Ivm Implementation Mnzava


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Ivm Implementation Mnzava

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