SIXTH INTERCOUNTRY MEETING OF

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• SIXTH INTERCOUNTRY MEETING OF
• NATIONAL MALARIA PROGRAMME MANAGERS
• CAIRO, EGYPT
• 3-6 July 2006
• Dr. Haji Hussien Elmi
  
  National Malaria Focal
  Point
  
  WHO Somalia

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Malaria Control Programme in Somalia

• Introduction
• Malaria situation in Somalia
• RBM progress
• Constraints
• Challenges
• Future plans

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Malaria control Programme Somalia
COUNTRY PROFILE SOMALIA Somalia is located in the
north- eastern corner of Africa, sharing border
with Ethiopia and Kenya in the west and has a
3300 km long coastal line in the east. Its
coastline, which runs along the Gulf of Aden and
the Indian Ocean, forms the outer edge of the
"horn" of Africa. Somalia covers more than
637,000 square kilometers . The population is
currently estimated at about 7852 million
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Facts About Somalia

• Population Over all population size is estimated
  to be around 7.8 million with internally
  displaced people estimated around 600,000.
• Nomadic pastoralists is 60
• Infant mortality rate 132/1000 (Unicef)
• Maternal mortality rate 1600/100,000
• Land and climate Dry, grassy plains called
  savannas cover almost all of Somalia. A mountain
  ridge rises behind a narrow coastal plain in the
  north. Some mountain peaks reach over 2,100
  meters above sea level. The flat central and
  southern areas have an average altitude of less
  than 180 meters above sea level. In the southern
  regions are crossed by shabelle/ Juba rivers were
  corridors of agricultural activities were
  established.

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Eco-epidemiology /Metreology

• Epidemiological Metrological characteristics
• Climatically, Somalia can be dividing into three
  zones
• 1. North -west zone hot arid climate with an
  average rain fall of 400mm/year.
• 2. Central and North-East zone hot arid
  climate and average rainfall 50-200mm/year.
• 3.Southern zone equatorial climate including
  the juba and shabelle inter-riverine areas
  and annual rainfall of up to 700mm/year.
• The main vector
• An.arabiensis in North and An.arabiensis
  An.fenustus in Central South.
• Rain fall
• Throughout the country rainfall is rather
  low and further more fluctuates with irregularity
  in total quantity and distribution, the
  unreliable rainfall cause high risks in
  agricultural production and crop failure .
• Moderate drought occur every 3-4 years.
  Average annual rainfall is approximately 28
  centimeters. Total rainfall is seldom more than
  50 centimetres a year, even in the south, which
  is the wettest region. Parts of northern Somalia
  receive only 5 to 8 centimetres of rain a year.

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Temperature Humidity

• The average temperature
• ranges from 30 to 40 C in Northern and
• 18 to 40 C in the South Somalia
• Humidity
• Relatively high and without much variations
  during the year, The highest values occur in May
  with an average of 75 and the lowest with 65.

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National Malaria strategy

• Disease Management
• Ensure early diagnosis and effective treatment
  of all malaria cases
• Vector control
• Promotion of ITNs among the vulnerable
• Indoor Residual Spraying
• Larval control (Biological Control)
• Prevention of malaria during pregnancy
• IPT (Meso Hyperendemic Areas Only) ITN
• Epidemic preparedness control
• Mainly for the NE NW

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Supporting strategy

• Supplies and logistic support
• Human resource
• IEC
• Monitoring evaluation
• Operation Research

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Progress made RBM Implementation 2005

• WHO support in maintaining sentinel sites for
  malaria surveillance
• Laboratory technician trained in Basic malaria
  microscopy
• Training on malaria epidemic preparedness GIS
  health mapping system, investigation of out break
  notification
• Malaria surveillance integrated with HIS
• Introduction of IPT in MCHs of Central Southern
  zones
• HANMAT meeting held in Cairo 27-29/ 2005
  development process for soliciting, reviewing and
  funding operational research studies within the
  net work.

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Progress made RBM Implementation 2005

• Monitoring therapeutic efficacy of ACTs
  Combination therapy (ASSP) In Janale Jamaame
  sentinel site 2005
• Anti-malarial drugs supplies to Hospitals
• Maintain/develop expand the existing sentinel
  sites for monitoring therapeutic efficacy for
  future research. (two more sentinel sites
  established in NE/NW )
• Monthly assessment of breeding site in all zones
  of Somalia
• Entomological vector surveillance in NE,NW and
  S/C zone
• Re-impregnation of bed nets conducted in NW NE
  and planned in South-central Zone
• Introduction of Rapid diagnostic test in south
  central zone.
• 9 Banadir hospital, lower Shabelle Middle
  shabelle regions

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Progress made RBM Implementation 2005

• Indoor residual spraying operation carried out in
  epidemic prone areas in NW
• and planned for selected villages in south
  central villages
• Malario metric survey conducted
• New interim malaria treatment protocol or
  guidelines currently prepared and endorsed by the
  health authorities, and introduced
• Increased capacity building of national health
  staff
• Baseline KAP Survey,ITNs, and IEC strategy
  developed
• Africa Malaria Day commemorated in all zones of
  Somalia on 25 April 2005

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Progress made in 2005/2006

• Training of Hospital and MCH staff on new
  anti-malarial treatment (ACTs) ASSP conducted by
  WHO/UNICEF and Merlin(gt 400 )
• Training of hospital and peripheral laboratory
  technicians on basic malaria microscopy and RDTs
  and also on blood safety including Hepatitis ,
  HIV testing.(80 Participants)
• Training of hospital staff on severe malaria
  treatment (72 staff)

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Updates on Malaria Burden 2006
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Monthly assessment of Breeding sites for larvae
2005
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Monthly assessment of Breeding sites for larvae
2005
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Monthly rainfall assessment 2005
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Updates on Malaria Burden 2006
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Monthly assessment of Breeding sites for larvae
2006
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Monthly rainfall assessment 2006
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Updates on vector control interventions and
inter- sectoral coordination for vector control
at country level

• LLITNs distributed through health facilities
• Organization of LLITNs
  Location
• WHO 3000
  Middle Shabelle 2005
• UNICEF 24,500
  All Zones
• UNICEF(GFATM) 80,000
  Central South Zones
• GFATM funded 80,000
  Currently in CS zones
• TOTAL 187,500
• IRS in selected villages

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Epidemics/outbreak control

• Malaria outbreak occurred in CS Zone in lower
  Shabelle Rural area and responded By WHO
• Epidemic preparedness plan in Place in NWZ and
  will be extended to other zones with support of
  partners
• Epidemic preparedness and GIS mapping training
  workshop conducted in the North (24 participants
  from all zones) by EMRO consultants

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Updating Therapeutic efficacy Of anti-malarial
drugsTherapeutic efficacy of Artesunatesulphado
xine/pyrimethamine (SP) in Jamaame and Jannale
sites
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Drug policy

• Drug policy in 2004
• First Line Chloroquine
• Second line S/P
• Third Line Quinine (Severe Malaria
  cases and Pregnancy)
• Interim Drug Policy in 2005
• First Line ASSP (Hospitals
  MCHs with Microscopy/RDTs)
• Second Line Quinine (Severe malaria
  Cases Pregnancy)
• At Health Post level SP

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Updates on case management - drug efficacy
studies , drug policy

• New treatment guidelines currently being
  introduced
• RDTs and ACTs procured and Distributed to
  hospitals and MCHs
• Training manual and guideline developed in
  Somali Language
• IPT (in MCHs of CS Zones)

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Constraints

• Difficults to coordinate malaria control
  activities due to lack of central government and
  frequent changing security situation
• Lack of functioning law and order, drug policy
  and regulation
• Increased migration pattern
• Poor maintenance of irrigation system
• Lack of quality control and quality assurance of
  laboratories in South central zones
• Irrational use of anti-malarial drug without
  medical prescription
• Increased migration due to continuing clan
  conflicts
• Importation of un authorized anti-malarial drug
  from different countries

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Constraints

• Lack of central reference laboratory for quality
  control
• Lack of human capacity in entomology and vector
  control
• Chemical Control Not available locally
• Lack of funds for maintenance and logistic
  support for vector control activities.
• Appropriate selection of insecticides and use of
  equipment
• Safe use of insecticides
• Operational costs for insecticide application

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Challenges

• The increasing resistance of plasmodium
  falciparum to affordable drugs
• General lack of consensus on the principle for
  assessing drug failure
• Delayed supplies and equipment, inappropriate
  storage, distribution and expiry date.
• Implementation of national drug policy and
  regulation to control drugs
• Lack of funds and logistic support
• Sustainability of the ACT RDTs adopted for
  Somalia (After GF ??)

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Monitoring Evaluation and national malaria
control

• Improve methods for measuring the indicators for
  malaria and malaria control contained in the
  National Malaria Strategy  
• To identify the logistical and resource issues
  associated with applying the proposed methodology
  and make recommendations on the way forward 
• To advise on methods and routes for disseminating
  the results of monitoring and evaluation and
  ensuring they are taken into account in strategic
  planning and review 

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Malaria Control Partners

• Partners
• Local Health Authorities (3 zones)
• WHO, UNICEF, SACB
• NGOs working in the health sector
• LNGOs and CBODonors
• -GFATM for malaria control project
• (3 year grant July 04-June 07).
• -RBM

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Operational Research

• Malaria-microscopy with RDTs in selected sentinel
  sites,8 Banadir Hospitals Two regional
  Hospital(Lower Shabelle, Middlle Shabelle)
• Home management of Malaria (HMM) proposal
  submitted
• Insecticide treated sheet (Indoor) pilot study
  in Hut houses .(HQ Support)

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Key Achievement in 2005

• STUDIES and SURVEYS
• 1Baseline KAPB, ITNs and IEC Strategy
• a/ Malaria KAPB survey
• b/ Communication study
• c/ ITN situational analysis
• d/ malario-meteric survey
• e/ Malaria control strategy

lt10 of households own a mosquito net
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MALARIA DIAGNOSIS

• 1/ Laboratory Strengthening
• - Training of new lab technicians (80)
• - Setting-up new peripheral laboratories
  (MCHs)
• - Quality assurance for labs (Pilot programe
  in the N-W Zone)
• - Supplied Laboratory equipment, reagents and
• Anti-malarial drugs to hospitals
• 2/ Rapid-diagnostic testing
• - Few health facilities currently
• - To be expanded to all MCHs over coming months

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Information Education Communication

• Through community based NGOs and LNGOs
• Malaria Control messages through communication
  like
• - Radio
• -Posters and brochures
• - Newspapers
• -Television
• Mosques
• Direct communication with community people in
  villages with the support of elders and village
  health commetties.

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Information Education Communication
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Human Resource Development

• Main key activities Achievements
• Peripheral Laboratory
• - Training of malaria Microscopists /Lab
  technicians for all zones
• Case management
• Health staff trained on new anti-malaria
  treatment guideline
• Vector Control Measures.
• Trained national staff in vector control
  management
• Epidemic preparedness and GIS
• National staff trained in epidemic/outbreak
  control and on GIS and health mapper

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Future Plans

• Implementation of Malaria home Management in BDN
  villages
• Monitoring therapeutic efficacy of anti-malarial
  drugs ASSP and ASAQ in three sentinel sits
• Continue implementing New interim malaria
  treatment protocol trainings in all health
  providers.
• Ensure the provisions adequate supplies of ACT
  RDT at all levels of health care system
  particularly MCHs, OPD/Hospitals and health post
• Establishing Sentinel districts for prevalence of
  malaria

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Future plans

• Strengthening human capacity in vector control
  in all zones
• Monitoring vector susceptibility status to
  insecticides
• Distribution of training manual and training for
  re-impregnating bed nets
• Establish reference labs for Quality control and
  Quality Assurance in all zones of Somalia
• Recruitment of malaria laboratory supervisor to
  improve laboratory quality in malaria diagnosis.
• Assess utilization coverage of IPT ITNS

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Thank You