Progress report:the national LF and STH programme

in Thailand

By Sunsanee Rojanapanus, Dr. Thitima Wongsaroj 2014

RPRG MeetingWHO Region

Background Information• Geography and Population–Total population 64,785,909 (31Dec2013)–Ecological zones Total area 520,000 km2 were divided to 6

geographical regions, based on natural features including landforms and drainage, as well as human cultural patterns. Bangkok geographically is part of the central plain as the capital.

North, north-east, central, east, west and south region

Background Information• Political & Health Administrative Divisions:

- First level (States, Regions, Provinces): Region (4); northern, north-east, central and southern/Province (77)Region; 12 Regional Health office

77 provincial health office

- Second level (Districts); 927 districts district health office

- Third level (Tambol , Villages)Sub-district or Tambol (7,409), Village (74,944)

Tambol health promotion hospital

Historical Perspective (1-2 slides)

• Summary of historical data on LF and STH before inception of the NTD programme, e.g. Geographical distribution Vector (LF) Brief history of interventions (drug distribution,

treatment of clinical manifestation, vector control etc)

LF

InterventionMDA; DEC+ALB once a year (NELF) DEC alone in Myanmar migrant groupIndividual treatment; DEC aloneClinical manifestation; home-based care promotionVector control; -surveillance in migrant group Cx mosquito

VectorsW. b Ae. niveus, Ae. annandalei Ae. Desmotes, Ae. ImmitatorB. m M. bonneae, M. uniformis M. dives, M. indiana, M. annulata, M. annulifera

LF Endemic province in Thailand, 2013

Non Endemic areaEndemic area (MDA stoped)

STH

Intervention100% stool exam in target area1st round Targeted treatment 2nd round Mass chemotherapy with ALB in area where prevalence>50%

National programme overviewIndicator LF STH

Year of inception of the national programme

1961-control program2002- elimination program

1977-control program

Target date for elimination 2017

Name of administrative unit for implementation of PC

Sub-village School/village

Total # administrative units requiring PC at the start of the programme

357 771 schools/villages

Total population requiring PC in the country

124,206 (2002)166,647 (2006)73,495 (2012)

131,000

PC Programme Financing

• Contributors to the 2013 programme costs (and rough estimate of contributions by each if available):

Contributor Funding (US$)National government LF 150,000 USD

STH 15,000 USDSub-national government -Internal donors (___) -External donors (___) -Others (___) -

PC programme achievements 2013

Indicator Targeted Achieved

M&E

Total # sentinel and spot check sites surveyed (LF) 0Total # sentinel sites surveyed (STH) 0

Total # IUs where stopping-MDA TAS implemented (LF) 0Total # IUs which passed TAS and stopped MDA (LF) 87Total # IUs where surveillance TAS implemented (LF) 0

MMDP# IUs where hydrocele surgeries performed 0# IUs where lymphedema and ADLA management provided 0

Activities

Targeted Achieved#

administrative units for PC

# people#

administrative units for PC

# people

PCMDA2 (DEC + ALB) 0 0 0 0T3 (ALB/MBD) for STH 1st round 119,384 22,925T3 (ALB/MBD) for STH 2nd round 119,384 119,384

Progress Towards LF Elimination

Definitions

Started MDA ≥5 MDA rounds Surveillance MMDP access*

MMDP access

Surveillance post-MDA

≥5 MDA rounds

Started MDA

0% 20% 40% 60% 80% 100%

84%

24%

24%

100%

Progress Towards STH scale up

𝑇𝑜𝑡𝑎𝑙𝑝𝑟𝑒𝑆𝐴𝐶𝑜𝑟 𝑆𝐴𝐶𝑡𝑟𝑒𝑎𝑡𝑒𝑑𝑇𝑜𝑡𝑎𝑙𝑝𝑟𝑒𝑆𝐴𝐶𝑜𝑟 𝑆𝐴𝐶𝑝𝑜𝑝𝑢𝑙𝑎𝑡𝑖𝑜𝑛𝑟𝑒𝑞𝑢𝑖𝑟𝑖𝑛𝑔 𝑃𝐶𝑖𝑛 h𝑡 𝑒𝑐𝑜𝑢𝑛𝑡𝑟𝑦*Coverage =

2011 2012 2013 2011 2012 20130

20

40

60

80

100

120

SACPre-SAC

PC coverage, 2013

*65% for LF and 75% for STH**reported coverage was verified by coverage survey or similar independent activity

PC type#

administrative units receiving

PC

# administrative units with

reported coverage above target*

# administrative units where

coverage was verified**

MDA2 (DEC + ALB) 0 0 0

T3 (ALB/MBD) for STH 1st round 771 schools/villages 0 771 schools/villages

T3 (ALB/MBD) for STH 2nd round 771 schools/villages 0 771 schools/villages

Impacts of MDA in Sentinel Sites (LF)# SS/SC sites

Sentinel Sites<1% mf

Sentinel Sites≥1% mf

Spot Check sites

<1% mf

Spot Check sites

≥1% mf

Baseline surveys(2002)

Ag 54 IUsMf 18 IUs

Ag 6 IUsMf 2 IUs

- -

Surveys (2005) Ag 23 IUsMf 4 IUs

0 Ag 5 IUsMf 1 IUs

Ag 3 IUs

Surveys (2006)*(2-6 year)

270 IUs Ag=0/Mf=015/87IUs Mf=0

Surveys (2011)**(4-6 years )

270 IUs Ag=0/Mf=087 IUs Ab=0.6% (Mf=0.16%)

Latest surveys (post-MDA)

- - - -

Non endemic Area

Endemic Area

Hospital

Post-MDA surveillance2014

hospital No of blood test

Ab- Ab+

Narathiwatratchanakarin

255 255 0

Sungaikolok 154 154 0

Reusau 261 261 0

total 670 670 0

PC Monitoring and Evaluation

• Describe how coverage is monitored- report

- survey

• SAE protocol– Detection by survey– Management; every severe SAE cases had to report

to health officer for treatment – Reporting; SAE report

Progress to date in assessing transmission #

# administrative units currently eligible for surveys to stop mass treatment 0

# administrative units where surveys to stop mass treatment were conducted 357

# administrative units where criteria was passed and mass treatment stopped 357

• Justification for stopping MDA without TAS in the above IUs -

• Integrated assessment of STH considered? -

LF Transmission Assessment Survey to stop MDA

LF Transmission Assessment: Forecasting

YearNumber of IUs to

be coveredTAS1 TAS2 TAS3

Total number of EUs

ICT/LF ST Required*

2014

2015 87 3 2500

2016

2017 87 3 2500

2018

2019

2020

*sum of the total sample size required for each EU assessed;

Integrated Vector Management (LF)

• Describe any activities targeted to control LF vectors (including those conducted by other programmes)

no for LF vectorsimprove household sanitation for possible vectors

• Describe monitoring and evaluation of such activitiesentomological survey; density, infective, infection

LF MMDP – StrategyLF

National policy exist? yes

Organizational placement within the government (who is responsible?)

Tambol health promoting hospital under provincial health office

How integrated with the health service?

A part of home visit activity by Tambol health promoting hospital

Training of service providers conducted (by who? How frequent?)

Training for provincial health staff by central office (BVD). And they trained affected persons and theirrelatives to taking care themselves at home to prevent ADL.

Patient mobilization and registration (by who? How?)

Tambol health promoting hospital through home visit activity.Report by health volunteer

LF MMDP – monitoring and evaluation

LFDescribe how MMDP services are currently monitored and reported to the national programme

Monitored and report by Provincial health office, regional office and to BVD.

How is “access” determined? Training

Is there any quality assessment of provided services?

Survey by BVD

Best Practices

• Describe interventions and/or M&E activities that worked well- Small IUs in NELF- Antibody test

Challenges and “Issues”

• For each disease, list the specific challenges/issues that need advice from RPRG- post-MDA surveillance-TAS2,3-Surveillance in migrant group

Programme Plan Activities

2014 target 2015 target# administrative

units for PC # people # administrative units for PC # people

PCMDA2 (DEC + ALB) 0 0 0 0T3 (ALB/MBD) for STH 1st round 771 schools 130,000 771 schools 130,000T3 (ALB/MBD) for STH 2nd round 771 schools 130,000 771 schools 130,000

Activities 2014 Target 2015 Target

M&E

# districts/IUs where coverage surveys are planned for any PC diseases 771 schools for STH 771 schools for

STH# IUs where pre-TAS sentinel site and spot checks planned (LF) 0 0

# IUs where TAS for stopping MDA is planned (LF) 0 0

# IUs where STH survey integrated with LF TAS planned

# IUs where MMDP is to be evaluated (LF) 50 sub-district hospitals

# IUs where surveillance activities are to be carried out (LF)

MMDP # IUs where MMDP services newly initiated (LF) 0 0IVM # IUs where IVM coordinated to target LF vectors 0 0

PC medicine request for 2015　 ALB (LF) ALB (STH) MBD DEC

required - - -

in stock

in pipeline

requested to WHO

requested toMDP (IVM) or ITI (AZI)

Procured from other sources(source, # tablets and target age group)