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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
Artemisinin Conference | 12-14 October 20103 |
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
GLOBAL MALARIA PROGRAMME
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
GLOBAL MALARIA PROGRAMME
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
Artemisinin Conference | 12-14 October 20105 |
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
GLOBAL MALARIA PROGRAMME
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%)
Artemisinin Conference | 12-14 October 20106 |
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%
GLOBAL MALARIA PROGRAMME
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
Artemisinin Conference | 12-14 October 20107 |
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.
GLOBAL MALARIA PROGRAMME
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
Artemisinin Conference | 12-14 October 20108 |
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
GLOBAL MALARIA PROGRAMME
Countries with proCommunity CCommunity C
Malaria Consortium
PSI/TDR
Malaria Consortium
Save the Children
IRC
Catalytic Initiative
PMI/MCH
Artemisinin Conference | 12-14 October 20109 |
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
Artemisinin Conference | 12-14 October 20100 |
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)
GLOBAL MALARIA PROGRAMME
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