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Malaria Prevention and Control in Ethiopia

2. Country Profile

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Malaria Prevention and Control in Ethiopia

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    1. 1 Malaria Prevention and Control in Ethiopia

    2. 2 Country Profile –Malaria Burden 75% of the land malarious (altitude < 2000 m), >50 million(68%) of the population at risk, Malaria is the first cause of illness & death (2003/04) OPD 15.5%: 1st Admissions 20.4%: 1st Hospital Deaths 27.0%: 1st Transmission season- Sept.- Dec., April- May, (seasonal & unstable) Coincide with major harvesting season; aggravate economic loss, Major epidemics occur every 5 - 8 years, focal epidemics are common,

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    4. 4 Impact of malaria control interventions: Trends in Malaria Cases, Admissions and Deaths

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    12. 12 Strategic Approaches 1) MAIN TECHNICAL ELEMENTS OF STRATEGIC APPROCHES: Early diagnosis and effective treatment Vector control Insecticide treated materials Residual house spray Other vector control methods; Environmental Mx, Larviciding etc Epidemic prevention and control 2) SUPPORTING STRATEGIES: Human resource development Operational research Information, education and communication Program monitoring and evaluation

    13. 13 General Objective To reduce the overall burden of malaria (mortality and morbidity) by 50% by 2010.

    14. 14 Specific Objectives Achieve 100% access to effective and affordable treatment for malaria by the end of 2008 Achieve 100% coverage of all households in ITNs targeted districts with at least two ITNs per household by August 2007,

    15. 15 Specific Objectives contd…. Achieve 60% coverage of villages targeted for Indoor Residual Spraying (IRS) the end of 2010 as compared to the 20-30% coverage in 2005, Early detect and contain 80% of the malaria epidemics within two weeks from onset by 2010 as compared to 31% in 2005,

    16. 16 Rapid Scale-up for Impact (SUFI)

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    21. 21 Major Achievements: Vector Control/ITNs Vector Control: LLINs 15.5 million LLINs have been Distributed to users 5,108,168 nets have been procured and is on pipeline 700,000 gap is secured or now under negotiation with partners (GF) 88 % coverage at 2 ITNs per household

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    23. 23 Status of Procurement and Delivery of LLINs

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    25. 25 Indicative Budget Requirement (2006 – 2010)

    26. 26 Major sources of fund in malaria prevention and control activities GF ATM UNICEF WHO CIDA/CANADA The Carter Center USAID/PMI PSI PBS/The World Bank Japan/JICA DFID Other partners

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    28. 28 Data required for new malaria intervention introduction decisions Efficacy and Effectiveness Length of protection Cost effectiveness compared to other interventions Safety in different risk groups - <5s; pregnant women; breastfeeding; High Reduction of occurrence of sever malaria Potential for wide-spread use – all levels of health care system & community level, Consumer acceptability Formulation; dosage regimen; taste, Potential to delay resistance

    29. 29 Example of decision-making Policy change to ACTs is a good example Efficacy study, Validation of findings Dissemination workshop Recommendation Guideline revision Training of health workers Resource mobilization and procurement Implementation of the new policy

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    33. 33 Sulfadoxine-Pyrimethamine Efficacy Study Findings & Treatment Policy Change

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    35. 35 Is There a Need to Change? YES! Preliminary findings of the nationwide therapeutic efficacy study results on sulfadoxine-pyrimethamine show treatment failure rates that warrant for change, The need to use safe and effective anti-malaria drugs during malaria epidemics Which drug (s)?

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    37. 37 Minimal criteria for selection of Anti-malarial drugs Therapeutic efficacy – Clinical and parasitological cure Safety in different risk groups - <5s; pregnant women; breastfeeding; Potential for wide-spread use – all levels of health care system & community level, Consumer acceptability- formulation; dosage regimen; taste, Cost effectiveness Potential to delay resistance

    38. 38 Recommended Options for Ethiopia Treatment of uncomplicated falciparum malaria Artemether-Lumefantrine (highly recommended) Artesunate + Amodiaquine (unlikely due to failure of AQ) Artesunate + Sulfadoxine-Pyrimethamine (unlikely due to failure of SP) Artesunate + Mefloquine (needs investigation) Non ACT option: SP + Amodiaquine (unlikely due failure of both) Treatment of vivax malaria (Chloroquine, Primaquine (radical cure) Treatment of Sever & complicated malaria – Quinine Chemoprophylaxis (Daily Proguanil + weekly chloqroquine) Other issues to be considered Need to identify safe drugs for the treatment of malaria during pregnancy, Treatment of sever and complicated malaria in peripheral health facilities during malaria epidemics, Chemo prophylactic drug for travellers (with easy dose regimen).

    39. 39 1. Artemether - Lumefantrine AM-LUM is highly recommended: Very past parasite elimination Prompt reduction in fever Effective gametocyte clearance Effective in multi-drug resistant areas Does not show any evidence of organ or system specific toxicity Fixed dose combination treatment

    40. 40 Efficacy Study Results of Artemether-Lumefantrine on P. falciparum Infections (Sep. – Dec. 2004)

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