Macepa presentation

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  • Based on national survey data (3 MISs)Suggests consistently much lower burden in Lusaka, Southern and Western provincesNew Strategic Plan creates 3 tier stratification to acknowledge this
  • Macepa presentation

    1. 1. Malaria incidence reduction and surveillance: Zambia’s experience Web: www.nmcc.org.zm www.makingmalariahistory.org Email: malaria@nmcc.org.zm
    2. 2. Historical context: The malaria fight • A little over a decade ago, global leaders began coming together to fight malaria in Africa. • Despite the fact that malaria is one of the leading killers of young children, it was the first time in years anything had been done to control the disease.
    3. 3. Historical context: The malaria fight • Using the “Scale-Up for Impact” approach to rapidly deliver life-saving tools, many countries were able to quickly bring down malaria illnesses and deaths
    4. 4. Stratification of Malaria in Zambia  Data from Zambia’s  Data from Zambia’s National Malaria Indicator has shown a steady decrease in parasitemia in young children.  Now, the country is working to establish large areas entirely free from malaria, with the long-term goal of eliminating the disease.
    5. 5. The goal: Malaria elimination • It is an exciting time for the malaria community – countries like Zambia are demonstrating that for the first time in history, we have the potential to eliminate malaria in Africa.
    6. 6. Baseline transmission Reduced transmission Mass Screen and Treat Near-zero transmission Community case management with household re- screen and treat Universal LLIN coverage So what will it take to end malaria? Adapted from WHO Global Malaria Programme: Community-based transmission reduction of malaria May 2011 - DRAFT STEP 1 Zambia Rapid Reporting system STEP 2 Clear parasites from people STEP 3 Surveillance as an intervention STEP 4 All cases identified, investigated and cleared. Document elimination
    7. 7. Zambia is piloting new strategies to stop malaria transmission
    8. 8. Rapid reporting informs decision- making, identifies gaps in coverage, and targets resources. Information collected through rapid reporting includes: • Coartem by pack size (dispensed and balance on hand) • RDT stocks (tested and balance on hand) • Clinical and confirmed malaria cases • Total outpatient attendance at health clinics Establishing Rapid Reporting systems
    9. 9. Why mobile phones? Information that used to take 3 to 4 months to reach the central level now only takes one week. Data is sent by health facilities over low cost, Java-enabled mobile phones to a server that is accessed by district health officials who are able to view and respond to the local malaria situation in near-real time.
    10. 10. Mass testing and treating for malaria • Once a rapid reporting system is in place, health workers test every member of a household for malaria and treating positive cases. • Data is collected using PDAs and smartphones. The Test & Treat approach is unique in that it looks both for people who have symptoms and for those who don't but who are infected (asyptomatics).
    11. 11. Actively investigating malaria cases • In areas of very low burden (as determined by the data from rapid reporting) surveillance is the approach: positive cases investigated and contained. • A systematic approach to follow up on individual cases—in very low burden areas to pursue each incidence of confirmed malaria—will be informed by the experience of surveillance now taking place in Lusaka.
    12. 12. COMMUNITY HEALTH FACILITY MOBILE PHONE REPORTING CHW INDICATORS CLINIC INDICATORS PASSIVE: PATIENT SEEKS OUT CLINIC Symptomatic individuals tested at the clinic Record: Name, Age, Sex, Address, Purpose, Comment*, Result Treatment ACTIVE: CHW CONDUCTS TEST AND TREAT Test as many individuals living around the positive case as possible (1 day / 2 boxes) Record : Name, Age, Sex, Address, Symptoms, Travel, Result, Treatmen t PASSIVE: PATIENT SEEKS OUT CHW Symptomatic individuals tested by CHW Record: Name, Age, Sex, Address, Purpose, Comment*, Result Treatment Malaria Surveillance for Elimination EHT Data CHW POSITIVE POSITIVE * - Travel History
    13. 13. Next steps • Document evidence and approaches from Zambia’s malaria elimination efforts • Defining and establishing malaria free zones • Continue pushing malaria elimination strategic thinking • Optimize strategies for intervention delivery • Focusing on reducing parasite reservoirs at community level • Work more broadly with partners to improve diagnostics and drug delivery
    14. 14. Conclusion • This approach will ultimately create the space needed to establish malaria-free zones. As Zambia again serves as the pace-setter for malaria prevention and control it will be important to provide evidence of the feasibility and cost of these steps, and to document the entire process for the benefit of Zambia, other countries and the global malaria community. The ultimate goal? A world free from malaria.

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