Impact of vector control and malaria diagnostics on AC · malaria diagnostics (e.g. test zAt global...

Impact of vector cImpact of vector cImpact of vector cImpact of vector cdiagnostics on ACdiagnostics on ACdiagnostics on ACdiagnostics on AC

t d b presented by Dr A. Bosman, Global Malaria Prog

Artemisinin Conference 201012 O t b 2010 A t i M12 October 2010, Antananarivo, M

ontrol and malaria ontrol and malaria ontrol and malaria ontrol and malaria CT consumptionCT consumptionCT consumptionCT consumption

ramme

M dMadagascar

Malaria decreaeffectieffecti

Systematic review: 24conducted betwi 15 diff t

Systematic review: 24conducted betwi 15 diff tin 15 differentincluding 15’33in 15 differentincluding 15’33

Proportion of malaria a2% to 81%: Medi

Proportion of malaria a2% to 81%: Medi

Median PfPR 198

d f Median PfPR 200

D'Acrémo

Artemisinin Conference | 12-14 October 20102 |

ase in Africa due to ve control ve control

d d4 studiesween 1989 and 2005t Af i t i

4 studiesween 1989 and 2005t Af i t it African countries1 patients

t African countries1 patients

among fevers highly variable: ian parasite rate = 26%among fevers highly variable: ian parasite rate = 26%

85-19992-10 = 37%

%00-20072-10 = 17%

ont et. al. (2009). PLoS Med, 6 (1): e252

GLOBAL MALARIA PROGRAMME

Reduction o29 countries ou

Reduction o29 countries ou

(a) Americas (high incidence)

20 50Honduras

(c) Eastern Mediterranean

1.0

ource: World Malaria Report 2009) ource: World Malaria Report 2009) 29 countries ou29 countries ou

8

10

12

14

16

18

20

30

40

0 po

pula

tion

(Sur

inam

e)

HondurasBelizeNicaraguaPeruSuriname

0 4

0.6

0.8

r 100

0 po

pula

tion

Saud

i Ara

bia)

0

2

4

6

8

1997 1998 1999 2000 2001 2002 2003 2004 2005 20060

10

20C

ases

per

100

0

0.0

0.2

0.4

1997 1998 1999 2000 2001 2

Cas

es p

e(Ir

an,

(b) Americas (low incidence)0.5 0.03

na)El Salvador

Mexico

(d) Europe

1 5

0.2

0.3

0.4

0 01

0.02

1000

pop

ulat

ion

(Arg

entinMexico

Argentina

1.0

1.5

es p

er 1

000

popu

latio

n ba

ijan,

Geo

rgia

, Tur

key)

0.0

0.1

1997 1998 1999 2000 2001 2002 2003 2004 2005 20060.00

0.01

Cas

es p

er 1

0.0

0.5

1997 1998 1999 2000 2001

Cas

e(A

zerb


of >50% in cases: utside of Africa and of >50% in cases:

utside of Africa and 0.010

(e) South-East Asia

25 6

utside of Africa and …utside of Africa and …

0 004

0.006

0.008

er 1

000

popu

latio

n co

, Om

an, S

yria

)

IranOmanSaudi ArabiaMoroccoSyrian AR

15

20

r 100

0 po

pula

tion

an, S

ri La

nka)

3

4

5Sri LankaBhutanThailandIndia

2002 2003 2004 2005 20060.000

0.002

0.004

Cas

es p

e(M

oroc

c

0

5

10

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Cas

es p

er(B

huta

0

1

2

5

6

stan

)

Turkey

(f) Western Pacific

25

3Lao PDR

2

3

4

5

1000

pop

ulat

ion

(Taj

ikisGeorgia

AzerbaijanTajikistan

10

15

20

s pe

r 100

0 po

pula

tion

(Lao

PD

R)

2

3Viet Nam

Malaysia

Philippines

2002 2003 2004 2005 20060

1

Cas

es p

er

0

5

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Cas

e

0

1


Reduction o in 9 Af

Reduction o in 9 Af

12000 Malariainpatient casesMalariainpatient deaths

Eritrea

…. in 9 Af…. in 9 Af

6000

8000

10000

Case

s

0

2000

4000

Accelerationstarted

02001 2002 2003 2004 2005 2006 2007 2008

Malariainpatient cases

Malariainpatient deaths

14000

16000

18000

Sao Tome and Principe

6000

8000

10000

12000

Malar

iainp

atien

tcas

es

0

2000

4000

6000

2000 2001 2002 2003 2004 2005 2006 2007 2008

Accelerationstarted

Artemisinin Conference | 12-14 October 20104 |Also: Botswana, Cape VerdAlso: Botswana, Cape Verd

of >50% in cases: frican countriesof >50% in cases: frican countries

140 Malariainpatient casesMalariainpatient deaths

12000

14000

250

300Rwanda

frican countriesfrican countries

80

100

120

Deat

hs

6000

8000

10000

12000

Case

s

150

200

250

Death

s

0

20

40

60

0

2000

4000

2001 2002 2003 2004 2005 2006 2007 20080

50

100

Accelerationstarted

0

160000

180000

200000

6000

7000Malariainpatient cases

Malariainpatient deaths

300

350

Zambia

80000

100000

120000

140000

Malar

iainp

atien

tcas

es

3000

4000

5000

Malar

iainp

atien

tdea

ths

150

200

250

Malar

iainp

atien

tdea

ths

0

20000

40000

60000

2001 2002 2003 2004 2005 2006 2007 20080

1000

2000

Accelerationstarted

0

50

100


de, Namibia, South Africa, Swazilande, Namibia, South Africa, Swazilan

Impact of free ACT anImpact of free ACT an& pregnant women) on& pregnant women) onImpact of free ACT anImpact of free ACT an

& pregnant women) on& pregnant women) on& pregnant women) on& pregnant women) on& pregnant women) on& pregnant women) onBhattarai et al (2007) PLoS Med 4(11): e309Bhattarai et al (2007) PLoS Med 4(11): e309Bhattarai et al., (2007). PLoS Med 4(11): e309Bhattarai et al., (2007). PLoS Med 4(11): e309

P it t d d 2P it t d d 2 f ld i 2005 d thf ld i 2005 d thParasite rate reduced 2Parasite rate reduced 2--fold in 2005 and anothefold in 2005 and anotheUnderUnder--5 malaria outpatients, inpatients and dea5 malaria outpatients, inpatients and deaThe climate in Zanzibar remained favourable toThe climate in Zanzibar remained favourable to


nd free LLIN (to children U5 nd free LLIN (to children U5 n malaria burden in Zanzibarn malaria burden in Zanzibarnd free LLIN (to children U5 nd free LLIN (to children U5 n malaria burden in Zanzibarn malaria burden in Zanzibarn malaria burden in Zanzibarn malaria burden in Zanzibarn malaria burden in Zanzibarn malaria burden in Zanzibar

ACTACT LLINLLINACTACT LLINLLIN

10 10 f ld i 2006 f ld i 2006 r 10r 10--fold in 2006 fold in 2006 aths reduced 4aths reduced 4--fold in 2005 compared to 2003 fold in 2005 compared to 2003 malaria throughout the same period malaria throughout the same period


Adoption of policies fAdoption of policies fp pp pPolicy AFRO AMRO

No. endemic countries 43 23

42 11 Pf endemic countries 42 (98%)

11 (48%)

f D i bli t 25 13 free Dx in public sector 25 (58%)

13 (56%)

Dx test: all age groups 33 (77%)

15 (65%)Dx test: all age groups (77%) (65%)

Dx test: only > 5yrs old 10 (23%)

0(23%)

RDT at community 15 (35%)

7 (30%)


for malaria diagnosis (Dx)for malaria diagnosis (Dx)g ( )g ( )EMRO EURO SEARO WPRO Total

12 9 10 10 107

9 1 9 9 81 9 (75%)

1 (11%)

9 (90%)

9 (90%)

81 (76%

8 8 10 9 73 8 (67%)

8 (89%)

10 (100%)

9 (90%)

73 (68%

5 (42%)

8 (89%)

8 (80%)

7 (70%)

76 (71%(42%) (89%) (80%) (70%) (71%

1 (8%)

0 0 0 11 (10%(8%) (10%

3 (25%)

0 5 (50%)

5 (50%)

35 (33%


Diagnosis of main public sector with

Diagnosis of main public sector within public sector within public sector with

.

60%

80%

100%rm

ed d

iagn

osis

20%

40%

case

s with

con

fi

0%

Euro

pe

Amer

icas

h-E

% re

porte

d c

Sout

h

Based on cases reported tocountries reporting tend to


laria: % reported cases h parasitological diagnosislaria: % reported cases

h parasitological diagnosish parasitological diagnosish parasitological diagnosis

h-Ea

st A

sia

Afric

a

dite

rrane

an

tern

Pac

ific

h

East

ern

Med

Wes

te

to WHO: African % biased upwards since o undertake more case confirmation.


Rwanda: preliminaRwanda: preliminapp

Malaria cases Malaria cases & ACT annual orders& ACT annual ordersMalaria cases Malaria cases & ACT annual orders& ACT annual orders

3000000

3500000

2000000

2500000

1000000

1500000

2000000

500000

1000000 LLIN distributioLLIN distributio

02001 2002 2003 2004 200


ary analysis (WMR 2010)ary analysis (WMR 2010)y y ( )y y ( )

% malaria positive% malaria positive% malaria positive% malaria positive%%

50

60% malaria positive% malaria positive% malaria positive% malaria positive% malaria outpatien% malaria outpatien% malaria outpatien% malaria outpatien% malaria inpatients% malaria inpatients% malaria inpatients% malaria inpatients

%%

40 Malaria casesACT orders

20

30 Positivity rate% malaria OPD% malaria IPD

10

% malaria IPD

onon

5 2006 2007 2008 20090


Countries with proCommunity CCommunity C

Malaria Consortium

PSI/TDR

Malaria Consortium

Save the Children

IRC

Catalytic Initiative

PMI/MCH


ojects on (integrated) Case Management Case Management

GLOBAL MALARIA PROGRAMMECourtesy of Dr F. Pagnoni, TDR

ConConMalaria trends reducing due tand LLINs - often combinedMajor impact of malaria diagnj p g(reporting suspected "fever cReduction of ACT consumptiReduction of ACT consumptimalaria diagnostics (e.g. testAt global level limited impact At global level limited impact

– low use of malaria diagnostics– expansion of community casep y– variable of coverage of vector


nclusionsnclusionsto increasing use of RDTs, ACTs

nostics on malaria surveillance cases" → malaria confirmed cases)on in areas with high level of use of on in areas with high level of use of ting >80% of suspected cases) on ACT consumption because: on ACT consumption because:s, esp. in countries with high burden management with ACTs and AMFm (Phase Ig ( control operations (malaria resilience)


Impact of vector control and malaria diagnostics on AC · malaria diagnostics (e.g. test zAt global...

Documents

Transcript of Impact of vector control and malaria diagnostics on AC · malaria diagnostics (e.g. test zAt global...