Eritrea National Malaria Control Program: On the road to malaria eradication

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Eritrea National Malaria Control Program On
the road to malaria eradication

• Saleh Meky
• Minister of Health
• Government of Eritrea

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Roll 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.

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Success

• 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)

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Common 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

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The 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

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Eritrean 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

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Country 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.

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Targeted integrated vector management Nets
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Targeted integrated vector management Breeding
sites treated, filled or drained(Average per
year per zobas)
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Targeted integrated vector management Indoor
Residual Spraying(per year, per zoba in GB,DB
and SKB)
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Massive community mobilizationinformation and
communication malaria sessions (average per
year, per zoba)
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Massive community mobilizationpopulation
participating in site cleaning (average per
year, per zoba)

• Community participation very significant factor
  in explaining breeding site cleaning

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Evidence-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

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Effectiveness 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)

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• Increasing access to ITNs to 100 per 1000
  population reduced malaria under five incidence
  by 76 cases.

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Moving 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

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Moving 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

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Thank you