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    Malaria Profile: Ethiopia Malaria Profile: Ethiopia Presentation Transcript

    • Malaria Prevention and Control in Ethiopia Abdi Ahmed Program Asst., Health Sector, PC-E Daniel Allen Malaria Initiative Coordinator, PC-E
    • Ethiopia: The Roof of Africa
      • Africa’s second most‐populous country(2007) ~ 74 million
      • Predominantly rural 84% (decreasing trend)
      • Poor access to safe water, housing, sanitation, food, and health services
      • Per capita income : $232 USD
      • Malaria mortality rate 1.9% among inpatients
      • with malaria (5.6% of all inpatients)
    • Epidemiological Profile –Malaria Burden
      • Malaria is a major public health problem in Ethiopia
      • Consist ~4% of all cases in Africa
      • 75% of the land is malarious (altitude < 2000 m),
      • >50 million (68%) of the population at risk
      • Malaria was the leading cause of OPD visits, health facility admissions, and inpatient deaths, accounting for 12% of reported OPD visits and nearly 10% of admissions( 2008/2009)
    • Malaria Burden
    • Ep.cal Profile
      • Transmission is unstable and seasonal
        • Divers Eco-climate condition /altitude and climate are determinant factor
        • Seasonal transmission occurs in highland fringe areas (1500-2500m) affected by frequent epidemic
        • Relatively longer transmission duration in lowland areas, river basins and valleys area (below 1500m) .
    • Ep.cal Profile Cont …
      • Major transmission season occurs in the period September - December following June -Sept rains
      • Minor transmission season occurs in April – May following the February – March rains.
        • Coincide with major planting and harvesting season for farmers - aggravate economic loss
    • The spatial distribution of Plasmodium falciparum malaria stratified by endemicity class map in 2010 in Ethiopia
    • Ep.cal Profile Cont …
      • Vector and Parasit e
      • Major malaria vector / Anophelas species
        • Mainly Anopheles arabiansis .
        • pharoensis , funestus and nilli also play secondary role
      • Major parasite/plasmodiam species
        • Plasmodium falciparum (60%)
        • P. vivax (40%)
    • Ep.cal Profile Cont …
      • Epidemic History
      • Epidemics first documented in the 1930s by Italian investigators
      • Most notable epidemic of malaria occurred in 1958 resulted in 3 million cases and 150,000 deaths
      • Since 1958, major epidemics of malaria occurred at intervals of approximately 5-8 years
      • Recently there has been a trend towards smaller-scale, more frequent, sporadic epidemics and seasonal case build ups.
    • Intervention Polices and Strategies
      • History of Malaria control in Ethiopia
      • 1959 - Malaria Eradication Service established with funding support by USAID along with Zimbabwe and South Africa
        • One year after major malaria epidemic
      • 1976 - The country shifted from an ‘eradication’ program to a ‘control’ program known as the National Organization for the Control of Malaria and Other Vector-Borne Diseases.
      • 1993 – Malaria control was integrated into general health system and decentralized
    • Current Strategy
      • Ethiopia recently developed Five-year National Strategic Plan for Malaria Prevention and Control (2011 – 2015)
      • Goals
      • By 2015, achieve malaria elimination within specific geographical areas with historically low malaria transmission;
      • By 2015, achieve zero deaths due to malaria in the remaining areas with malaria transmission.
    • Strategies Cont…
      • Starting from 1997 Ethiopia have been applying almost all Recommended and Optional WHO Policies and strategies
      • 1) Main strategies :
      • Early diagnosis and effective treatment using RDTs and/or microscopy and treating according to national guidelines.
      • Vector control
          • Insecticide treated nets/ LLINs – Free of charge and for targeting all groups
          • Indoor Residual Spray– primary vector control
          • Environmental management activities
      • Epidemic prevention and control
    • Anti-malaria Drugs (adopted 2004)
      • 1 st line - unconfirmed malaria - AL
      • 1 st line - P. falcifram (confirmed) - AL
      • Treatment of severe malaria - QN
      • Treatment failure of P. falcifram - QN
      • Treatment of P. vivax - CQ
    • Implementing Malaria Control
      • More than 20 million ITNs were distributed between 2005 and 2009;
      • 15 million were distributed in 2010 and 2011 to replace ITNs distributed previously.
      • In 2010, 646,619 structures were sprayed and more than 2.1 million residents protected with IRS.
    • Coverage of IRS and ITN
    • Major sources of funds
      • Global Fund:
      • Round 2 (2002 - 2008; $73 million)
      • Round 5 (2005 - 2010; $140 million)
      • Round 8 (2008 – 2013; $276 million). And recently applied for Global Fund Round 10
      • President’s Malaria initiative/PMI.
      • In 2007, Ethiopia became one of the PMI focus countries
    • Major sources of funds...
      • Funding increased from $2.7 million USD in 2001 to over $200 million USD between 2004 and 2007, mainly from the Global Fund and the United States President’s Malaria Initiative (PMI).
      • The program has secured over $150 million USD for the next five years.
    • Cont….
      • Sources of funds
      • GFATM
      • USAID/PMI
      • UNICEF
      • WHO
      • CIDA/CANADA
      • The Carter Centre
      • PSI
      • The World Bank
      • Japan/JICA
      • Other partners
      • PMI Implementing Partners
      • Colombia University ICUP
      • University of North Carolina
      • John Snow Inc(JSI)DELIVER TO3
      • MSH
      • UNICEF
      • FHI360 C-Change
      • FIDO
      • Pathfinder International
      • Malaria Consortium
      • United state Pharmacopeia/ USP
      • Abt Association
    • FINANCING – Government and external financing
    • Considerations for Ethiopia Malaria Prevention
        • Lots of implementing partners
        • Health Extension Program
          • 2005: 2737 HEW and 776 health officers
          • 2009: Over 30,000 HEW and 1606 health officers
          • Over 10,000 health posts (2 HEW per post, 5 posts per HC)
        • Free diagnosis, free anti-malarial drugs, free distribution of ITNs and IRS
        • ITP is not used in Ethiopia
    • Trend in Malaria Morbidity & Mortality
      • Historically there have been an estimated 10 million clinical malaria cases annually,
      • Cases have reduced trend since 2006.
    • Reported malaria cases, per 1000 (2010)
    • History of Peace Corps in Malaria Prevention
      • PC came in Ethiopia first in 1962 with an education sector , then closed in 1977 due to political unrest during Derg socialist regime.
      • PC returned to Ethiopia in 1995 and then closed again in 2000 at the beginning of the Ethiopia-Eritrea War .
      • PC returned to Ethiopia in 2007 to work in the fight against HIV/AIDS.
      • 2010 : Environmental sector added
      • 2011 : Education sector added, HIV/AIDS sector shifts to Health
      • All 3 sectors can be informally involved in malaria
      • Malaria training provided during PST
      • Partnering with organizations such as PMI
      • Volunteer-led activities such as:
        • Participate in environmental management activities with community health workers at community-level
        • Participate in Mass LLIN distribution and education campaigns
        • Social behavior change communication (SBCC)
      Current Malaria Activities
      • Following this training, a 3 rd year PCV will join the Ethiopia head office staff as Inter- Sectoral Malaria Initiative Coordinator .
    • Distribution and Seasonality of Malaria in Ethiopia
    • Thank you