Malaria Profile: Ethiopia
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Malaria Profile: Ethiopia Presentation Transcript

  • 1. Malaria Prevention and Control in Ethiopia Abdi Ahmed Program Asst., Health Sector, PC-E Daniel Allen Malaria Initiative Coordinator, PC-E
  • 2. 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)
  • 3. 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)
  • 4. Malaria Burden
  • 5. 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) .
  • 6. 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
  • 7. The spatial distribution of Plasmodium falciparum malaria stratified by endemicity class map in 2010 in Ethiopia
  • 8. 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%)
  • 9. 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.
  • 10. 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
  • 11. 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.
  • 12. 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
  • 13. 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
  • 14. 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.
  • 15. Coverage of IRS and ITN
  • 16. 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
  • 17. 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.
  • 18. 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
  • 19. FINANCING – Government and external financing
  • 20. 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
  • 21. Trend in Malaria Morbidity & Mortality
    • Historically there have been an estimated 10 million clinical malaria cases annually,
    • Cases have reduced trend since 2006.
  • 22. Reported malaria cases, per 1000 (2010)
  • 23. 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
  • 24.
    • 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
  • 25.
    • Following this training, a 3 rd year PCV will join the Ethiopia head office staff as Inter- Sectoral Malaria Initiative Coordinator .
  • 26. Distribution and Seasonality of Malaria in Ethiopia
  • 27. Thank you