Malaria affects poor people the most

1
Realization of antimalaria programms in Central
Asia
Sh.Razakov Director of Isaev Research Institute o
f Medical Parasitology , Uzbekistan
?bilisi, Georgia
17-19 September 2007
2

• AREAS OF CONCERN
• 13 MILLION PEOPLE OR 30 OF THE TOTAL
  POPULATION, LIVE IN AREAS AT RISK OF MALARIA
  
• THE TOLL OF P. VIVAX MALARIA IS STILL
  UNDERESTIMATED IN TAJIKISTAN AND UZBEKISTAN
  
• ENDEMIC MALARIA IS STILL A FOCAL PROBLEM IN
  TAJIKISTAN
  
• POTENTIAL OUTBREAK SITUATIONS WHICH MAY PRODUCE A
  HIGH INCIDENCE OF THE DISEASE
  
• OCCURRENCE OF DRUG RESISTANCE
• CROSS-BORDER MALARIA PROBLEMS

AUTICHTONOUS MALARIA CASES in CENTRAL ASIA

• MALARIA SITUATION
• LARGE-SCALE EPIDEMICS OF MALARIA CONTAINED
• TRANSMISSION OF P. FALCIPARUM MALARIA
  SIGNIFICANTLY REDUCED AND ITS ELIMINATION IS
  FEASIBLE IN TAJIKISTAN AND CENTRAL ASIA AS A
  WHOLE
• SUBSTANTIAL REDUCTION IN THE INCIDENCE AND NUMBER
  OF ACTIVE FOCI OF P. VIVAX MALARIA

3
Areas with reported autochthonous cases of
malaria, Central Asia and Kazakhstan, 2006
AREAS WHERE AUTOCHTHONOUS CASES ARE REPORTED





AREAS WHERE AUTOCHTHONOUS CASES OF P. FALCIPARUM
ARE REPORTED





4
Current situation with P. falciparum malaria in
countries of Central Asia and Kazakhstan, 2006

• Countries where cases of P. falciparum
  autochthonous malaria are presently
  reportedTAJIKISTAN
  
• Countries where autochthonous P. falciparum
  malaria has been recently reported, but are
  presently free from its transmissionKYRGYZSTAN
  
• Countries free from autochthonous P. falciparum
  malaria
  UZBEKISTAN,TURKMENISTAN and KAZAKHSTAN

5
Number of P. falciparum cases and their active
foci in Tajikistan, 2000-2006
6
15090 ?ases. (1,4)
590708 ?ases. (54,8)
Total 694750 ?ases. (64,4)
88952 ?ases. (8,3)
7
Malaria vectors

• There are 8 species of malaria vectors registered
  in the countries of Central Asia region. The most
  dangerous species An. superpictus,
  An.pulcherrimus, An.maculipennis ?????????????
  breed in all these ?ountries.
• Genetic studies of the main vectors according to
  the EuroWHO project in 2002 show that An.
  superpictus, An.pulcherrimus from Tajikistan and
  bordered territories of Uzbekistan were infected
  by malaria parasites. Infectivity rate was up to
  50.
• The studies of resistance to different
  insecticides show that maximal resistance to
  DDT(77) had malaria vectors in Western part of
  Kazakhstan. An. superpictus from Fergana region
  of Uzbekistan were resistant to melation,
  fenitration, bendiakarb and propoksur. The rest
  vectors are sensible to all usually used
  insecticides

8
Malaria struggle in countries of Central Asia and
Kazakhstan

• During the last years the countries of Central
  Asia region, met with relapse of malaria,
  reconsidered national strategies and programs in
  accordance with principles of global and regional
  Roll Back Malaria. Some national and regional
  conferences were organized on this theme in
  Uzbekistan, Tajikistan, Kyrgyzstan and other
  countries
• The main results of these measures are that
  leaders of the countries take obligations to make
  all possible efforts to stop malaria epidemy and
  its spreading in Central Asia region
• There are long-time national plans on malaria
  struggle and instructions based on WHO
  recommendations

9
Main problems

• The countries of Central Asia region are similar
  ecological-epidemiology characteristics and
  problems, connected with malaria
  
• The main technical problems
• The spreading of resistance of P. falciparum to
  CQ and S-P in ??jikistan and possibly, in
  neighboring countries of Central Asia
  
• Human activities which became the region of
  increasing places of malaria vectors breed
  
• Increasing of imported malaria cases in the free
  malaria regions, because of human migration in
  bordered zones. Carriers of parasites among them
  the main source of import P.vivax and P.
  falciparum malaria and its transferring on new
  territories

10
Main problems

• ?perational problems
• Absence of correct data of real morbidity.
• Insufficient ability of quick foundation of
  malaria situation on country level. Weak
  technical base of parasitological services
  
• Lack of staff of national parasitological and
  entomological services
  
• Reducing of qualifying specialists on country
  level
  
• Shortage in malaria epidemiological control,
  including everyday monitoring
  
• Lack of knowledge in scientific methodology and
  possibilities of institutions relating to malaria
  struggle on country level
  
• Lack of knowledge ?f population about malaria and
  its prophylaxis
  
• Insufficient intersectoral collaboration in
  struggle against malaria vectors

11
The strategy of antimalaria programs

• Foreseeing of epidemics
• Finding and curing patients
• Struggles with malaria vectors
• Scientific and practical studies
• and involving people in realization of the
  programs
  
• Intersectoral cooperation
• Staff studying
• Improving of technical base
• The main task is perfecting of existing malaria
  epidemic survey systems for timely reaction on
  changing of malaria situation

12
Partners for programs realization

• During the last years the partners and team
  donors of The Roll Back Malaria Programme in
  the countries of Central Asia and Kazakhstan WHO
  (all countries), USAID (Tajikistan, Kyrgyzstan),
  UNICEF (Tajikistan), Humanitarian office of EU
  (Tajikistan), World Food Programme (Tajikistan),
  Agency of International Development USA
  (Tajikistan), International Emergency Agency
  (??RLIN) (Tajikistan, Kyrgyzstan), ?gency for
  technical cooperation and development (ACTED)
  (Tajikistan, Kyrgyzstan, Uzbekistan) and also
  Governments of Japan, Norway, and Italy
  (Tajikistan).

13
Global fund for HIV, tuberculosis and malaria
struggle

• At present time the large input in realization of
  antimalaria programms in the Central Asia region
  contributes the Global Fund for HIV, Tuberculosis
  and malaria struggle.
• In the countries affected by malaria
  Tajikistan, Kyrgyzstan and Uzbekistan the
  antimalaria projects, financed by Global Fund
  are realized
• The Global fund projects are given to all main
  strategic directions of national antimalaria
  struggle