Malaria in Rwanda. A closer Look - PowerPoint Presentation

Slide1

Malaria in Rwanda.

A closer LookSlide2

Contents.

Global Scale.

International Response.

Elimination Question?

Rwanda’s Burden.

National Malaria Control Program.

Our Work and the Role of PCVs.Slide3

The Global Scale.

Burden and distributionSlide4

Worldwide.

106

malaria-endemic countries.

3.3 billion

people at risk.Slide5

Health Burden.

According to the WHO, there were approximately

216 million cases

of malaria.

Malaria killed

655,000 people

.

That

was in

2010

alone.Slide6

Economic Burden.

Economists estimate that

malaria drains

1.3%

of Sub-Saharan Africa’s

annual GDP

,

estimated at

$13 billion

.Slide7

Education Burden.

Malaria in childhood can lead to

impaired cognitive development

.

Malaria is the leading cause of

school

age absenteeism

in Africa

.Slide8

91%

of malaria deaths were in

Africa

.

86%

were

children

.

Global distribution.Slide9

the international Response.

MDGs, RBM, and GFSlide10

Millennium Development Goals.

Malaria

directly affects

6

MDGs

.Slide11

Millennium Development Goals.

Malaria

directly affects

6

MDGs

.Slide12

Millennium Development Goals.

Malaria

directly affects

6 MDGs

.Slide13

Global partners.

Multilaterals

Donor Countries

Research & Academia

NGOs

Private Sector

Ex officio members

UN Special Envoy for Malaria

Foundations

Endemic countries

109 malaria endemic-countries

including RwandaSlide14

Global partners.

Multilaterals

Donor Countries

Research & Academia

NGOs

Private Sector

Ex officio members

UN Special Envoy for Malaria

Foundations

Endemic countries

109 malaria endemic-countries

including RwandaSlide15

2

billion US$

for malaria control and prevention

270 million ITNs distributed; 44 million dwellings

sprayed; 260 million drug treatments delivered

The amount committed, while substantial, is still

inadequate.

Global Fund for AIDS, TB, and MALARIA.Slide16

The Elimination Question?

Rwanda is moving towards Pre-Elimination by 2017Slide17

Era of Renewed optimism.

2007

2005

2002

1998Slide18

Melinda Gates, 2007.

“Any goal short of eradicating malaria is accepting malaria; it’s making peace with malaria; it’s rich countries saying: ‘We don’t need to eradicate malaria around the world as long as we’ve eliminated malaria in our own countries.’

That’s just unacceptable.

”Slide19

What’s the difference?

Eradication

Permanent reduction

to zero of

worldwide incidence

of malaria infection caused

by a

specific

agent

, ex. a particular parasite species.

GLOBAL;

FINAL

Elimination

Interruption

in a

defined geographical area

of local

mosquito-borne malariatransmission, i.e. zero incidence of locally contracted cases.

REGIONAL;

SUSTAINEDSlide20

Global Malaria Action Plan.Slide21

Remember…

Elimination

does not mean

SOME;

it means

NONE

.Slide22

Rwanda’s Burden.

The reason we are hereSlide23

Rwanda’s Burden.

227,015

malaria cases in 2011.

389

deaths caused by malaria in 2011.

76

children under five per 1,000 live births dying from all-causes every year.

+

the indeterminate burdens

: strain on the health system, the economic costs and continuation of the poverty cycle, and the consequences for education.Slide24

Malaria Incidence By District.Slide25

Malaria Death Cases By District.Slide26

Cases by month in High burden districts.Slide27

Cases by month in High burden districts.Slide28

National Malaria Control Program.

Strategies, policies, and SuccessSlide29

Prevention Strategy.

Integrated vector control management

Universal coverage

of

Long- Lasting Insecticide-treated Nets

(LLINs)

Blanket

Indoor Residual Spraying

(IRS) in targeted high-burden districts

Integrated

Information, Communication, Education

(IEC) and

Behavior Change Communication

(BCC) CampaignsSlide30

Diagnosis and treatment Policy.

Integrated Community

Case Management of Childhood Illnesses

(ICCM/IMCI/C-IMCI)

All

presumed malaria cases

laboratory confirmed

by microscopy or rapid diagnostic test

Treatment with

Artemisinin

-based

Combination Therapy

(ACT)Slide31

Annual Child mortality Rate.Slide32

Key Indicators between 2005 and 2010.

86%

87%

74%

71%Slide33

Major Interventions AND SPR.Slide34

Lesson learned: Gains are Fragile!Slide35

Sustained Malaria Control.Slide36

Our Work.

A partnership between PC, PMI, RFHPSlide37

Activity:

Support the implementation of

C-IMCI

related to malaria diagnosis and treatmentSlide38

A few More Acronyms.

IMCI: Integrated Management of Childhood Illnesses

Aims to reduce illness, death and disability by targeting

the most common and deadly

childhood illnesses

with integrated prevention and treatment

Case management at

health centers, villages and households

ICCM: Integrated Community Case Management

Strategy enabling prevention, treatment, and referral of most common and deadly diseases

Case management at the

community level

C-IMCI: Community Integrated Management of Childhood Illnesses

I

ntegrated management of

childhood illnesses Case management at the

community levelSlide39

Primary Causes of Child Mortality.

In Rwanda, the

primary causes

are:

Malaria

Diarrhea

Pneumonia

MalnutritionSlide40

Coverage of Core Interventions.Slide41

Secondary Causes.

The

secondary causes

of child mortality in Rwanda are

:

Lack of immediate

care

Being far from health center

Delays in seeking treatment

Inadequate

treatment from caregivers

Inability to diagnose and treat

illnessesSlide42

Secondary Causes.

The

secondary causes

of child mortality in Rwanda are

:

Lack of immediate

care

Being far from health center

Delays in seeking treatment

Inadequate

treatment from caregivers

Inability to diagnose and treat

illnesses

Lack of appropriate care at the community levelSlide43

To achieve its global

commitment and national

priorities

,

Rwanda must

treat the

main

illnesses

affecting

children

at

the

community level.

.Slide44

National Community Health Policy.

In each village, there are 4 CHWs:

2 CHWs (1

male/1 female)

compose the

Binome

1

Maternal and Child Health

1

Social Affairs

VillageSlide45

National Community Health Policy.

In each village, there are 4 CHWs:

2 CHWs (1

male/1 female)

compose the

Binome

1

Maternal and Child Health

1

Social Affairs

VillageSlide46

CHW Binome

Responsibilities.

1.

Case management for children under five years old at the community level (C-IMCI)

Referral

of children with danger signs to health center

Treatment of simple confirmed cases of malaria, diarrhea,

and pneumonia

Checking

for severe and moderate malnutrition

Promotion of family health practices and disease

prevention

2. Participating

in outreach activities organized by the health center

VillageSlide47

Training for CHWs.

The

CHW

binome

receives training on

C-ICMI

with refresher trainings as needed

Training

contains 8 lessons:

National Community Health Policy

Materials and Tools Used by the CHW

Individual Sick Child Recording Form

Community IMCI Register

Referral and Counter-Referral Form for a Child

Drug ManagementSupervision Forms for CHW ActivitiesMonthly Activity Report for CHWsSlide48

Algorithm for treatment.Slide49

Algorithm For Fever.Slide50

Role Of PCVs in C-IMCI.

PCVs have a role working with CHWs to encourage

proper treatment

and

disease prevention

.Slide51

Activity:

Support improvement in the quality and timeliness of CHW-reported malaria data to

SISComSlide52

Health Information Systems.Slide53

SISCom Data Flow.Slide54

Monthly Activities report.

The

Monthly Activities Report

is composed of 9 parts:

Treating Sick Children:

Lines 1-7

Nutrition, Vaccination, and Nutritional Supplement:

Lines 8-14

Missing

Maternal Health and Community-Based Nutrition:

Lines15-26

Family Planning:

Lines 27-29Mortality

: Lines 30-33Disease Follow-Up: Lines 34-38Supervision and Meetings/IEC Participation

: Lines 39-41PaymentsDrugs and Supplies

A.

B.D.

E.

F.

G.

H.

I.

J.Slide55

Monthly Activities report: Fever.

CHWs calculate

:

Number of sick children under 5 years old seen by the CHW

(Total/Treated/Referred (directly or after treatment))

Cases 6-59 months with fever/malaria presenting within 24 hours

(Total/Treated)

Cases 6-59 months with fever/malaria presenting after 24 hours

(Total/Treated)

Number of RDTs carried out

(Total/Positive/Negative/Invalid)

A.Slide56

Sources of Information.

Individual Sick Child Recording Form

C-IMCI RegisterSlide57

Role of PCVs in SISCom

.

1. Retrospective review of

SISCom

data compared to health center and CHW data

collected by PCVs

.

2. Organize

training-of-trainers for PCVs

to provide training to CHWs on data collection and reporting.

3. Analyze and relay feedback on

SISCom

to health centers where

PCVs are placed to encourage data use in decision-making

.4. Maintain and disseminate process documentation to support further rollout of data quality training.

5. Perform post-assessment to identify improvements in data quality and timeliness of reporting on malaria at the community level.Slide58

Activity:

Reinforce the active surveillance of LLIN usage and longevitySlide59

LLIN Tracking Study.

Indicators:

Survivorship

: the

number

of nets hanging in study households

Durability

: the

condition

of the nets in study households

Bio-efficacy

: the

effectiveness

of insecticide on nets in the study householdsSlide60

At 18 months, the percent

survivorship

was estimated to be in the range of 71-81%.Slide61

Durability Measurement Tool.Slide62

Durability Calculation.

Proportional Hole Index

(1 x # of

Size 1

) + (23 x # of

Size 2

) + (196 x # of

Size 3

) + (574 x # of

Size 4

)

1.6 cm²

36 cm²

306 cm²

900 cm²Slide63

Durability Analysis.

ServiceableSlide64

Durability.Slide65

Bio-Efficacy.Slide66

Conclusion:

The

l

ongevity

of nets

in

Rwanda

is

only

1.5

years

!Slide67

Lesson learned: Gains are Fragile!Slide68

Research Question.

What

behavioral

aspects

determine the durability and bio-efficacy of nets and contribute to LLIN loss?

.Slide69

Role of PCVs in LLIN Survey.

1. Develop a

Rapid Survey Tool for PCVs

to assess LLIN loss by households on a quarterly basis.

2. Conduct

ToT

for PCVs

in application of the survey tool and LLIN activities

3. Maintain and provide

process documentation

to support further roll out of LLIN surveillance.Slide70

First Malaria Survey.

Results are coming!Slide71

START STOMPING!

Contact your Malaria Volunteers

for more resources.

Murakoze

!