1 eritrea national malaria control program: on the road to malaria eradication saleh meky minister...
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Eritrea National Malaria Control Program: On the road to malaria eradication
Saleh MekySaleh MekyMinister of HealthMinister of Health
Government of EritreaGovernment of Eritrea
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Roll Back Malaria Initiative
• case management, • vector control, • insecticide-treated nets (ITNs), • information, education and communication
material, training, • epidemic forecasting and preparedness, • operations research and monitoring, • evaluation and supervision.
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Success
• Eritrea as one of the four countries in the world with successful malaria control programs
• Together with India, Brazil and Vietnam
(Source: The World Bank Rolling Back Malaria: Global Strategy and Booster Program)
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Common elements of success
• Conducive country conditions
• Targeted technical approach
• Data-driven decision making – surveillance and operational research
• Strong leadership and commitment at all levels of government
• Community planning and implementation
• Adequate financing
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The Eritrean Program• Established in 1999 following devastating malaria
epidemics (1997-1998)
• Support from WHO, USAID, WB, Global Fund
• Introduced:– Early diagnosis and treatment at health facility and community
levels– Proper management of severe malaria at zoba/subzoba level– Reduction of man-mosquito contact through ITN (national
coverage)– Community awareness through the promotion of information,
education, and communication– Environmental management through community participation
and prevention and control of malaria outbreaks.
• Reduced malaria morbidity and mortality by 80% during 1999-2005
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Eritrean experience
• Success factors:– Targeted integrated vector management– Massive community mobilization – Organization and supervision– Evidence-based
• Corroborating factors: – No year round malaria transmission and – Manageable country size
• Once targets were exceeded more donor interest and funding
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Country conditions
• Seasonal malaria and low to moderate transmission
• Small country – 121,320 sq km– Population 4,906,585 (est.
2007 World Bank).
• Arid environment and seasonal rainfall patterns
– temporary free-standing pools of water,
– clearing and levelling an attractive option.
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Targeted integrated vector management:
Breeding sites treated, filled or drained(Average per year per zobas)
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Targeted integrated vector management:
Indoor Residual Spraying(per year, per zoba in GB,DB and SKB)
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Massive community mobilization:information and communication malaria sessions
(average per year, per zoba)
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Massive community mobilization:population participating in site cleaning
(average per year, per zoba)
• Community participation very significant factor in explaining breeding site cleaning
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Evidence-based: examples
• 2005 RTI studies showed that the most prevalent mosquito is anopheles arabiensis (bites early in the evening and late morning, not only in the middle of the night). – Use of ITNs as a sole prevention mechanisms is
insufficient– Indoor residual spraying perhaps required
• Sintasath et al. 2005 showed that housing construction known as agudo, in the western lowland of Eritrea, increases risk of parasitemia.– Implication for housing materials
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• Areas (subzobas) with above average ITN distribution reduced – Under five malaria incidence by 4 cases per month (23%
reduction per month)– Above five malaria incidence by 8 cases per month (14%
reduction per month)
• Areas (subzobas) with above average larvae site cleaning (treatment, filling and draining) reduced – Above five malaria incidence by 9 cases per month (15%
reduction per month)
Effectiveness of malaria interventions on incidence
(preliminary findings)Carneiro, Hassane, Legovini, Sy 2008
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Increasing access to ITNs to 100 per 1000 population reduced malaria under five incidence by 76 cases.
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Moving forward
• Securing longer term financing is a priority:– Need evidence on the economic impact of
malaria interventions to motivate continued investments in malaria control
– Need rigorous evaluation of the elements of the program and complementary interventions to understand what is required to eliminate malaria
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Moving toward evidence-based eradication
• Impact evaluation cross-country workshop (Asmara, Feb 2008)– Capacity for evidence-based policy making – Community of practice across malaria programs in the region
(15 delegations from national malaria and HIV programs)– Dissemination of Eritrean and other successful practices across
the Africa region (site visits)
• Experimental approach to understanding what more needs to be done to eradicate malaria
– Randomized evaluation of indoor residual spraying value added to the national program
– Randomized evaluation of communication and community mobilization approaches