Malaria Profile: Ethiopia


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Malaria Profile: Ethiopia

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