Progress report:the national LF and STH programme

in MALDIVES

Mohamed Faisal2014

RPRG MeetingWHO Region

Geography and Population◦ Total population: 371,507 (Census 2006)

◦ Ecological zones – next slide

Political & Health Administrative Divisions:- First level :Central Level - HPA- Second level : Regional (political

but not for health sector) - Atoll Level

- Third level : Island Level

Background Information

REPUBLIC OF MALDIVES

• Maldives comprises of 1190

Islands

• Administrative natural atolls 20

• Total inhabited Islands 197

• Country population (2013 projected) 371,507

• Av. flow of expatriate workers per year 44,845

• Av. flow of visitors (tourist) per year 395,320

• Climate (monsoon) (NW

&SW)

• Av. temperature 25-31 deg

C

Filaria was considered as a public health problem in the Maldives, 50 years ago.

First survey was carried in 1951, in southern most 5 atolls. Seenu Ghaviyani Gaaf Alif Gaaf Dhaal Laamu

Disease incidence rate was 24% (1951). National control programme was launched on 1968 in

Male’. Filaria control programme in atolls was started on 1974

and continued till 1997.

History of LF

10 known endemic islands by 1998. National filaria elimination plan was

developed. (2002-2007) A re-assessment survey of the 10 islands

were conducted in 2003. Only Laam Fonadhoo(island) was found to

be endemic. MDA 5 rounds completed

◦ First round of MDA in Laam Fonadhoo started in 2004.

◦ Fifth round of MDA in Laam Fonadhoo completed on 23rd June 2008.

History of LF

Disease under elimination since 2008

No local cases since 2008 Imported cases: (2011-13) nil

Vector – Culex Quinquefasciatus still exists

Surveillance rounds ongoing since 2008

Treatment provided free for any new cases

History of LF

PC programme achievements 2013

Indicator Targeted Achieved

M&E

Total # sentinel and spot check sites surveyed (LF) 5 (2012)Total # IUs where stopping-MDA TAS implemented (LF) 0Total # IUs which passed TAS and stopped MDA (LF) 0Total # IUs where surveillance TAS implemented (LF) 0

MMDP

# IUs where hydrocele surgeries performed

No recent data

Describe how coverage is monitored Surveys conducted every year ~4 atolls

SAE protocol

Monitoring and Evaluation

Progress Towards LF Elimination

DefinitionsStarted

MDA≥5 MDA rounds Surveillance MMDP

access

MMDP access

Surveillance post-MDA

60% 80% 100%

85%

100%

Conducting awareness programmes about LF and vector control methods

Reporting through health facilities to HPA on vector control programmes conducted by atoll level.

Integrated Vector Management (LF)

LF MMDP – StrategyLF

National policy exist? yes

Organizational placement within the government (who is responsible?)

Health protection Agency/ Ministry of health

How integrated with the health service? Ministry of education/school health programme

Training of service providers conducted (by who? How frequent?)

Health protection Agency/ Ministry of health

Patient mobilization and registration (by who? How?)

Health protection Agency/Ministry of health

Describe interventions and/or M&E activities that worked welli. Integrated activities

i. Elimination activitiesii. Disease-specific activities: ICT surveys every

year for 4 atollsiii. At present, activities (surveys) are low.

Best Practices

For each disease, list the specific challenges/issues that need advice from RPRG

For LF, ◦ Now low priority as it is under elimination, so less

resources for continuing activities◦ Need programs for preventing re-entry of the

disease as vector is still present. e.g. Testing migrants, vector surveillance and IVM

Challenges and “Issues”

MNS (Micro nutrient survey) 2007:4% of children 6 months to 5 years of age were found having any kind of worm infestation.(stool examination)

Prevalence in all age groups: 6.1%

History of STH

Government provides deworming syrups to all children under the age of 2-5 years

Government provides deworming tablets (albendazole) to all children under the age of thirteen years.(6-13 years)

Public health awareness programs are conducted in all the schools

Public awareness programs are conducted through media

IEC materials are developed and distributed in all health centers and schools

Conduct awareness programs on personal hygiene

History of STH

National programme overviewIndicator LF STH

Year of inception of the national programme

1968Elimination plan:

2002-2007

1999

Target date for elimination 2010Name of administrative unit for implementation of PC

Central Central

Total # administrative units requiring PC at the start of the programme

10 56

Total population requiring PC in the country

Eliminated since 2008Mainly migrants

PC programme achievements 2013

Indicator Targeted Achieved

M&E Total # sentinel sites surveyed (STH) 0

Activities

Targeted Achieved

# administrative units

for PC# people

# administrative units

for PC# people

PC

MDA2 (DEC + ALB) 0T3 (ALB/MBD) for STH 1st round 56 54822 56 44998

T3 (ALB/MBD) for STH 2nd round 56 54822 56 44479

2009 2010 2011 2012 20130

10

20

30

40

50

60

Coverage- School Age Children

Coverage- School Age Children

Progress Towards STH scale up

2009 2010 2011 2012 20130

10

20

30

40

50

60

Coverage- School Age Children

Coverage- School Age Children

Progress Towards STH scale up

2011 2012 20130

10203040506070

Coverage- Pre school

Coverage- Pre school

Progress Towards STH scale up

PC coverage, 2013

*65% for LF and 75% for STH**reported coverage was verified by coverage survey or similar independent activity

PC type

# administrat

ive units receiving

PC

# administrative units with

reported coverage

above target*

# administrati

ve units where

coverage was

verified**MDA2 (DEC + ALB) 0 0 0T3 (ALB/MBD) for STH 1st round 56 17

T3 (ALB/MBD) for STH 2nd round 56 20

Patients detected through health facilities◦ Management

Treatment provided free of charge from Nutrition programme

◦ Reporting – through health facilities to HPA (Central Level)

Monitoring and Evaluation

For each disease, list the specific challenges/issues that need advice from RPRG

STH: ◦ Since the programme started in 2000, there is an

need to review and strengthen the deworming programme.

Challenges and “Issues”

Programme Plan

Activities

2014 target 2015 target

# administrative units for

PC

# people

# administrative units for

PC

# people

PC

MDA2 (DEC + ALB) Not required Not required

T3 (ALB/MBD) for STH 1st round 56 55376 56 55979

T3 (ALB/MBD) for STH 2nd round 56 55376 56 55979

PC medicine request for 2015

　 ALB (LF) ALB (STH) MBD DEC

required 61064

in stock 65200

in pipeline -