Bi-national Commission on Health Guyana Suriname

Bi-national Commission on HealthGuyana Suriname

Neglected Tropical Diseases

Dr. Shamdeo PersaudChief Medical Officer

GUYANA

NTD Control• Guyana on 1 of four in the Americas where LF still

endemic and 3 other NTD• Development of National Plan• Identification of Priorities

– LF – Targeted for elimination by 2016– STH – Targeted for control by 2015– Chagas – Elimination of vertical and Blood Transfusion

transmission; control of Oral and vector transmission – Leprosy – Elimination– ONCO and SCH not transmitted – Dengue, Leptospirosis and Malaria remain endemic in selected

Regions

Region Neglected Diseases

Region 1 – Barima Wine Chagas, Malaria, STH

Region 2 – Pomoroon/Supername Chagas, STH, LF, Leprosy, Rabies

Region 3 – West Demerara/Essequibo LF, STH, Leprosy, Dengue, Leptospirosis

Region 4 – East Bank Demerara LF, STH, Leprosy, Dengue, Leptospirosis

Region 4 – East Coast Demerara LF, STH, Leprosy, Dengue, leptospirosis

Region 4 – Georgetown LF, STH, Leprosy, Dengue, Leptospirosis

Region 5 – West Berbice/Mahaica LF, STH, Leprosy

Region 6 – East Berbice Corentyne LF, STH, Leprosy, Rabies

Region 7 – Cuyune/Mazurini Malaria, STH, Malaria, LF

Region 8 – Pataro/Sepurini Malaria, STH

Region 9 – Upper Essequibo/Upper Takatu

Malaria, STH, LF, Dengue

Region 10 – Upper Demerara/Upper Berbice

STH, LF, Malaria, Leprosy, Dengue

SEROLOGY PREVALENCEOF LF ANTIGEN

Ministry of Health, Guyana

Key: PrevalenceRed=20%-50%Yellow=4-20%Green< 4%

Plan for Transmission Interruption• Phase one (2003 – 2007)

– Social Mobilization– Develop, distribute, promote and use DEC salt– Monitoring and evaluation progress at sentinel sites

• Phase two (2008 – 2015)– Synergies with other neglected diseases– Evaluation of Phase one– Identify “Hot Spots” using surveillance information– Implement MDA with DEC and Albendazole– Monitor and evaluation progress at sentinel and spot

check sites

Ministry of Health, Guyana

Endemic LF IUs in Guyana

Ministry of Health, Guyana

Region/province

Total population

Source of population

data

Year of first round of MDA

Current Status

Region II 49,254 Cencus 2002 2003-DEC SaltDEC/Alb 2009

Eliminated

Region III 103,061 “ 2003-DEC Salt Endemic

Region IV 310,320 “ 2003-DEC Salt2012– DEC/ALB

Endemic

Region V 52,428 “ 2003-DEC Salt2008–DEC/Alb

Endemic

Region VI 123,694 “ 2003-DEC SaltDEC/Alb 2009

Eliminate

Region X 41,112 “ 2003-DEC Salt Endemic

Other Ares 11,000 Estimated 2003 – DEC Salt

Eliminate

Total 690,869

Phase oneSalt Fortification

• Adding beneficial chemical to salt• Does not alter taste or other qualities of salt• To combat public health problems (IDD, Dental Caries, Malaria, LF)

Iodine Deficiency Disorder (IDD)• Inadequate iodine in the body• Disease observed as enlarged thyroid, Mental retardation and

Cretinism, but several stages of physical sluggishness, learning disability, growth retardation and childhood morbidity

Iodized Salt- successful in eliminating these problems

Ministry of Health, Guyana

DEC-Salt for Mass Treatment • Program Launched in July 2003

– 2003 to early 2004 - 480 tons imported • Hurricane in Jamaica disrupted production, New

plant commissioned in March 2005• Salt became blue in 2006• Production recommenced in August 2005

– 2005 – 49 tons– 2006 – 80 tons – 2007 – 290 tons

• Production stop in August 2007

Ministry of Health, Guyana

Phase IIMass Drug Administration

Region 5 – Annually form 2009 - 2015◦Population - 52,428◦Eligible Pop – 47,000◦Population Treated - (2008 =81.7) (2010 =84%)

Region 2 – one round 2009Region 6 – one round 2010Region 4 – 2010 -2015

Georgetown/East Bank/East Coast360,000*Eligible 300,000*

Ministry of Health, Guyana

Phase IIMass Drug Administration

• Region 3 – Annual 2012 – 2016◦Population - 103,061◦Eligible Pop – 91,000

◦Region 10 – Annual 2012 – 2016◦Population – 41,112◦Eligible Pop – 37,200

Integrated NTD ProgramBackground

• The Georgetown Sanitation Improvement Project (GSOP) was developed by the Government of Guyana to improve the sanitation in the Capital City

• Project was supported by Inter-American Development Bank (IDB)

• Guyana Water Incorporated is the executing Agency a

Sentinel Monitoring

Ministry of Health, Guyana

Sentinel Site

Microfilaria%

Antigen(ICT) %

YEAR 2003 2006 2008 2012 2003 2006 2008 2012

LodgeRegion 4

11.2 7.2 NA 2.9 38 17.7 18.2 8.6

TucburRegion 6

2.6 2.9 1.7 NA 17.5 10.9 12 NA

Spot Check Sites

MelanieRegion 4

NA NA 1.7 27 NA NA 7.9

Bush LotRegion 5

NA 3,7 NA NA NA 14.6 NA

GSIP

The aims of the program are:i. Improve the operational performance of the

Georgetown sewerage system through the reconstruction of its most critical components;

ii. Strengthen GWI operational and financial performance by improving asset management and decreasing energy consumption;

iii. Limit the transmission of the water-related diseases lymphatic filariasis and intestinal helminthiasis.

Results of Baseline StudySentinel

SiteSample ICT

PrevalenceMicrofilara STH

(KATOKAT)

Lodge 462 8.6 2.9 1.7

Melanie Damishana

448 7.9 1.7 2.1

Totals 910 8.25 2.3 1q.9

Training• Develop MDA guidelines in

accordance with the Program Managers Guidelines

• Procure all essential medicines (DEC, albendazole) and supplies

• Training and orientation of health workers

• Requirement and training of community volunteers and supervisors

Mass Drug Administration

• Packaging of medication• Implement MDA (door to

door, Booths at Health Centers and Outreach teams)

• Collect and analysis program data on Coverage

• Conduct Coverage survey (post treatment survey)

Mass Drug AdministrationImplementation Unit –

Demerara/Mahaica (Region IV)– Population – 310, 320 (41.3%

Guyana's Population)– Eligible population – 301,000– Divided into 3 areas

• The City of Georgetown – Prevalence 28% (ICT)

• East Coast Demerara – Prevalence 16.5 % (ICT)

• East Bank Demerara – Prevalence -10.8% (ICT)

Age/height ALB DEC

By age group 2-5 years 400mg (1 tablet)

100mg(2 tablets)

6-15 years 400mg (1 tablet)

200mg(4 tablets)

> 15 years 400mg (1 tablet)

300mg(6 tablets)

Guyana Mass Treatment ChartNTD (LF/STH)

Coverage – Region IVYear 1

Treatment Area

Target population

HouseholdTargets

Adults Children Total

East Coast A-57,000C-8,000

T-65,000

15,476 39,482 6,109 45,591(70.1%)

East Bank A-41,000C-6,000

T-47,000

11,190 27,921 4,977 32,898(70%)

Georgetown A-152,000C-15,600

T-167,000

39,761 87,134 11,924 99,05859.4

Total A-250,000C-19,000

T-269,000

66,427 154,537 23,010 177, 54766%

Monitoring and evaluation

– Program coverage – Data management

– Survey coverage – Post treatment cluster surveys

– Morbidity– Reporting

• IDB and GWI• National and Regional

Programs– Impact evaluation

• Surveillance• National feedback

Challenges• Capacity – Technical and administrative (PAHO/WHO and MOH

assisted), Training (University Interns)• Supervision and Data management – PAHO supported training

and coordination• Administrative and Logistic Support – Transport, Office space,

Medicine storage and packaging (MOH provided all support)• Procurement and supplies chain – DEC Procurements from

Brazil, ALB donation from GSK• Social Mobilization – Mass Media program was late and did not

reach target population, MOH and GWI used their individual to enhance SM and HW conducted community Mobilization

Innovations

• Training of Volunteers from Community and Faith Based Organization

• Target large employers – Ministries, work places and Institutions

• Establishment of Distribution Points mainly at Health facilities

• Special Outreaches and “Mop-up” Exercises• Public Education – opportunities to “talk health”• Integrated Vector management.

Leprosy situation at national level,2011

Prevalence 0.9 per 10,000 pop

Number of new cases 24

% of multibacillary cases amongst new cases

70.8%

% of cases with grade 2 disability amongst new cases

4.2%

% of cases in children under 15 amongst new cases

12.5%

Detection rate(x 100.000 population)

3.2 x 100,000

Prevalence at first sub-national administrative level, 2011

1 2 3 4 5 6 7 8 9 100

0.51

1.52

Prevalence at first subnational level-

2011, GUYANA

Thank You