prompt appropriate Case Management Of Symptomatic Women 3. Constant use of Long Lasting Insecticidal Nets (LLINs) 15
The Enhanced Pillars of Safe Motherhood in Nigeria Safe Motherhood Family Planning Focused Ante-Natal Care Clean and Safe delivery Newborn Care Post-Natal Care Post-Abortion Care Emergency Obst. Care STIs/ PMTCT-Plus Skilled Birth Attendants Communication for Behavior Change + Male involvement Primary Health Care / Supportive Health Systems Equity, Reproductive Health Rights and Education for Women 16
Challenges with Malaria Case Management Human Resistance to changes; difficult to convince individual with fever with negative RDT results Low skills of officers carrying out microscopy Inadequate / dilapidated equipment and consumables for malaria microscopy Huge capacity gap in diagnosis at the private sector Inadequate commodities Government resources and partners supports are directed to the Public Sector
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