Malaria burden and control in Somalia - PowerPoint Presentation

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Malaria burden and control in Somalia

Dr. Marian Muse Osman

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Background

Malaria continues to cause unacceptably high levels of disease and death, as documented in successive editions of the World malaria report.

According to the latest report, there were an estimated

241 million cases

and 627 000 deaths globally in 2020.

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Malaria is preventable and treatable, and the global priority is to reduce the burden of disease and death while retaining the long-term vision of malaria eradication.

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Geography and Climate

Across the years, rainfall offers the most variability and unpredictability of all climatic parameters.

Floods

are prevalent along the Juba and Shebelle alluvial plains.

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Historically, floods have affected riverine areas during the

Deyr

season

(principally between October to December), and less frequently during the Gu season.

Years in which rainfall patterns are anomalous can result in increased seasonal malaria transmission and

epidemic

outbreaks.

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Malaria Epidemiology

A description of malaria in Somalia was first published as early as the

1930s

by

Gelonesi, who described the disease in the Benadir region.

Later, a

malariometric

survey conducted in 1938 revealed

Plasmodium falciparum

prevalence of over 50% in areas of Southern Somalia.

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The epidemiological differences in malaria were first described in a WHO report authored by Dr.

Giglioli

in 1960.

This report noted the following:

The risk of malaria was low in the arid northern and central regions of Somalia; epidemics were likely to occur in these regions during the rainy seasons. The riverine

regions were considered

endemic

malaria regions.

The

coastal

regions were considered

malaria-free

.

Malaria Epidemiology

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Malaria transmission was mostly

seasonal

.

Usually occurs in the spring (May-August) and autumn (December – January). which are the main rainy seasons in the country.

Anopheles arabiensis the main vector of malaria in the country.

A.

nili

and

A.

funestus

have also been reported in the southern part of the country.

Malaria Epidemiology

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Current Malaria Profile and the Pathway to Elimination

Like the trend for much of the African continent, malaria transmission declined during the Millennium Development Goal era of 2000-2015 across most of Somalia.

Much of the country now has a transmission risk of

less than 5%

which equates to unstable transmission (

hypoendemic

).

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Main findings of Malaria Indicator Survey (MIS 2017)

Its mission is that “through an integrated health systems approach, the National Malaria Control

Programme

, with the involvement of communities and in coordination with all partners and relevant sectors, will expand, sustain and monitor implementation of high-quality, evidence-based control and elimination interventions.”

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Main findings of MIS 2017

In 2017, the national prevalence of the disease remained the same as in 2014, at

1.9%

.

All the same, the prevalence of SCS declined to 0.73% in 2017 from 2.8% reported in 2014. This drop-in malaria prevalence in a region where the disease has been considered endemic is a great achievement in SCS, resulting from concerted efforts by different agencies working against the disease.

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Regarding national household accessibility to long-lasting, insecticide-treated nets (LLINs) and insecticide-treated nets, the number of households with at least one mosquito bed net rose from 19% in 2014 to 27% in 2017.

Despite this increase, 27% ownership is low and calls for scaling up LLIN distribution in these regions to reach the recommended 85% coverage.

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According to the MIS 2017 report, 239 or 1.1% of all household members sampled nationally reported having fever two weeks preceding the day of the survey; 20% of these sought treatment.

The majority of respondents with fever sought treatment in a

private clinic (59%)

, while only

19% of seeking treatment in a public facility. there is a need to enhance

public-private partnerships.

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Out of 1,119 women of childbearing age who were pregnant in the 12 months preceding the survey, 65% had attended antenatal care services during their pregnancy, compared with 72% reported in MIS 2014.

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Regarding general knowledge of malaria,

over 90%

of respondents knew it was caused by the bite of a mosquito.

However, respondents had a generally low level of knowledge as to the major symptoms of the disease. Of

10,471 people interviewed, only 18% listed fever as a symptom.

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The dominant species of malaria throughout Somalia

is P. falciparum

and responsible for

>90%

of infections.Population movement, can complicate matters.

Further, if non-immune individuals move to areas in which transmission is more stable

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Challenges MIS 2017:

Security issues led to the exclusion of some malarial areas, namely the entire Middle Juba region and some districts.

Other incidents, such as a car accident involving the National Malaria Control

Programme

(NMCP) in Puntland, hampered effective supervision and coordination of the work and the teams.

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The MIS was combined with the Expanded

Programme

on Immunization surveys in terms of resources (time, HR, and cost); this caused many challenges.

The RDT used (pf/Pan) was not accurate and did not exclude false mixed infection, which was recorded in the survey.

Challenges MIS 2017:

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Malaria Control

Programme

Malaria control activities in Somalia started only after the launch of the Abuja Declaration in 2000.

In 2002, the Health Sector Committee applied for funding from the Global Fund to Fight Aids, Tuberculosis, and Malaria and was awarded US$12.9 million over 3 years to develop a national strategy and begin implementation of activities starting in July 2004.

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Strategies and

Components MIS 2017

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Strategy 1

: Prevention

Vector control interventions

Component 1

: LLIN (long-lasting insecticide mosquito net) coverage from the provision of one LLIN per two persons. free of charge.

Component 2:

Indoor Residual Spraying (rainy seasons and IDP focused)

Component 3

:

Integrated Entomological Surveillance, Data collection, reporting, analyses, and response.

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Strategy 2

: Case Management

Component 1

:

Diagnosis should be confirmed by either microscopy or RDT. (diagnostic and treatment services have been expanded to primary health care

levels)

Component 2:

Treatment An efficacious ACT (artemisinin-based combination therapy) guidelines for the 1st line antimalarial treatment of uncomplicated.

Component 3:

Selective IPTp Intermittent Presumptive Treatment of pregnant women (

Sulfadoxine

pyrimethamine) in 2nd trimester

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Strategy 3

: Epidemic Preparedness, Detection, and Response

Component 1

:

Epidemic Detection A reliable early warning system from numerous sources and from surveillance.

Component 2

:

Epidemic Response Containment of outbreaks/epidemics will require a continuous preparedness plan.

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Strategy 4:

Advocacy and Behavioral Change Communication

Component 1

:

Higher Level Advocacy for Malaria.

Component 2

:

Mass Media & Community Based Interventions The communication strategy for BCC (behavior change communication).

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Strategy 5:

Surveillance, Monitoring and Evaluation

Component 1

:

Monitoring and Information System, further strengthen the existing integrated HMIS/DHIS2 and address the reporting.

Component 2

:

Early Warning Disease Surveillance System, strengthened further as part of Epidemic Preparedness, Detection, and Response.

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Component 3:

Impact and Outcome Surveys Periodic data collection systems will include the Malaria Indicators Survey (MIS)

Component 4

: Operational Research A strong local evidence base will be required to adopt new interventions

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Strategy 6

:

Programme

Management and Coordination

Component 1: Partnership and Coordination NMCPs are mandated to coordinate all malaria control and elimination efforts. Component 2:

Human Resource Development Human resource capacity, training.

Component 3

:

Logistical Management Efficient procurement and supply chain management (PSCM) is essential for the uninterrupted supply of malaria

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Supplementary interventions

Larval source management

(LSM): is the management of water bodies that are potential larval habitats for mosquitoes.

Topical repellents

, insecticide-treated clothing, and spatial/ airborne repellents: These methods have also been proposed for specific population groups,

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Housing modifications

: any structural changes, pre- or post-construction, of a house that prevents the entry of mosquitoes.

Chemoprevention

is the use of antimalarial medicines for prophylaxis and for preventive treatment

Malaria vaccine (2021) The RTS, S/AS01 malaria vaccine should be used for the prevention of P. falciparum malaria in children living in regions with moderate to high transmission as defined by the WHO

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References

World malaria report 2021

SOMALI NATIONAL MALARIA CURRICULUM 2015

SOMALIA NATIONAL MALARIA STRATEGIC PLAN 2017-2020

SOMALI MALARIA INDICATOR SURVEY REPORT MIS 2017 WHO Guidelines for malaria 2022

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