Roll Back Malaria in the Sudan

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Roll Back Malaria in the Sudan

• 3rd Inter-country Meeting
• for National Malaria Programmes Managers
• Lahore, Pakistan, 12 -15 May 2003

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Important facts

• P. falciparum
• A. arabiensis, A. funestus and A. gambiae
• Resistance to CQ is increasing
• Resistance to insecticides is widely spread

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Insecticide resistance
Malathion
fenitrothion
DDT
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Sudan Major Malaria Strata

High transmission Irrigated Rural, high
seasonal Riverine Urban
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Malaria Burden

• 7.5 million cases (50 of EMRO cases)
• 20 40 of the total out-patient attendance
• 30 of the annual in-patient attendance
• 35,000 deaths (70 of EMRO malaria deaths)
• 22 loss of working days
• Patient cost (direct) 5.2 17.2 (Hanan, M. A.
  1999)

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Epidemic-prone areas (red color)
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Main Strategic Direction

• Disease management
• Multiple prevention
• ITNs
• IPT
• IVM
• prevention, early detection and containment of
  epidemic
• Upgrading local capability to compact the disease

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Progress madeDisease management

• Hospital-based malaria mortality reduction
  project
• WHO UNICEF
• 112,000 to cover 10 hospitals out of 75
• Kosti, Damazin and Gadarif

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Progress madeDisease management

• National protocol for malaria treatment
• One copy for each prescriber in a form of booklet
  and wall-chart.
• Efficacy studies (overall result 38)
• New version of the protocol (CT CQSP)

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Progress madeDisease management

• Improvement of microscopic diagnosis
• City-based project (40 -60)
• Assessment, training, SE, QA system
• Covers all sectors
• 7 states (plan for 13)
• Wall-chart
• Reference lab (7 ---20)

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Progress madeMultiple prevention

• ITNs
• ITNs strategic plan
• Partial elimination of taxes and tariffs
• Involvement of private sector in procurement
• 500,000 nets distributed
• Other vector control activities
• Gazera and Khartoum
• Biological control
• IVM

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Progress madeMalaria and pregnancysize of the
problem, case management, IPT and ITNsLink with
Reproductive health
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Progress madeEpidemic control

• Early detection
• Regular weekly and monthly reports (17 states)
• Feedback
• Forecasting project
• Buffer stock
• We didn't face epidemics during 2001 -02

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Progress made Capability Building

• Sustained political commitment
• Higher committee, Media fund
• Staff recruitment and training
• Regular meetings and technical support
• SE
• Enabling environment
• Transportation (bicycles, motors and cars)

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Community Involvement Social Mobilization

• School competition
• Media campaign
• AMD
• Malaria committees
• Cartons

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Partnerships

• Malaria Free Initiative
• Khartoum / Gazera
• Gambia Project
• Egypt / GOS
• Plan Sudan / GSK
• Shell Sudan
• Detasi / Telsman
• UNICEF
• MSF

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Horn of Africa InitiativeControl of Malaria at
borders of Ethiopia-Sudan
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GFATM??
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• What is the result???

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Malaria Burden
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Malaria deaths during Jan, Feb and March, 2001 -
2003
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Challenges

• Free malaria treatment
• Scaling up ITNs
• Showing success stories

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Future Perspective

• Developing an innovative protocol for treatment
  based on CT.
• Increasing the malaria free areas
• Dealing with mortality determinants at the
  community level
• Free treatment
• Paving the road for GFATM

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