General Overview of The National Malaria Control Program in Timor Leste Johanes Don Bosco National Malaria Control Program Department of CDC, MoH DRTL
Malaria situation in Timor Leste Malaria is the leading cause of morbidity and mortality in Timor Leste Total Population : 1, 017,187 (80% of pop. Living in Malarious areas) > 100, 000 clinical malaria cases/year 200 deaths/year 20-40% 40% of all outpatients & 30% of all hospital admissions present for malaria symptoms
No. of clinically diagnosed and microscopically confirmed malaria cases and deaths due to malaria Year Clinically diagnosed cases Laboratory confirmed P. falciparum Cases (%) P. vivax Total 2000 108,609 15,212 4,663 (30%) 10549 123,821 134 2001 83,049 NA NA NA 83,049 NA 2002 93,693 26,651 14,124 (52%) 12,527 120,344 NA 2003 39,328 # 33,411 18,019 (54%) 15,392 72,739 NA 2004 203,793 39,164 23,006 (58%) 16,158 243,695 61 2005 138,206 40,409 25,810 (64%) 14,599 180,560 50 2006 184,650 38,269 25,348 (66%) 12,921 222,919 58 2007 167,280 46,832 34141 (73%) 125420 214,112 44 deaths
No. of malaria cases reported from 2004 to May 2007 35000 30000 No. of malaria cases 25000 20000 15000 10000 5000 0 months
No of malaria cases according to districts 2006 Districts Total Populasi Clinical Cases Conformed Cases Total Malaria cases Morbidy rate (per 1000 Pp*) Aileu 39840 17170 3024 20194 507 Ainaro 57919 4812 268 5080 88 Baucau 112937 11089 125 11214 99 Bobonaro 88976 6859 678 7537 85 Covalima 60416 20939 8986 29925 495 Dili 181199 18283 10735 29018 160 Ermera 111423 11143 1583 12726 114 Lautem 62049 24652 4541 29193 470 Liquica 59463 8480 826 9306 157 Manatuto 41666 7222 1896 9118 219 Manufahe 47774 8511 97 8608 180 Oecuse 63203 5799 1328 7127 113 Viqueque 71749 39691 4182 43873 611 Total 998,613 184,650 38269 222919 223
Map.1 Micro-Stratification of Malaria Incidence (1000 population) Based on Data 2005 ATAU R O MAUBA RA METINA RO DOM A LEIXO C R IS TO R E I LAC LO LAL EIA BAZAR TETE LAU LA RA MANATUTO LIQ U IÇ Á RE MEX IO RA ILA CO LIQUIDOE L A C L U B A R ER MER A AILE U VIL A HA TO LIA L A C L U T A ATABA E LETEFOHO TU R IS C A I SOIB AD A CA ILA CO MAU BISSE BAR IQU E/NA TAR BOR A ATSAB E H A TU - B U IL IC O BALIBO FA T UB E R LIU SAM E MALIAN A ALA S BOBO NA RO A IN A R O VEM ASE OSSU BAU C AU VEN ILALE VIQU EQ UE Q U E L IC A I LAG A BAGU IA UA TU C AR BA U W A T U L A R I LAU T EM LU RO IL IO M A R ACI LOSP ALO S Very High ->250 High 150-250 Medium 150-50 Low <50 TU T U A LA PAN TE M AC AS AR LO L O T O E FATULULIC FA TUM EAN MAU KA TAR FO RO HE M ZU M A LA I SU AI HA TU -U DO NITIBE OESILO TILO M A R PASS ABE Most malaria transmission appears to be occurring in near the South coast of island. Twenty nine out of 65 sub-districts account for 59% of the total malaria cases in the country.
National strategy for malaria control Clinical management providing effective and prompt treatment Distribution of insecticide treated bed nets to high risk group Integrated vector control Epidemic preparedness and response
Clinical management providing effective and prompt treatment New treatment protocol has been adopted introducing ACT to treat pf cases. Use of RDT for Malaria at HFs without Microscope
Treatment Protocol P. vivax - chloroquine + premaquine P. falciparum or mix P. falcipharum 1 st line ACT (Arthemether/lumefantrine( Arthemether/lumefantrine) 2 nd line- Quinine combination of quinine/doxycyclene or clindamycin PW 1 st Trimester (Pf f case) : quinine + clindamycine
Distribution of LL-ITN to high risk group Mainly used vector control method in the country Total number of LL ITN distrbuted : Mass distribution to CU5 : 118, 707 PW : 15,669 Distributed trough ANC visit Other target : 49,600 (targeting 80% of population at high endemic areas) Ministry of health distribute free of charge with substantial help from NGOs
Integrated vector control Commenced with entomological Surveillance Existing challenges for malaria control program Commenced with support from WHO Entomological laboratory established Number of preliminary surveys carried out in malaria high risk areas To to develop evidence based appropriate vector control strategy
Vectors and behavior 10 anopheline species found in Timor Leste Vectors 1. An. subpictus 2. An. barbirostris Biting and Resting behavior - Mainly rest indoors on walls, roof and under furniture - Mainly bite indoors - Prefer human blood
Biting pattern % anopheline bite 16 14 12 10 8 6 4 2 0 6-7 PM 7-8 PM 8-9 PM 9-10 PM 10-11 PM 11-12 PM 12-1 AM 1-2 AM 2-3 AM 3-4 AM 4-5 AM 5-6 AM An. barbirostris- 6PM-3 3 AM & another small peak from4-5 AM An. subpictus- 6-10 PM & Another peak- 12-3 3 AM Time 18 16 14 An. barbirostris Biting time of the vectors does not always correlate with the hours that persons at risk would utilize bed nets. % mosquito bites 12 10 8 6 4 2 0 6-7:00 7-8:00 8-9:00 9-10:00 10-11:00 11-12:00 12-1:00 1-2:00 2-3:00 3-4:00 4-5:00 5-6:00 Time Therefore nets are probably not be the most effective or only prevention method required to reduce man-vector contact. An subpictus
Epidemic preparedness and response Build evidence-based district policies to cope with unnatural variation in malaria transmission that could generate focal epidemics and mitigate as far as possible impact related to outbreaks
Major constrains of malaria control programme Shortage of officers at National and District level for effective implementation of programme Delayed implementation of vector control programmes (IRS) due to lack of entomological information Poor microscopic diagnosis of malaria parasites and shortage of analysts/microscopists
Increased transmission due to very limited coverage of Insecticide Treated Long Lasting Nets (LLINs)) in high risk malaria areas and low utility rate of distributed LLINs nets Limited or no access to Health institutions with laboratory facilities. Emergence of Sulfodoxine-pyremethamine resistance to P. falciparum cases Community knowledge, attitude and practice regarding malaria prevention and treatment is relatively low. (KAP Survey 2005)
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