PURPOSE The purpose of the Malaria Control Strategic Plan 2005/06-2009/10 is to provide a common platform and detailed description of interventions for all RBM partners and sectors of society. It encourages all partners to engage themselves in malaria control with a common strategy and objectives, i.e. one plan, one implementation and coordination mechanism and one M&E plan. Vision At the end of the period of the strategic plan Malaria will no longer be the major cause of illness and death in Uganda and families will have universal access to malaria prevention as well as treatment.
The actual targets in providing prompt and highly effective anti-malarial combination therapy malaria episodes are to: Achieve cure and thus reduce the number of cases progressing to severe malaria Prevent or at least delay development of resistant parasite strains Reduce malaria transmission by reducing the reservoir of parasite stages transmissible by the mosquito vector (gametocytes) To prevent death in severe malaria. Save the life of the mother in treatment of severe malaria in pregnancy. gradually phase out the availability and use of monotherapies
The NMCP aims at achieving by 2009/10 strategic plan review; Artemisinin-based combination therapy (ACT) will be universal including those accessing treatment through the commercial sector All children under 5 will be accessing ACT malaria treatment within 24 hours of fever onset through home-based management of malaria fever The case fatality of severe malaria will have reduced through a system that provides highly effective prereferral treatment and good management capacity at health facilities and hospitals Where possible all malaria cases are confirmed by high quality clinical and parasitological diagnosis
Home based management of fever Aims to complement availability of free malaria treatment by bringing it closer to the home - Community Medicine Distributors (CMD) Has been rolled out to cover all districts in the country + IDP camps Surveys and Evaluations show that with HBMF, compliance with this treatment is excellent (>95%) increase of timely treatment of fever episodes is achieved: (55-60% within 24 hours and 80% or more within 48 hours of onset of symptoms. Reduction of severe anaemia (up to 60%) particularly less than 2 years age group District records do indicate a reduction in severe cases and deaths. Utilisation of Public health services has increased on average 40-50% of fever episodes are treated by the CMDs. reduced the proportion of cases that seek treatment from drug shops and informal private sources
Major challenges for the HBMF implementation Sustainability of the volunteer CMDs through an equitable provision of incentives: Attrition as high as 50% but can be kept as low as 2% in areas where some additional support through NGOs or other mechanisms. Supervision, data flow and utilization and supply management often is hindered by insufficient operational funds and human resources. Avoidance of establishment of a vertical programme and ensure integration with other community-based health activities such as IMCI Ensuring continuity of the programme during the frequent transitions to the ever changing treatment policies. Regulatory issues regarding handling of drugs by the CMDs, Safety issues - pharmacovigilance, Operational issues RDT implementation.and Financial issues (e.g. to finance this extra need for drugs)
Malaria Case management Strategy III Malaria in pregnancy. Principally aims at: Increasing coverage with at least two doses of intermittent preventive treatment (IPT), using DOT. Those with HIV will get the third dose. Emphasizing the prevention of malaria with ITNs among pregnant women by including distribution mechanisms suitable for this target group and promote the regular and correct use of the nets.
Diagnosis With the introduction of ACTs there is increasing need to minimise unnecessary treatment while at the same time provide maximum coverage with treatment access. NMCP aims at increasing Coverage of high quality clinical and parasitological malaria diagnosis through microscopy or rapid diagnostic tests (RDT). Choice of diagnostic method - guided the level of health care, availability of skills, laboratory supplies and equipment. Choice of RDTs is guided by evidence on sensitivity, specificity, ease of use and stability in the field = WHO performance evaluation and pre-qualification schemes.
Severe Malaria. This policy aims at Introduction of suitable and easily applicable pre-referral treatment (e.g. rectal Artesunate) at peripheral health facilities (HC II) & community level. Improving availability of safe blood and blood products as well as other relevant IV fluids and ancillary treatments Improvement of the management of severe disease at higher level health facilities (HC II & IV) and hospitals Availing medicines and commodities
Malaria and HIV/AIDS This affects mainly adults and multipara gravid women who had already developed good acquired malaria immunity previous to HIV infection. PLWHA are being included as high risk group in all components of the malaria programme. Pregnant ones are being encouraged to get up to 3 doses of IPT
Drug efficacy and quality monitoring The Malaria Control Programme together with its partners in the research continues to monitor drug sensitivity and safety of antimalarial drugs with a view of prompt revision of treatment policy. Aims to improve the KAP of health care providers through campaigns The NDA quality of antimalarial medicines will be regularly monitored by the NDA in collaboration with relevant regulatory and
To ensure early diagnosis and prompt effective treatment of malaria within 24 hours of onset of symptoms. To ensure that all malaria treatment is supported by parasitological diagnosis where feasible. To ensure pregnant women receive IPTp with appropriate medicine and receive early diagnosis and prompt management of malaria episodes. To ensure every pregnant woman sleeps under a LLIN throughout her pregnancy and thereafter.
Uncomplicated malaria The first line treatment is Artemether/Lumefantrine. Any ACT recommended by WHO & MOH and registered with the NDA - alternative first line. Quinine is the interim second line treatment drug of choice for treatment of malaria until Dihydroartemisinin/piperaquine (DP) is available on the WHO treatment guideline for malaria. The first line medicine for uncomplicated malaria shall be the drug of choice for Home
Severe malaria: Parenteral quinine, is the recommended medicine for the treatment of severe malaria for all patients until new WHO guidelines are available.. Parenteral artesunate or artemether are the alternatives.
Pre-referral treatment for severe malaria Rectal artesunate shall be used as pre-referral treatment for severe malaria in children, at the community and lower level health facilities (HC III, II, and Community medicine Distributors (CMDs)).
Provide adequate quantities of the recommended antimalarial medicines, diagnostics and other supplies Development of appropriate guidelines and tools. Implementation of HBMF in medium to high transmission areas Supporting interventions to enable achievement of these objectives shall include: Adequate Training and support supervision of the health work force, Enhancing Advocacy and social mobilisation, Insisting on Coordination of activities including partners Involving Public-private partnership in the