Malaria border area

• 1. MALARIA DIAGNOSIS ANDTREATMENT IN BORDER AREAS:WHAT SHOULD WE PAY ATTENTION TO?Asep PurnamaTC Hillers Hospital, Maumere, NTT

2. STRATEGIES PreventionVector control, Long Lasting Insecticide Net, Repellent etc Accurate diagnosis Prompt treatment with ACT Partnership Increase Coverage of ServiceErna Tresnaningsih, Direktur Pemberantasan Penyakit Bersumber Binatang, Depkes RISeminar Nasional Manajemen Malaria Terkini, Manhattan Hotel-Jakarta, 14 Juni 2008 3. MALARIA DIAGNOSISPROBLEMS 4. Clinical responses to malaria infection vary widely 5. CLINICAL MALARIA, BLOOD SAMPLE TAKEN & POSITIVE DIAGNOSIS IN INDONESIA3,500,0003,000,0002,500,0002,000,0001,500,0001,000,000 500,000 0 80001020304050607020 20 20 20 20 20 20 20ar M n-Ja Not all Malaria cases are diagnosed by microscopist or RDT Slide positive malaria cases dont decrease significantly 6. M ALARIA KLINIS DAN PE EM RIKSAAN SE DIAAN DARAH M ALARIA DI JAWA BALI TAHUN 2000-20041600000Klinis Pem SD147570414000001200000 12105301000000 998791800000756833600000 480048400000200000 0200020012002 20032004 MALARIA KLINIS DANPEMERIKSAAN SEDIAAN DARAH MALARIA DI LUAR JAWA BALI TAHUN 2000-2004 1974882 2000000 1702508 1732557 1686176 Kl i ni sPem SD 1800000 1522831 1600000 1400000 1200000 1000000 404714 389477 337583 348366 479441800000600000400000200000 0 2000 20012002 20032004 7. S ED I A A N D A R A H M A L A R I A P OS I T I FD A N M A L A R I A P f D A N M I X D I J A WA B A L I TA H U N 2 0 0 0 - 2 0 0 4120000 SD Positif Pf + mix100000 80000 60000 40000 20000 0 2000 2001 20022003 2004 SED I A A N D A R A H M A LA R I A PO SI T I F D A N M A LA R I A Pf D A NM I X D I LU A R JA W A B A LI T A HU N 2 0 0 0 - 2 0 0 4SD Posit ifPf + mix200000 181315 155796 148478150000 140769 1320951000005000002000 2001 2002 20032004 8. MALARIA DIAGNOSISWhat should we pay attention to? Prompt and accurate diagnosis is critical to theeffective management of malaria Based on microscopic diagnosis/RDT Capacity building Equipment (microscope, RDT) Cost Quality Control 9. Survey of General PractitionersKnowledge, Attitude and Practice on Malariain Sikka District, East Nusa Tenggara 2008 Jane Hidayat, Asep Purnama 10. MALARIA TREATMENTPROBLEMS 11. P. falsiparum : chloroquine resistance Countries with at least one study indicating chloroquine total failure rate > 20% Countries with at least one study indicating chloroquine total failure rate > 10% No recent data available 12. P. falsiparum:Sulfadoxin-pyrimethamine resistanceCountries with at least one study indicating sulfadoxine-pyrimethamine total failure rate > 20%Countries with at least one study indicating sulfadoxine-pyrimethamine total failure rate > 10%Sulfadoxine-pyrimethamine total failure rate < 10%No failure reportedNo recent data available 13. P. vivaxprophylactic or treatment failureP. vivax prophylactic or treatment failure 14. Anti Malaria Drug Resistance In Indonesia,RESISTANCE OF PLASMODIUM TO MALARIA DRUGS IN INDONESIA 1978 - 2003 15. SAFE & EFFECTIVE DRUGS 16. COMPLIANCE 17. COST 18. MALARIA TREATMENTWhat should we pay attention to? Artemisinin based Combination Treatment Radical treatment is essential Outcome focus on clinical cure, parasitologicalclearance, and blocking transmission Monitoring therapeutic efficacy of antimalarial drugsbased on clinical and parasitological responses (in-vivo 28 days) 19. 74 countries have adopted ACTsUpdated1 Oct 2007Continent Countries Drug LineBurundi, Cameroon, Congo, Cte dIvoire, Democratic Republic of Congo, Eq.AS + AQ1stGuinea, Gabon, Ghana, Guinea, Liberia, Madagascar, Eritrea, Mali, Mauritania, Senegal,Sao Tom & Principe (ST&P), Sierra Leone, Sudan (S), AFRICA Tchad, ZanzibarAngola, Benin, Botswana, Burkina Faso, Central African Republic, Comoros, AL 1stEthiopia, Gambia, Guinea Bissau, Kenya, Malawi, Mozambique, Namibia, Niger,Nigeria, Rwanda, Uganda, S. Africa, Tanzania, Togo, Zambia, ZimbabweCte dIvoire, Djibouti, Gabon, Sudan (N), ST&P, Zanzibar AL 2ndDjibouti, Somalia, Sudan (N)AS + SP1stCambodia, Malaysia, Myanmar, ThailandAS +1st MQ Bangladesh, Bhutan, Laos, Philippines, Solomon Islands, Sri Lanka, Vanuatu AL 1stASIAIndonesia AS + AQ1stAfghanistan, India, Iran, Pakistan, Saudi Arabia, Tajikistan, Yemen AS + SP1stViet Nam, China DP 1st Papua New Guinea AS + SP2nd Iran, Saudi Arabia,AL 2ndSOUTHEcuador, PeruAS + SP1st AMERICA Bolivia, Colombia, Peru, VenezuelaAS +1st MQBrazil, Colombia, Guyana, SurinameAL 1st 20. INDONESIAS TREATMENT POLICYUncomplicated Pf Complicated Pf ATS3+AQ3+PQ QN parenteral-oral7+Dx7/Clin7 DHP3+PQ Artemether im-AQ3+ATS3 QN7+DX7/Clin7+PQ Artesunate iv-AQ3+ATS3Uncomplicated Pv Prophylaxis ATS3+AQ3+PQ14 Doxycycline DHP3+PQ14 Outbreak containment (MFS) QN7+PQ14 AQ3+ATS3+PQ1 21. Since 2004 Artesunate-amodiaquine as the first lineACT for P.falciparum malaria (based on the Africanstudy Adjuik M et al, Lancet 2002). Efficacy of Artesunate-amodiaquine varied betweenstudy sites 78-96% (Gasem H et al, 2004 ; Tjitra E et al, 2004; andSutanto I et al, 2004; Setyoningrum E et al, 2005; Hasugian et al, CID 2006 ). Utility of Artesunate-amodiaquine reported low (