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` A Case for Environmental Management Control of Malaria in Anambra State ’

Health and Economic Burden of Malaria and our Community Environment. ` A Case for Environmental Management Control of Malaria in Anambra State ’. Henry Debem ( Ph.D . Student ) Walden University, USA PUBH 8165 Instructor : Dr. Lezah Brown-Ellington Spring Term, 2013. Learning Objectives

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` A Case for Environmental Management Control of Malaria in Anambra State ’

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  1. Health and Economic Burden of Malaria and our Community Environment ` A Case for Environmental Management Control of Malaria in Anambra State ’ Henry Debem (Ph.D. Student) Walden University, USA PUBH 8165 Instructor : Dr. Lezah Brown-Ellington Spring Term, 2013

  2. Learning Objectives • What is Malaria? • Global Epidemiological Background of Malaria • Nigerian Context of Malaria Burden • Health and Economic • Brief Background of Anambra state • Current Malaria Control Measures in Anambra State • Common Points of Interference for Malaria Control • Key Stakeholders of Malaria Control in Anambra State • Environmental Risk Practices in Anambra State • Environmental Management Control (EMC) Measures • Efficacy and Cost Effectiveness of EMC • Other Advantages of EMC • Recommendations for Malaria Eradication in Anambra State. • Revision of the Learning Objectives Presentation Outline

  3. At the end of this presentation, participants will be able to: • Learn mosquito and malaria cycle • Understand the health and economic burden of malaria in the World and Nigeria • Learn the current control measures in Anambra State and their Merits and Demerits • Understand the superiority of Environmental Management Control over others • Make better informed and strategic decisions in the fight against malaria in Anambra Communities and beyond. Learning Objectives

  4. Vector-borne disease caused by transmission of Plasmodium species by Anopheles mosquitoes. • Plasmodium specie is the malaria parasite that causes malaria in humans • Transmission occurs through mosquito bites on humans during blood meals • Mosquitoes primarily breed in water What is Malaria?

  5. Plasmodium sp. and Mosquito Life Cycle Images Retrieved from: 1. www.scienceblogs.com 2. Skeeters. www.bcps.org

  6. Global Epidemiological Background of Malaria • Global and African Context: • Malaria, a serious global concern particularly in Africa • About half the world’s population (3.3 billion people) are affected by Malaria • 216 million cases occurred in 2010; 81% in African region • Malaria caused over 600,000 deaths in 2010; 91% in African region • Third leading cause of death for children under 5 years • Almost 1 out of 5 deaths of children under 5 in Africa is caused by Malaria WHO (2013). Global health observatory. Retrieved from: http://www.who.int/gho/malaria/en/index.html

  7. Health Burden: • Nigeria bears about 25% of the Malaria burden in Africa • About 97% of the Nigeria’s population is at risk of Malaria • Estimated 110 million malaria cases and 300,000 death annually • Estimated 11% of maternal deaths is caused by malaria Nigeria Context of Malaria Burden Chima, R., Goodman, C., & Mills, A. (2003). The economic impact of malaria in Africa: a critical review of the evidence. Health Policy,63(1), 17-36. National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010. WHO (2013). Global health observatory. Retrieved from: http://www.who.int/gho/malaria/en/index.html

  8. Economic burden: • Costs can be divided into direct and indirect cost • Direct costs – households and government expenditures on treatment and prevention • Indirect costs – losses of labor productive time due to mortality and morbidity • Nigeria Government losses close to $1 billion ($868,421,052) annually (Jimoh, et al, 2007) • In general context (Other studies outside Nigeria): • Monthly expenditure on malaria treatment is between $0.41 and $3.88 per person • Treatment equivalent between $1.88 and $26 per household (Chima, et al, 2003) • Very poor households spend 28% of their income on Malaria • In Africa, government spend estimated $1.83 and $8.01 per person (Shepard, et al, 1991) Nigeria Context of Malaria Burden…2 Chima, R., Goodman, C., & Mills, A. (2003). The economic impact of malaria in Africa: a critical review of the evidence. Health Policy,63(1), 17-36. Jimoh, A., O. Sofola, A. Petu, and T. Okorosobo. 2007. “Quantifying the Economic Burden of Malaria in Nigeria Using the Willingness to Pay Approach.” Cost Effectiveness and Resource Allocation 2007, 5:6. doi:10.1186/1478-7547-5-6. Shepard, D., Ettling, M., Brinkmann, U., & Sauerborn, R. (1991). The economic cost of malaria in Africa. Tropical Medicine And Parasitology: Official Organ Of Deutsche TropenmedizinischeGesellschaft And Of Deutsche GesellschaftFürTechnischeZusammenarbeit (GTZ), 42(3), 199-203.

  9. Created in 1991 and Located in the South Eastern Nigeria • Eight most populated state (4,055,048) and second most densely populated (840/km2) in Nigeria. • Total area of 4,844 km2 • Dominated by Igbos by tribe (98%) • Capital City as Awka, while Onitsha and Nnewi are the biggest most commercial cities Brief Background of Anambra State National Population Commission [NPC] (2008). Demographic and Health Survey [DHS] 2008.

  10. Most Malaria program in Nigeria, including the 1998 WHO RBM program adopted these Strategies: • Diagnosisand treatment (D&T) with effective medicines • Distribution and use of insecticide-treated nets (ITNs) to achieve coverage of populations at risk, with particular focus on Children under 5 and Pregnant women • Indoor residual spraying (IRS) to curtail transmission • Intermittent preventive treatment (IPT) Current Malaria Control Strategies in Anambra National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010.

  11. Concerns • No emphasis on the vectors life cycle (Weak intervention) • Expensive particularly in poor regions (Cost of regular purchases and maintenance) • High behavioral adherence / compliance requirements. E.g. only 35% of the population in the South Eastern Nigeria use at least one bed net(NMCP, 2012). IRS, ITN IRS, ITN IPT, D&T IPT, D&T Common Points of Interference for Malaria Controls Image retrieved from: www.crick.ac.uk National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010.

  12. Government: • Federal and State of Ministries of Health • National and State Malaria Control Programs • Local Health Departments • Primary Health Care Departments • Non Governmental Organizations (NGOs) • Community based Non-Governmental Organizations • Community groups and Coalitions • Major Donor Agencies • WHO • USAID • DFID • World Bank • Global Fund Stakeholders of Malaria in Anambra State National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010.

  13. Vegetation Clearance • Fumigation of bushes • Draining swamps • Surface application of oil to open water bodies • Modification of River boundaries • Disposal of all potential open water storage facilities and objects away from residential area. Environmental Management Control (EMC) Strategies Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine & International Health: TM & IH, 6(9), 677-687.

  14. Environmental Risk Practices in Anambra State • Indiscriminate dumps of refuses and wastes close to residences • Dumps in swamps and drainages causing stagnant waters • Abandonment of vegetation's and bushes within residential areas. • Farming within residential areas

  15. Efficacy and Cost Effectiveness of EMC • Studies have shown that EMC in combination with quinine and ITN is capable of: • Reducing malaria related incidence, morbidity, and mortality rates by 70 – 95% within 3 - 5 years • Averting estimated 4173 deaths and 161,205 malaria attacks in one local community in 20 years • Saving estimated $858 per death and $22.20 per attack . • Averting disability adjusted life year (DALY) to the cost of $524 – 591 per DALY Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine & International Health: TM & IH, 6(9), 677-687.

  16. Other Advantages of EMC • Strong benefits of the EMC strategy is the potential to: • Leverage the available community resources; hence, saving great cost • Create more effective community sustainability and ownership. • Encourage sound community participation and communal efforts. • Provide less stringent behavioral compliance • No significant side effect • Address other of other environmental issues unrelated to malaria.

  17. Recommendations for Malaria Eradication in our Communities • First, malaria eradication, rather than malaria control should be emphasized in the state policy and strategic plan for communities. • Channel more proportion of Malaria control donor and government funds to community EMC • Empower and involve the State environmental Protection Agency (EPA) as active stakeholders in the fight against Malaria • Strengthen the community participation in the community EMC • Leverage the community resources to support this strategy • Empower the community leaderships to support this course in every community. Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine & International Health: TM & IH, 6(9), 677-687.

  18. Reference Chima, R., Goodman, C., & Mills, A. (2003). The economic impact of malaria in Africa: a critical review of the evidence. Health Policy, 63(1), 17-36. Jimoh, A., O. Sofola, A. Petu, and T. Okorosobo. 2007. “Quantifying the Economic Burden of Malaria in Nigeria Using the Willingness to Pay Approach.” Cost Effectiveness and Resource Allocation 2007, 5:6. doi:10.1186/1478-7547-5-6. National Malaria Control Program [NMCP] (2012). Nigeria Malaria Indicator Survey 2010. National Population Commission [NPC] (2008). Demographic and Health Survey [DHS] 2008. Shepard, D., Ettling, M., Brinkmann, U., & Sauerborn, R. (1991). The economic cost of malaria in Africa. Tropical Medicine And Parasitology: Official Organ Of Deutsche TropenmedizinischeGesellschaft And Of Deutsche GesellschaftFürTechnischeZusammenarbeit (GTZ), 42(3), 199-203. Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine & International Health: TM & IH, 6(9), 677-687. WHO (2013). Global health observatory. Retrieved from: http://www.who.int/gho/malaria/en/index.html

  19. Revision of Learning Objectives • Have we achieved the objectives of this presentation, otherwise ask questions for further clarifications? • Do you understand the mosquito and malaria cycle? • Do you understand the health and economic? burden of malaria in the World and Nigeria? • Do you know the available malaria control measures in Anambra State and their Merits and Demerits? • Do you know the advantages of EMC over others? • Can you now make better informed and strategic decisions on the fight against malaria in your communities? Utzinger, J., Tozan, Y., & Singer, B. (2001). Efficacy and cost-effectiveness of environmental management for malaria control. Tropical Medicine & International Health: TM & IH, 6(9), 677-687.

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