Title: Eritrea National Malaria Control Program: On the road to malaria eradication
1Eritrea National Malaria Control Program On
the road to malaria eradication
- Saleh Meky
- Minister of Health
- Government of Eritrea
2Roll Back Malaria Initiative
- case management,
- vector control,
- insecticide-treated nets (ITNs),
- information, education and communication
material, training, - epidemic forecasting and preparedness,
- operations research and monitoring,
- evaluation and supervision.
3Success
- Eritrea as one of the four countries in the world
with successful malaria control programs - Together with India, Brazil and Vietnam
- (Source The World Bank Rolling Back Malaria
Global Strategy and Booster Program)
4Common elements of success
- Conducive country conditions
- Targeted technical approach
- Data-driven decision making
- surveillance and operational research
- Strong leadership and commitment at all levels of
government - Community planning and implementation
- Adequate financing
5The Eritrean Program
- Established in 1999 following devastating malaria
epidemics (1997-1998) - Support from WHO, USAID, WB, Global Fund
- Introduced
- Early diagnosis and treatment at health facility
and community levels - Proper management of severe malaria at
zoba/subzoba level - Reduction of man-mosquito contact through ITN
(national coverage) - Community awareness through the promotion of
information, education, and communication - Environmental management through community
participation and prevention and control of
malaria outbreaks. - Reduced malaria morbidity and mortality by 80
during 1999-2005
6(No Transcript)
7Eritrean experience
- Success factors
- Targeted integrated vector management
- Massive community mobilization
- Organization and supervision
- Evidence-based
- Corroborating factors
- No year round malaria transmission and
- Manageable country size
- Once targets were exceeded more donor interest
and funding
8Country conditions
- Seasonal malaria and low to moderate transmission
- Small country
- 121,320 sq km
- Population 4,906,585 (est. 2007 World Bank).
- Arid environment and seasonal rainfall patterns
- temporary free-standing pools of water,
- clearing and levelling an attractive option.
9Targeted integrated vector management Nets
10Targeted integrated vector management Breeding
sites treated, filled or drained(Average per
year per zobas)
11Targeted integrated vector management Indoor
Residual Spraying(per year, per zoba in GB,DB
and SKB)
12Massive community mobilizationinformation and
communication malaria sessions (average per
year, per zoba)
13Massive community mobilizationpopulation
participating in site cleaning (average per
year, per zoba)
- Community participation very significant factor
in explaining breeding site cleaning
14Evidence-based examples
- 2005 RTI studies showed that the most prevalent
mosquito is anopheles arabiensis (bites early in
the evening and late morning, not only in the
middle of the night). - Use of ITNs as a sole prevention mechanisms is
insufficient - Indoor residual spraying perhaps required
- Sintasath et al. 2005 showed that housing
construction known as agudo, in the western
lowland of Eritrea, increases risk of
parasitemia. - Implication for housing materials
15Effectiveness of malaria interventions on
incidence(preliminary findings)Carneiro,
Hassane, Legovini, Sy 2008
- Areas (subzobas) with above average ITN
distribution reduced - Under five malaria incidence by 4 cases per month
(23 reduction per month) - Above five malaria incidence by 8 cases per month
(14 reduction per month) - Areas (subzobas) with above average larvae site
cleaning (treatment, filling and draining)
reduced - Above five malaria incidence by 9 cases per month
(15 reduction per month)
16- Increasing access to ITNs to 100 per 1000
population reduced malaria under five incidence
by 76 cases.
17Moving forward
- Securing longer term financing is a priority
- Need evidence on the economic impact of malaria
interventions to motivate continued investments
in malaria control - Need rigorous evaluation of the elements of the
program and complementary interventions to
understand what is required to eliminate malaria
18Moving toward evidence-based eradication
- Impact evaluation cross-country workshop (Asmara,
Feb 2008) - Capacity for evidence-based policy making
- Community of practice across malaria programs in
the region (15 delegations from national malaria
and HIV programs) - Dissemination of Eritrean and other successful
practices across the Africa region (site visits) - Experimental approach to understanding what more
needs to be done to eradicate malaria - Randomized evaluation of indoor residual spraying
value added to the national program - Randomized evaluation of communication and
community mobilization approaches
19Thank you