1 Eritrea National Malaria Control Program: On the road to malaria eradication Saleh Meky Minister of Health Government of Eritrea.

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Eritrea National Malaria Control Program: On the road to malaria eradication

Saleh MekySaleh MekyMinister of HealthMinister of Health

Government of EritreaGovernment of Eritrea

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Roll Back Malaria Initiative

• case management, • vector control, • insecticide-treated nets (ITNs), • information, education and communication

material, training, • epidemic forecasting and preparedness, • operations research and monitoring, • evaluation and supervision.

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Success

• Eritrea as one of the four countries in the world with successful malaria control programs

• Together with India, Brazil and Vietnam

(Source: The World Bank Rolling Back Malaria: Global Strategy and Booster Program)

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Common elements of success

• Conducive country conditions

• Targeted technical approach

• Data-driven decision making – surveillance and operational research

• Strong leadership and commitment at all levels of government

• Community planning and implementation

• Adequate financing

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The Eritrean Program• Established in 1999 following devastating malaria

epidemics (1997-1998)

• Support from WHO, USAID, WB, Global Fund

• Introduced:– Early diagnosis and treatment at health facility and community

levels– Proper management of severe malaria at zoba/subzoba level– Reduction of man-mosquito contact through ITN (national

coverage)– Community awareness through the promotion of information,

education, and communication– Environmental management through community participation

and prevention and control of malaria outbreaks.

• Reduced malaria morbidity and mortality by 80% during 1999-2005

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Eritrean experience

• Success factors:– Targeted integrated vector management– Massive community mobilization – Organization and supervision– Evidence-based

• Corroborating factors: – No year round malaria transmission and – Manageable country size

• Once targets were exceeded more donor interest and funding

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Country conditions

• Seasonal malaria and low to moderate transmission

• Small country – 121,320 sq km– Population 4,906,585 (est.

2007 World Bank).

• Arid environment and seasonal rainfall patterns

– temporary free-standing pools of water,

– clearing and levelling an attractive option.

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Targeted integrated vector management: Nets

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Targeted integrated vector management:

Breeding sites treated, filled or drained(Average per year per zobas)

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Targeted integrated vector management:

Indoor Residual Spraying(per year, per zoba in GB,DB and SKB)

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Massive community mobilization:information and communication malaria sessions

(average per year, per zoba)

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Massive community mobilization:population participating in site cleaning

(average per year, per zoba)

• Community participation very significant factor in explaining breeding site cleaning

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Evidence-based: examples

• 2005 RTI studies showed that the most prevalent mosquito is anopheles arabiensis (bites early in the evening and late morning, not only in the middle of the night). – Use of ITNs as a sole prevention mechanisms is

insufficient– Indoor residual spraying perhaps required

• Sintasath et al. 2005 showed that housing construction known as agudo, in the western lowland of Eritrea, increases risk of parasitemia.– Implication for housing materials

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• Areas (subzobas) with above average ITN distribution reduced – Under five malaria incidence by 4 cases per month (23%

reduction per month)– Above five malaria incidence by 8 cases per month (14%

reduction per month)

• Areas (subzobas) with above average larvae site cleaning (treatment, filling and draining) reduced – Above five malaria incidence by 9 cases per month (15%

reduction per month)

Effectiveness of malaria interventions on incidence

(preliminary findings)Carneiro, Hassane, Legovini, Sy 2008

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Increasing access to ITNs to 100 per 1000 population reduced malaria under five incidence by 76 cases.

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Moving forward

• Securing longer term financing is a priority:– Need evidence on the economic impact of

malaria interventions to motivate continued investments in malaria control

– Need rigorous evaluation of the elements of the program and complementary interventions to understand what is required to eliminate malaria

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Moving toward evidence-based eradication

• Impact evaluation cross-country workshop (Asmara, Feb 2008)– Capacity for evidence-based policy making – Community of practice across malaria programs in the region

(15 delegations from national malaria and HIV programs)– Dissemination of Eritrean and other successful practices across

the Africa region (site visits)

• Experimental approach to understanding what more needs to be done to eradicate malaria

– Randomized evaluation of indoor residual spraying value added to the national program

– Randomized evaluation of communication and community mobilization approaches

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Thank you