Malaria affects poor people the most

1
The Move from Malaria Control to Elimination in
the WHO European Region
Mikhail Ejov
Malaria Programme WHO
Regional Office for Europe Cairo, Egypt
3
6 July 2006
2
NUMBER OF AUTOCHTHONOUS MALARIA CASES IN THE
REGION, 1996 and 2005
2005
1996
3
Current malaria situation in the WHO European
Region

• Countries where malaria remains a major public
  health problem TAJIKISTAN, TURKEY
  
• Countries where malaria epidemics have been
  contained and the results achieved need to be
  consolidated further AZERBAIJAN, KYRGYZSTAN,
  GEORGIA
• Countries where malaria is a focal
  problemARMENIA, TURKMENISTAN, UZBEKISTAN
  RUSSIAN FEDERATION
  
• Countries free from autochthonous malaria and
  imported malaria reported ALL REMAINING COUNTRIES

4

COUNTRIES OF CENTRAL ASIA

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

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

5
Areas with reported autochthonous cases of
malaria, Central Asia, 2005



AREAS WHERE AUTOCHTHONOUS CASES ARE REPORTED




AREAS WHERE AUTOCHTHONOUS CASES OF P. FALCIPARUM
ARE REPORTED



6
Number of P. falciparum cases and their active
foci in Tajikistan, 2000-2005
7
FOCI OF P. FALCIPARUM MALARIA TAJIKISTAN 2002
Dushanbe
Kurgan- Tube
158
Active foci of P. falciparum malaria (residual
new)
8
FOCI OF P. FALCIPARUM MALARIA TAJIKISTAN 2004
Dushanbe
Kurgan- Tube
70
Active foci of P. falciparum malaria (residual
new)
9
FOCI OF P. FALCIPARUM MALARIA TAJIKISTAN 2005
Dushanbe
Kurgan- Tube
48
Active foci of P. falciparum malaria (residual
new)
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THE CAUCASIAN COUNTRIES

• AREAS OF CONCERN
• 7.5 MILLION PEOPLE OR ALMOST 45 OF THE TOTAL
  POPULATION OF THE CAUCASIAN REGION, LIVE IN AREAS
  AT RISK OF MALARIA
  
• THE TOLL OF MALARIA IS UNDERESTIMATED IN
  AZERBAIJAN
  
• POTENTIAL OUTBREAK SITIATIONS MAY PRODUCE A HIGH
  INCIDENCE OF THE DISEASE
  
• CROSS-BORDER MALARIA PROBLEMS

• MALARIA SITUATION
• LARGE-SCALE EPIDEMICS OF MALARIA CONTAINED
• SUBSTANTIAL REDUCTION IN THE INCIDENCE AND THE
  NUMBER OF ACTIVE FOCI OF P. VIVAX MALARIA AND ITS
  ELIMINATION IS FEASIBLE IN ARMENIA

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Areas where autochthonous malaria cases reported,
TransCaucasian countries, 2005
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TURKEY

• AREAS OF CONCERN
• 15 MILLION PEOPLE OR 23 OF THE TOTAL POPULATION
  OF TURKEY, RESIDE IN AREAS, WHERE MALARIA IS
  ENDEMIC
  
• THE EXTENT OF THE MALARIA PROBLEM IS LARGER THAN
  THE INCIDENCE REPORTED, PARTICULARLY IN THE
  SOUTH-EASTERN PART OF THE COUNTRY, AND
  
• ENDEMIC MALARIA IS STILL PROBLEM THERE

• MALARIA SITUATION
• LARGE-SCALE EPIDEMIC OF MALARIA CONTAINED
• SUBSTANTIAL REDUCTION IN THE INCIDENCE OF P.
  VIVAX MALARIA

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Areas where autochthonous cases of malaria
reported, Turkey 2005
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Regional Objectives Goal

• THE OBJECTIVES ARE
• TO INTERRUPT MALARIA TRANSMISSION IN COUNTRIES
  WHERE MALARIA IS A FOCAL PROBLEM AND THERE IS
  CLEAR EVIDENCE OF POLITICAL SUPPORT, TECHNICAL
  AND OPERATIONAL FEASIBILITY OF ELIMINATION
• TO REDUCE FURTHER THE INCIDENCE AND PREVALENCE OF
  MALARIA IN COUNTRIES WHERE ELIMINATION DOES NOT
  APPEAR TO BE FEASIBLE AT PRESENT
  
• TO PREVENT THE RE-ESTABLISHMENT OF MALARIA
  TRANSMISSION AND TO MAINTAIN MALARIA-FREE STATUS
  IN COUNTRIES AND TERRITORIES WHERE IT HAD BEEN
  ELIMINATED

THE
ULTIMATE GOAL IS TO INTERRUPT THE TRANSMISSION O
F P. FALCIPARUM MALARIA BY 2010 IN TAJIKISTAN AND
CENTRAL ASIA AS A WHOLE TO INTERRUPT THE TRANSMI
SSION OF MALARIA BY 2015 AND ELIMINATE THE
DISEASE WITHIN ALL AFFECTED COUNTRIES OF THE
REGION
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Key Strategies to Accomplish the Objectives
In settings where malaria control is recommended,
the strategy should be focused on

1. strengthening capacities to
provide early diagnosis and adequate treatment

2.
to plan and implement cost-effective and
sustainable preventive measures

3. to detect
early and contain or prevent epidemics
4. to reinforce malaria
surveillance
5. to increase community
participation in malaria prevention

In settings where elimination is feasible,
particular attention should be paid to

1.
developing plans of operations for malaria
elimination

2. applying IRS and other attack measures
and evaluating results regularly

3. notifying
early on all suspected and confirmed cases of
malaria and treating them

4. building
reliable and sensitive malaria surveillance system
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Countries' Status to Eliminate Malaria, 2006-2015
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Main Constraints Challenges

• The limited financial resources invested in
  malaria control and elimination by Governments
  and donors
  
• How to attract the donor interest towards
  supporting the new regional malaria elimination
  initiative

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Priority Actions 2006-2007

• Providing technical guidance and financial
  support in planning, implementing and evaluating
  anti-malaria programmes, incl. projects funded by
  GF and other partners
• Main Products
  
  1. New regional strategy published,
  2006
  2. Implementation
  of GF malaria project technically guided in
  Georgia, Uzbekistan, Tajikistan Kyrgyzstan
  
  3. Regional Programme
  Managers Meeting held, 2007
  4. Regional and country-level
  malaria-related trainings conducted
  
  5. Technical expertise and advise
  rendered to countries

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Priority Actions 2006-2007

• Maintaining effective partnership to increase
  overall recourses to support malaria control and
  elimination
  
• Main Products
  
  1. GF malaria project proposals
  developed with assistance of EURO in
  Turkmenistan, Armenia, Azerbaijan Georgia
  (project extension) and submitted for the 6th
  round
  2. Malaria project
  proposals (Central Asia/Afghanistan and Caucasian
  Region) developed and submitted for fund-raising
  
  3. Country-level partnership
  actions coordinated and relevant meetings
  conducted

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Priority Actions 2006-2007

• Ensuring that concern and action to move from
  malaria control to elimination are high on the
  health and development agenda throughout affected
  countries of the Region
• Main Products
  
  1. Progress with implementation of Regional
  Resolution reported to the next Regional
  Committee, 2006
  2. Strategic Plan of
  Action to Eliminate P. falciparum malaria in
  Central Asia developed and discussed amongst
  participating countries, 2006

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Priority Actions 2006-2007

• Ensuring that pilot countries are fully
  supported in their efforts to move forward with
  elimination campaigns
  
• Main Products
  1.
  Malaria elimination strategies developed and
  relevant programmes launched in pilot countries
  
  2. Elimination efforts
  technically guided and coordinated by WHO (EURO
  HQ) and financially supported by WHO, GFATM and
  other partners

22
Priority Actions 2006-2007

• Supporting operational research related to
  malaria
  
• Main Products
  
  1. Informal consultation to discuss
  outcomes of operational research related to
  malaria held, 2006
  2.
  Proceedings on outcomes of regional research
  programme on malaria published, 2007
  
  3. Regional operational research
  programme continued to be implemented
  
  

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Possible Areas of Collaboration between EMRO
EURO

• CROSS-BORDER COLLABORATION
• CENTRAL ASIAN COUNTRIES/AFGHANISTAN AS WELL
  AS CAUCASIAN COUNTRIES/TURKEY/SYRIA/IRAQ/IRAN
  1. Joint
  project proposals
  2. Inter-regional meetings
  3. Exchange and study
  tours
• A JOINT OPERATIONAL RESEARCH IN AREAS OF MUTUAL
  INTEREST
  
  
  

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• THANK YOU
• FOR MORE INFORMATION, YOU MAY VISIT OUR
  REGIONAL MALARIA WEB SITE
  
• www.euro.who.int/malaria