INTERCOUNTRY WORKSHOP ON SCALING UP ITN IMPLEMENATION FOR CONTROL OF MALALIA AND OTHER VECTORBORNE D

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INTER-COUNTRY WORKSHOP ON SCALING UP ITN
IMPLEMENATION FOR CONTROL OF MALALIA AND OTHER
VECTOR-BORNE DISEASES IN EMR

• Plan of action for promotion and distribution of
  insecticide treated nets in Djibouti

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COUNTRY PROFILE

• Population 600 000
• Surface area 23 000 square kilometers
• Climate hot with average daily
• temperature of 36
  degree
  
• Celsius
• Humidity 60
• Pluviomerty 130 millimeters per year
• Two main seasons
• Hot season may to September
• Cold season November to April

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EPIDEMIOLOGICAL SITUATION OF MALARIA IN DJIBOUTI

• Malaria inexistent in Djibouti at the beginning
  of the century
  
• Anopheles arabiensis mentioned between 1901 and
  1906
  
• From 1906 to 1962, only imported cases declared
• In 1963 14 malaria cases diagnosed in
  autochthon population
  
• In 1994 35 malaria cases declared
• In 1978 First malaria epidemic with 316
  malaria cases
  

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EPIDEMIOLOGICAL SITUATION OF MALARIA IN DJIBOUTI
(introduction of malaria in the country)
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EPIDEMIOLOGICAL SITUATION OF MALARIA IN DJIBOUTI
(suite)

• In 1988 and 1994 Flooding with increase
  bleeding sites
  
• Number of malaria cases confirmed declared each
  year 4000 7000 case
  
• Population at risk 360 000 (60 of the total
  population)
  
• Areas most affected by malaria
• - Djibouti city Ambouli and Balbala
• - Tadjurah district Sagalou, Kalaaf, Dorra et
  Weima
  
• - Dikhil district As-Eyla, Hanlé
• Type of parasite Plasmodum falciparum (98 )

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MALARIA HIGH RISK AREAS IN DJIBOUTI
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MALARIA VECTOR CONTROL IN DJIBOUTI

• Malaria vector control introduced in 70s
• consisting in insecticide spraying
• At present, different vector control methods are
  used
  
• - Inside and outside insecticide spraying
• with malathion
• - Bleeding sites Introduction of
• Abbate

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INSECTICIDE TREATED NETS (ITN)

• Before 1990 utilization of ITN individual
  initiative
  
• In 1990, first involvement of MOH in promotion of
  ITN with assistance from WHO
  
• - Training of NGOs
• - Involvement of NGOs in ITN
• distribution
• - Symbolic contribution of 0.06 cents by
• beneficiaries
• Priority were given to high risk areas, mainly to
  nomadic people in rural area were others vector
  control activities are not applicable

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INSECTICIDE TREATED NETS (ITN) (suite)

• In 1999, MOH initiated a campaign in all
  districts to sensitize the population on ITN
  
• Contribution of different partners including WHO,
  USA and one NGO
  
• Involvement of community in ITN promotion through
  local associations, community health workers and
  the community itself
  
• Population sleeping under ITN in high risk areas
  
  
• 10 - 20
• Mosquito nets available at local market
• at the cost between US 8 to US 10

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CONSTRAINTS

• Lack of follow-up
• Lack of collaboration and coordination with local
  businessmen importing mosquito nets
  
• Lack of awareness of the population
• Insufficient financial resources
• Limit access to ITN for poor population
• Quality of nets imported through private sector

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PLAN OF ACTION FOR PROMOTION AND DISTRIBUTION OF
ITN IN DJIBOUTI

• Population targeted in ITN plan of action
• Population leaving in high risk areas (360
  000) which are
  
• - Ambouli and Balbala in Djibouti
• city
• - As-Eyla in Dikhil District
• - Sagalou/Karaaf and Dorra in
• Tadjourah District

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OBJECTIVES

• General objective
• Reduction of mortality and morbidity due to
  malaria
  
• Specific objectives
• - 60 of the population leaving in high
  risk
  
• areas using ITN
• - 60 of pregnant women and children
  leaving in
  
• high risk areas sleeping under ITN

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STRATEGIES

• Creating an enabling environment for the
  promotion and distribution of ITN
  
• Creating demand
• Supplying and distribution
• Monitoring and evaluation
• Operational research

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CREATING AN ENVIRONMENT FOR THE PROMOTION AND
DISTRIBUTION OF ITN

• Meeting and coordination with partners
• Meeting with NGOs
• Meeting with community leaving in high risk ares
• Identification of local businessmen to be
  implicated in ITN promotion and distribution
  
• Decision by the Ministry of Health for 0
  taxation of nets
  
• Define procedure and modality of collaboration
  with NGOs

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CREATING DEMAND

• Identification of NGOs to be involved in
  promotion and distribution of ITN
  
• Training of NGOs members
• Involvement of communities trough community
  health workers, local associations and NGOs
  
• Introducing ITN promotion in BDN sites
• Involvement of media including training of
  journalists
  
• Elaboration of educational materials
• Monthly publication of articles in local
  newspapers

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Facilitating supply and distribution of ITN

• Importation of ITN by the Ministry of Health in
  collaboration with partners
  
• Importation of nets through private sector (local
  businessmen)
  
• Training members of NGOs
• Establishment of district teams in charge of ITN
  distribution
  
• Distribution of ITN through BDN
• Training of District team members
• Importation of insecticides for nets treatment

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MONITORING AND EVALUATION

• Define indicators for the evaluation of ITN plan
  of action
  
• Survey on knowledge, attitude and practices in
  high risk areas
  
• Follow-up of ITN importation, distribution and
  utilization
  

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OPERATIONAL RESEACH

• Study on sensibility of anopheles to insecticide
  (k-othrine)

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Principal indicators

• Number of nets imported through public and
  private sectors
  
• Number of ITN distributed
• of household with one or more ITN
• of persons sleeping under ITN in high risk
  areas
  
• pregnant women and children under five sleeping
  under ITN in high risk areas
  
• Number of malaria cases confirmed and declared
  every year