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Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
Ivm Implementation Mnzava
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Ivm Implementation Mnzava


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  • 1. IVM IN EMR: Progress and Challenges Abraham Mnzava Scientist, Vector Control RBM WHO/EMRO CAIRO, EGYPT
  • 2. EMR-where three continents converge ……………… Implications for VBDs
  • 3. Oriental Palaearctic Sub-saharan
  • 4. Nature and VBDs at their best…
    • Each zone – specific cluster of dominant vector spp with diff. ecological needs
    • Margins – distribution less stable and easy to control
    • Core – well entrenched – require powerful intervention packages
    • SPPs abundance and diversity very sensitive to changes in weather & hydrology with conseq. for VBDs trans. risks
    • Strategies needed that will decrease VBD’s burden and still maintain ecological integrity
  • 5. Problem of Vector-borne diseases
    • Contribute to 2.2% total burden
    • 11% of global burden found in EMR (8% global popln)
    • 7% and 17% of CDs and IDs respectively
    • Malaria contributes the greatest burden
    • Other vector-borne diseases
      • Bancroftian filariasis
      • Leishmaniasis
      • Onchocerciasis
      • Trypanosomiasis
      • Arboviruses
      • Other vectors/pests of PH importance
  • 6.     † E nteric infections causing diarrhoeal diseases are only partly transmitted by vectors, being more often acquired directly from faecal/oral route or via contaminated water and foodstuffs   * Source. World Health Report - 2002 Table 1   Vector-Borne Disease EMR Burden: DALYs* Member States Endemic Epidemic Prone Non-Endemic   † Diarrhoeal diseases   10,784,000   ALL   ALL   0 Malaria 2,050,000 AFG, DJI, SOM, SUD, YEM   ALL 18 Trachoma 602,000 AFG, DJI, EGY, IRA, IRQ, LIB, MOR, OMA, PAK, SOM, SUD, UAE, YEM - BAH, CYP, JOR, KUW, LEB, PAL, QAT, SAA, SYR, TUN Lymphatic Filariasis 489,000 EGY, SUD, YEM - 20 Countries Leishmaniasis 278,000 17 SUD, PAK, AFG UAE, BAH, QAT, KUW, DJI, CYP Schistosomiasis 202,000 EGY, IRQ, SAA, SOM, SUD, YEM, MOR LIB, OMA, JOR, SYR- AFG, BAH, CYP, DJI, IRA, KUW, PAL, PAK, QAT, TUN, UAE Dengue 85,000 DJI, PAK YEM 20 Japanese Encephalitis 81,000 - AFG, PAK 21 Onchocerciasis 46,000 SUD, YEM - 21 Countries Trypanosomiasis 40,000 SUD - 22 Countries   Top 10 VBDs total   14,657,000 = 11% of DALYs attributed to VBDs globally =17% of DALYs attributed to communicable diseases regionally
  • 7. Group 1: 10 countries interrupted transmission: Bah, Cyp, Jor, Kuw, Leb, Lib, Pal, Tun, UAE Group 2: 4 countries targeting elimination: Egy, Mor, Oma, Syr Group 3: 4 countries low- moderate endemicity: Ira, Iraq, Pak, SAA Group 4: 5 countries high burden: Afghanistan, Dji, Som, Sud, Yem
  • 8.
    • Challenges of implementing vector control in EMR
  • 9. 1. Vector Control in Countries of Conflict
    • Increased VBDs as a result of:
      • Break-down essential health services
      • Population movement – their increased vulnerability
      • Access to health care and other resources affected
      • Malnutrition
    • A number of countries in EMR are under conflict
      • Lack of expertise on VC among NGOs and Agencies
    • Implementation of VC a big challenge
  • 10. 2. Operational Problems of implementation
    • In most countries VC measures are not applied cost-effectively
      • Targeting more than one VBD
      • Applied timely and correctly
      • Using products with approved specifications
      • Coverage of interventions low to give epidemiological impact
    • Most trials done in Africa
    • Evidence of available of non-ITNs in EMR
    • Not to WHO-approved specifications
    • Mostly project-funded and for free
    • Cost-shared – failed to target high risk groups
    • Mechanisms to involve public & private sectors and to identify role of each
  • 12. 4. Entomological surveillance
    • In a region where VBD are distributed unevenly – even within same country:
      • Entomological surveillance is crucial – spp composition, abundance and distribution
      • Must include insecticide resistance monitoring
      • Establishment of sentinel sites – preferably same as those of the diseases
      • Increased entomological capacity at national, provincial and districts
      • Establishment of national databases on information collected
      • Application of GIS and remote sensing in mapping distribution of vectors
      • In most countries of EMR ES is very weak and needs strengthening
  • 13. 5. Problem of Insecticide Resistance
  • 14.
    • DDT
    • Dieldrin/BHC
    • Malathion
    • Fenitrothion
    • Temephos
    • Propoxur
    • Primiphos methyl
    • Chlorophoxim
    • Phoxim
    • Iodophenphos
    • Chlorpyriphos
    • Fenthion
    • Bromophos
    • Carbaryl
    • Pyrethroid (permethrin)
    • Phenthoate
    • Diazinone
    Status of insecticide resistance in malaria vector species in the EMR
  • 15. Insecticide Resistance Status
  • 16. Detect, manage and map insecticide resistance
    • Planning to establish a Regional Network – meet annually
      • Individuals from selected countries ( SUD, YEM, MOR, IRN, PAK, SAA, OMA, UAE )
        • Involved in the monitoring
      • Experts from the Region (IRN, EGY)
        • Provide on the spot-training and TS
        • Maintain a database and provide GIS support for mapping
      • International experts
        • Train country people on specialized skills and work with identified regional laboratories
  • 17. Technical support
    • Sudan
      • Strategic planning for malaria vector control
      • Capacity building in entomology
      • ITN strategic planning
    • Afgh & PK
      • Assessment of Leishmaniasis situation among displaced people
      • Appropriateness of interventions and methods of implementation
    • Syria
      • Supported malaria and leishmaniasis vc programme
      • Weaknesses in selection of insecticides (types & formulations)
      • Entomology and implementation capacity weak
    • Yemen
      • Trained field teams in VC – spraying, ITNs, ento surveillance
      • Operational research on ITNs
      • ITN strategic planning
  • 18. Technical support cntd.
    • Iraq
      • Rehabilitation of the Malaria Centre
      • Implementation of ITNs (200 000) in northern Iraq
    • SAA
      • Mapping distribution of mosquito vectors
      • Assessment of Biological Agents for Larval control
    • Qatar
      • Strengthening ento surveillance
    • Oman
      • Documentation of successful malaria control
      • Entomological, epidemiological, financial and economic impact
      • Cost effective < than recommended health budget spending
      • Model other countries with similar resources
  • 19. Logistic Support
    • Test kits for insecticide resistance monitoring – UAE, Sudan, Yemen, SAA, EGY
    • Insecticide spraying equipment – SAA, DJI, Yemen
    • Insecticide-treated bednets – Iraq (LLNs “Olyset”), Sudan, DJI, AFG
    • Insecticides for vector control – Yemen, DJI
    • Entomological supplies – Iraq, Yemen, SAA
  • 20. IVM – the strategic approach
    • An evidence-based decision making to plan, deliver, ME targeted, cost-effective & sustainable combinations
    • May require merging of different control programmes to achieve synergies and efficiencies
    • Although countries have a long history of VC – have not fully utilized IVM concept
    • Recently developed a Regional framework on IVM
      • provide guidance on optimal use of resources
      • enhance protection of human health and the environment
    • Biggest challenge is to ensure that IVM is implemented at country level
  • 21. Key Actions for Implementation
    • Incorporation and strengthening vector control capability within national health policies & systems
    • Capacity building – establish/strengthen
    • Advocacy – political commitment for policies, legislation, community empowerment/participation, human/financial resources
    • Inter and intra-sectoral cooperation for optimal utilization of resources
    • Partnerships – mobilize public/private sectors – incl. Civil society etc
    • ME – using ES and OR for evidence-based interventions – post-registration monitoring of pesticides
  • 22. Role of countries
    • Establishing/strengthening or reorganization of VC services through multidisc. approach
    • Development of National PO by 2004 with new guidelines for VC
    • A comprehensive needs assessment to:
      • Identify resources/deficiencies
      • Develop proposal to establish IVM within existing NHP&S and obtain agreement from authorities
      • Develop guidelines and strengthen structure for planning, implementation and ME – a core group
      • Ensure inter/intra-sectoral collaboration and OR for evidence-based implementation
  • 23. Role of WHO
    • Disseminate strategic framework to countries
    • Obtain endorsement by the RC – Sept/Oct
    • Develop and disseminate guidelines for planning, implementation and ME of VC
    • Prepare and disseminate guidelines for situation analysis and needs assessment of IVM activities
    • Provide necessary support to conduct SA, NA, planning, implementation, ME of VC based on IVM approach
  • 24. Summary of priorities for 2004/5
    • Endorsement of IVM by RC
    • Formulation of national IVM plans of Action based on detailed VCNA
    • Development of IVM interventions cost-effectively
      • Scaling-up ITNs
      • National ITN strategic plans
    • Strengthening national capacity in:
      • Vector control (training at Postgraduate level)
      • M&E – including entomological surveillance
      • Appropriate pesticide safety and management
      • Capacity for OR
        • Monitoring insecticide resistance and establ. of network
        • Vector behaviour in relation to VC acceptability and impact
        • Distribution and mapping of malaria and other VBD
  • 25. Whereas IVM can be entertaining ……..
  • 26. And really …..amusing
  • 27. Can be quite terrifying!!!!
  • 28. THANK YOU