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Enhanced malaria diagnosis capacity in camps hosting migrants/ refugees in Greece, 2009-2017

Enhanced malaria diagnosis capacity in camps hosting migrants/ refugees in Greece, 2009-2017. Agis Terzidis Paediatrician, Vice president of Hellenic Center for Disease Control & Prevention (HCDCP), Special advisor to the Minister of Health. Malaria in Greece. 1974: malaria-free

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Enhanced malaria diagnosis capacity in camps hosting migrants/ refugees in Greece, 2009-2017

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  1. Enhanced malaria diagnosis capacity in camps hosting migrants/ refugees in Greece, 2009-2017 Agis Terzidis Paediatrician, Vice president of Hellenic Center for Disease Control & Prevention (HCDCP), Special advisor to the Minister of Health

  2. Malariain Greece • 1974: malaria-free • 2009-2014: 20-70imported cases/year • 74% of imported cases were migrants • 2015-2017: 80-110 imported cases/year • 83% of imported cases were migrants • Recent malaria crisis: vast migrants/ refugees influx in Greece •  20-35% of population originated from malaria endemic countries

  3. Imported malaria cases by place of infection, Greece, 2015-2017 • 83% (241/290) ofimported cases: migrants/ refugees • 84% (201/241) of migrants patients: P.vivaxmalaria • 23% (n=55) of migrants patients: hosted in camps/ hotspots

  4. Malariain Greece, 2009-2017 • 2009-2017: locally acquired malaria cases

  5. Activities for the management of malaria in Greece, 2011 - 2017 • Multi-sectoral National Committee - Working Groups on VBDs • Action Plan for the Management of Malaria (MoH, HCDCP) 1. Risk assessment 2. Enhanced malaria surveillance 3. Enhanced laboratory diagnosis 4. Case management - Standardization of treatment 5. Communication 6. Blood safety measures 7. Vector surveillance and control

  6. Activities for the management of malaria in Greece, 2011 - 2017 • Multi-sectoralNational Committee - Working Groups on VBDs • Action Plan for the Management of Malaria (MoH, HCDCP) 1. Risk assessment 2. Enhanced malaria surveillance 3. Enhanced laboratory diagnosis 4. Case management - Standardization of treatment 5. Communication 6. Blood safety measures 7. Vector surveillance and control

  7. Activities for the management of malaria in Greece, 2015 - 2017 • Multi-sectoralNational Committee - Working Groups on VBDs • Action Plan for the Management of Malaria (MoH, HCDCP) 1. Risk assessment 2. Enhanced malaria surveillance 3. Enhanced laboratory diagnosis 4. Case management - Standardization of treatment 5. Communication 6. Blood safety measures 7. Vector surveillance and control 8. Prevention activities in camps hosting migrants/ refugees

  8. Malaria prevention activities in camps hosting migrants/ refugees, Greece, 2016-2017 • Risk assessment (vector, environment, demographics) for each camp • Enhanced surveillance - laboratory diagnosis capacity • Support hospitals in case management (diagnosis, treatment) • Personal protection against mosquitoes • Intensifying vector surveillance and control • Camps location, MoH Circular (>6km from large Anopheles breeding sites or population from non-endemic countries)

  9. Enhanced laboratory malaria diagnosis capacityin camps hosting migrants/ refugees, Greece, 2016-2017 • Distribution of Malaria RDTs (P.f/ Pan) inhealthcare facilities providing health care to migrants/ refugees (POCs):- camps hosting migrants/ refugees, and - nearby healthcare facilities (hospitals and health centers) • Raised awareness among health professionals for testing suspected cases (letters, PHILOS personnel):- case definition of suspected cases- protocol on the management of suspected cases - guidelines on the use of RDTs (training of PHILOS personnel)- algorithm for case managing in negative and positive results • Monthly recording of the used RDTs (Jun - Dec 2017)

  10. Malaria RDTs (P.f/ Pan) distributionin camps hosting migrants/ refugees, Greece, 2016-2017 • 1,825 malaria RDTs were distributed to 58 camps • 1,780 malaria RDTs were distributed to 77 nearby health units Total RDTs supply, 2016-2017 (n=5,800): - Programme “PHILOS–Emergency health response to refugee crisis” (n=2,500) - KEELPNO (n=1,800) - MSF donation to KEELPNO (n=1,500)

  11. Malaria RDTs distributionin camps hosting migrants/ refugees, Greece, 2016-2017 KEELPNO sent 5,083 RDTs to 218 healthcare (HC) facilities, including 3,605 RDTs to 135 HC facilities - POCs for migrants/ refugees:- 1,675 RDTs to 54 (100%) camps - 1,780 RDTs to 77 (100%) nearby HC facilities - 150 RDTs to 4 migrants’ detention centers

  12. Recording of malaria RDTs usein camps hosting migrants/ refugees, Greece, 2017 Systematic recording of the RDTs use, June – December 2017 • In 35 (100%) camps with medical services and PHILOS personnel,where 1,150 RDTs were distributed:- 800 RDTs in 28 camps in the mainland- 350 RDTs in 7 camps on the islands • RDTs use recording:- at least once: from 28/35 (80%) camps (all 28 camps in the mainland)- at least once a month: from 12/35 (34%) camps

  13. Malaria RDTs use in camps hosting migrants/ refugees, Greece, 2016 - 2017 • 5% (39/800) RDTs were used in 39% (11/28) camps • 28 imported malaria cases were diagnosed among migrants/ refugees living in camps: - 18 in 2016 - 10 in 2017 RDTs contributed to diagnosis in 96% (n=27) of these cases (in POCs in camps or nearby HC facilities)

  14. Conclusions – Challenges • Malaria RDTs: contributed to prompt diagnosis of imported cases in areas hosting migrants/ refugees • Challenges: -high turn-over of health professionals (training, raise awareness)- recording of RDTs use- resources

  15. Conclusions – Recommendations Timely malaria diagnosis: pivotal for personal health benefit, and prevention of local transmission In all areas hosting migrants from malaria endemic countries: • Local malaria diagnosis capacity should be enhanced • Malaria RDTs: valuable tool in the field, should be available • Raise awareness among health professionals (for prompt detection and testing of suspected cases):pivotal, should be enhanced

  16. Thank you www.keelpno.gr

  17. Imported malaria cases, Greece, 2015-2017 • 83% (241/290) of imported cases: migrants • 23% (55/241) of migrants patients: hosted in camps/ hotspots (in 96% (53/55) of these cases: RDTs contributed to the diagnosis)

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