WHO BI-REGIONAL MALARIA ELIMINATION TRAINING

SOLOMON ISLANDS and VANUATU PRESENTATION

MT. MALARAYAT GOLF & COUNTRY CLUBLIPA CITY, BATANGAS, PHILIPPINES

10TH TO 18TH FEBRUARY 2014

MALARIA ELIMINATION SURVEILLANCE SYSTEM REVIEW

National Malaria Strategy 2015 to 2020

ELIMINATION OBJECTIVE:To achieve health systems related elimination criteria in pre-elimination provinces and to reach and maintain API <1/1,000 in elimination provinces (Temotu and Isabel) and to rollout to other provinces.

• The population of Temotu = 26,026 and Isabel = 28, 049

ACD from MSAT/MBS data

PCD (MIC. + RDT) data from health facilities – MCMR is now rolled out to capture all this data in future

COVERAGE INDICATORS

INDICATORS ISABEL TEMOTU

SPR (%) 2.6 8.1

ABER (%) 11.4 12.5

API (/1000) 3 10

Diagnostic – MIC +RDT (%)

100 86

Confirmed Cases (%) 27 100

Indicator Isabel Temotu

SPR (%) 1.4 1.6

ABER (% of target villages)

67 84

Malaria Elimination Surveillance Concepts

In elimination, a case of malaria = any case confirmed by quality controlled diagnosis to provide malaria parasite information (species, stages and density):

Demonstration of malaria parasites in Giemsa-stained blood films by light microscopy is the gold standard

Cases detected with RDTs only should also be investigated the same way as microscopy confirmed cases

CASE DEFINITIONS

Laboratory Detection Methods◦ Laboratory services are typically organized into 3 main levels (Peripheral

(NAP/RHC/AHC/UHC), Intermediate (Provincial Hospital) and National (NRH).◦ Microscopy is the gold standard◦ Rapid diagnostic test (RDTs) are distributed to all health facilities

Case Detection personnel and stakeholders◦ Malaria and other health officers including Malaria Elimination Officers (MEO)

or Microscopists) for MSAT/MBS in the field.◦ Nurse Aids and Registered Nurses at health facilities including Hospitals◦ Malaria Microscopists in health facilities microscopes◦ By affected family or other members of the communities

Detection Can be by either:◦ Passive (detected when sick patient attend a health facility to seek treatment)

or ◦ Active (detected at community or household levels when health workers screen

for fever and/or parasites in target high risk populations

CASE DETECTION METHODS and PERSONNEL

Each notified case of confirmed malaria is investigated within 48 hours in the field. This involves obtaining and verifying of the case and ACD in populations likely to harbour parasites. The case is then classified into one of the following categories:

Local: Indigenous = Case within the province (IP = 84 and TP = 263 in

2013). A case detected from a case investigation report in a village cleared of malaria for the past 2 years or more. Response must occur within 10 days of case reporting (Refer to SOP on Remedial Measures)

Introduced = Cases acquired from an imported case (first generation imported case or internally imported)

Imported or exotic: = Cases imported from other provinces/country (Need proper case investigation – within the past 3 months)

Induced: Congenital or contamination with infected blood (Hospital based) Clinical: = Unconfirmed cases but treated by clinicians for malaria

CASE INVESTIGATION and CLASSIFICATION

National guidelines for Malaria Surveillance

Every case should be confirmed by early laboratory examination (Microscopy) for species, density and presence of gametocytes in both public and private facilities

Cross Checking of slides Done quarterly at provincial level during Supervisory visits (10%

positives and 5% negatives). Slides are cross checked at the provincial level by a level 2 External Competency Assessed (ECA) Microscopist. This ECA is supported by WHO and is done annually at headquarters for selected Senior Malaria Laboratory officers from all provinces.

This is supplemented by an Internal Competency Assessment (ICA) at the provincial level, facilitated by a Senior Parasitologist from the programme headquarters (refer to SOP) as part of the annual refresher training for all microscopist.

Slide Bank is not yet well established

QUALITY ASSURANCE (QA) SYSTEMS

FOCUS: - A defined, circumscribed locality currently or formerly in a malarious area with continuous or intermittent epidemiological factors necessary for malaria transmission.

Focus investigation identifies the followings:◦ Mapping of geographical features: Location, Population at

great risk (house holds)◦ Vectors responsible for transmission (where they are &

when they transmit) Entomologist required for: ID breeding sites, mosquito

collection and identification, malaria and vector control interventions

From the investigation, the focus can be classified into 6 types:◦ Endemic, Residual Active, New Active, New Potential,

Residual non-active, Cleared-Up

FOCUS INVESTIGATION AND CLASSIFICATION

Active foci - Rapid parasitological and entomological responses (Need to effectively control transmission)

Residual foci – Strong surveillance and timely reporting Malaria Free – Strong surveillance system and case

management capacity

Current Practice:◦ Active foci - MSAT – Targeted ACD◦ Residual foci – MSAT - Supervisory work◦ Malaria Free – PCD

It is vital to track, review and update these foci classifications and investigation results periodically

OPPERATIONAL IMPLICATIONS FOR DIFFERENT TYPE OF FOCI

Data Collection and recording

◦A systematic system of recording, reporting and analysis of elimination data and information needs to be exercised at the various levels of the health services from health facility, Field, Regional and National.

◦Guidelines to ensure timely, completeness and quality of reports are achieved must be developed and applied with commitment.

RECORDING and REPORTING SYSTEM

Reporting Methods (Programmatic and Financial)

◦ Hard copy and Radio (VHF) sent to Programme Manager at Provincial level from regions (health facilities) before 15th of the following month

◦ Hard and Electronic copy to M & E Unit at Central level by 20th of the following month

◦ Spatial Decision Support system (SDSS) is being introduced in elimination provinces and needs refresher trainings and updating and improvement to cater for appropriate information input and analysis. It also requires provision of adequate equipment to ensure the system is working at the provincial level

Reports and feed-back methods from Central Level (Programmatic and financial)

◦ Annual M & E Support trainings for provincial officers to improve timely, completeness and quality of reporting from provinces

◦ By weekly or Monthly phone calls and e-mails to provincial level

◦ Quarterly Supervisory Visits to provincial level

◦ Quarterly Reports from M & E headquarters

◦ Annual Reports (National Annual Conference)

RECORDING and REPORTING SYSTEM

Changes Required to Adequately Accommodate Elimination

Review, Update and Complete all SOPs and guidelines including Malaria treatment protocol for elimination provinces

Nurse Refresher Training on Management of Malaria Recruit and train Surveillance Agents (Case Management) Recruit Field and Monitoring Officers (PSD) Review JDs for Malaria Elimination officers (MEO) Plan for Malaria Elimination Training for health workers and

stakeholders at provincial level Training and coordination of Community Mobilization and

engagement activities involving CBO/NGOs/private sectors including the development, distribution and utilization of IEC materials.

ELIMINATION PRIORITIES