Malaria Technical Update – ITNs Sixte Zigirumugabe President’s Malaria Initiative With thanks to Michael Mcdonald-PMI, Jo Lines WHO-GMP, Ibrahim Soce Fall-WHO Afro 1 The Alliance for Malaria Prevention Behavior Change Communication Workshop for Long-Lasting Insecticide-Treated Net (LLIN) Scale Up to Universal Coverage and Use Bamako, Mali 21 – 24 September, 2010
Malaria Technical Update – ITNs Sixte Zigirumugabe Presidents Malaria Initiative With thanks to Michael Mcdonald-PMI, Jo Lines WHO-GMP, Ibrahim Soce Fall-WHO.
Mar 26, 2015
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Malaria Technical Update – ITNs
Sixte Zigirumugabe President’s Malaria Initiative
With thanks to Michael Mcdonald-PMI, Jo Lines WHO-GMP,Ibrahim Soce Fall-WHO Afro
1
The Alliance for Malaria Prevention
Behavior Change Communication Workshop for Long-Lasting Insecticide-Treated Net (LLIN) Scale Up to Universal Coverage and Use
Bamako, Mali 21 – 24 September, 2010
Most available tool for malaria prevention Most easy to use component of IVM Proven reduction of malaria related
morbidity and mortality among the most vulnerable target groups.
AMPBCC Workshop Bamako September 2010
Large CoverageAdherence: appropriate usageInsecticide-treatment (LLINs nowadays)Well designed and implemented BCC
AMPBCC Workshop Bamako September 2010
Individual protective effect Reduction in malaria vector population Reduction in all-cause mortality in infants Reduction in health facility visits by sick
children Reduction in maternal &placental malaria Reduction in maternal anemia and LBW Community/ Mass effect
AMPBCC Workshop Bamako September 2010
0 10 20 30 40 50 60 70 80
Kenya (2000,2003)
Sierre Leone (2000,2005)
Côte d'Ivoire (2000,2006)
Niger (2000,2006)
Senegal (2000,2005)
Burundi (2000,2005)
Burkina Faso (2003,2006)
Uganda (2000, 2006)
Cameroon (2000,2006)
Central African Republic (2000,2006)
Tanzania (1999,2005)
Benin (2001,2006)
Ghana (2003,2006)
Malawi (2000,2006)
Zambia (1999,2006)
Togo (2000,2006)
Guinea-Bissau (2000,2006)
Sao Tome & Principe (2000,2006)
Gambia ,The (2000,2006)
Rwanda (2000,2007)
%Around 2000 Around 2005
AMPBCC Workshop Bamako September 2010
South Africa
0
5,000
10,000
15,000
20,000
25,000
30,000
2001 2002 2003 2004 2005 2006
Year
Ca
se
s
0
20
40
60
80
100
120
140
160
De
ath
s
Eritrea
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
2001 2002 2003 2004 2005 2006
Year
Ca
se
s
0
20
40
60
80
100
120
140
De
ath
s
Tanzania (Zanzibar)
0
7,500
15,000
22,500
30,000
37,500
45,000
2001 2002 2003 2004 2005 2006
Year
Ca
se
s
0100200300400
500600700800900
De
ath
s
Swaziland
02,0004,0006,0008,000
10,00012,00014,00016,00018,00020,000
2001 2002 2003 2004 2005 2006
Year
Ca
se
s
0
10
20
30
40
50
60
De
ath
s
YearCa
se
s
De
ath
s
Malaria Cases Malaria Deaths
South Africa
0
5,000
10,000
15,000
20,000
25,000
30,000
2001 2002 2003 2004 2005 2006
Year
Ca
se
s
0
20
40
60
80
100
120
140
160
De
ath
s
Eritrea
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
2001 2002 2003 2004 2005 2006
Year
Ca
se
s
0
20
40
60
80
100
120
140
De
ath
s
Tanzania (Zanzibar)
0
7,500
15,000
22,500
30,000
37,500
45,000
2001 2002 2003 2004 2005 2006
Year
Ca
se
s
0100200300400
500600700800900
De
ath
s
Swaziland
02,0004,0006,0008,000
10,00012,00014,00016,00018,00020,000
2001 2002 2003 2004 2005 2006
Year
Ca
se
s
0
10
20
30
40
50
60
De
ath
s
South Africa
0
5,000
10,000
15,000
20,000
25,000
30,000
2001 2002 2003 2004 2005 2006
Year
Ca
se
s
0
20
40
60
80
100
120
140
160
De
ath
s
Eritrea
0
20,000
40,000
60,000
80,000
100,000
120,000
140,000
2001 2002 2003 2004 2005 2006
Year
Ca
se
s
0
20
40
60
80
100
120
140
De
ath
s
Tanzania (Zanzibar)
0
7,500
15,000
22,500
30,000
37,500
45,000
2001 2002 2003 2004 2005 2006
Year
Ca
se
s
0100200300400
500600700800900
De
ath
s
Swaziland
02,0004,0006,0008,000
10,00012,00014,00016,00018,00020,000
2001 2002 2003 2004 2005 2006
Year
Ca
se
s
0
10
20
30
40
50
60
De
ath
s
YearCa
se
s
De
ath
s
Malaria Cases Malaria Deaths
AMPBCC Workshop Bamako September 2010
0
10
20
30
40
50
60
70
Ghana Tanzania Rwanda Senegal Zambia
% H
ou
seh
old
Ow
ner
ship
AMPBCC Workshop Bamako September 2010
0
20
40
60
80
100
120
140
160
180
Ghana Tanzania Rwanda Senegal Zambia
Dea
ths
per
100
0 liv
e b
irth
s
AMPBCC Workshop Bamako September 2010
AMPBCC Workshop Bamako September 2010
Pregnant Women in ITN Village:
During Pregnancy: < parasitemia 27% < anemia 16%
At Delivery: < placental malaria 20% < preterm delivery 40% Higher mean birth
weight 68.8 g
(Ter Kuile, et al. 1999; W. Kenya)
AMPBCC Workshop Bamako September 2010
◦ All age-groups - targeting to vulnerable groups only if necessary
◦ Socio-economic equity AND geographic equity ◦ draft indicators & how the mass effect works
Campaigns every 3 years – Yes but not alone!
◦ Current LLIN strategies assume that all LLINs exactly 3 years. Periodic campaigns alone give full and full-time coverage of the target population – but the data says this assumption is false!
Must have Keep-Up too - give equal priority to routine systems – ANC + EPI ?
Re-treatment of local nets during campaignsJoe Lines WHO GMP
AMPBCC Workshop Bamako September 2010
AMPBCC Workshop Bamako September 2010
Multi-country studies show unexpectedly large variation in effective life between locations – even more variation between locations than between brands
Evidence that the relative lifespan of different brands is not constant but varies in different contexts
So a global “top five” ranking is not realistic
Draft standard durability monitoring methods (by CDC and MC experts) now being circulated. Should user preference also be included?
Need constant flow of location-specific data. It is anticipated that this monitoring will be recommended as "good practice"
in all large-scale procurements/deployments, for all implementation agencies, and all donors, especially GFATM.
How to feed this data back to inform product choice in GF procurement? ◦ WHO will set standards and criteria for its independence and quality – this is the
key condition for procurement◦ Need for technical support from VCWG to roll-out these monitoring methods
◦ Joe Lines WHO GMP
AMPBCC Workshop Bamako September 2010
Responding to a mixture of nets – range of conditions, include untreated nets
- operational research needed, procurement SOPs, Logistics SOPs, Village- and Household-level SOPs ◦ Indices of Universal Coverage◦ Procure 1 net for 1.8 people at population level in order to
achieve 1 for 2 at HH level.◦ M&E questions – how to enumerate uncovered sleeping
places? ◦ Nets per person ratio at programme, village and HH levelsJoe Lines WHO GMP
AMPBCC Workshop Bamako September 2010
Do we need to remove old nets? ◦ 2 reasons suggested ... Blocking new nets and
environmental pollution. But Evidence? ◦ Research project - assess need to dispose and
methods ( meanwhile DON”T burn ) ◦ Old nets are best re-used within the community –
e.g., under the bed, as eave-curtains, or to protect seedlings / cabbages
◦ Joe Lines WHO GMP
AMPBCC Workshop Bamako September 2010
331 million nets distributed 2004-2010
218 million useful nets (distributed 2008-2010)
19-20 million nets distributed/month
By end of 2010 enough nets to cover needs….
But what about use?
(Net Mapping Project)
ITNs Distributed in Sub-Saharan Africa 2004-2010
0
10
20
30
40
50
60
70
80
90
100
2004 2005 2006 2007 2008 2009 2010 2Q
In M
illi
on
s
AMPBCC Workshop Bamako September 2010
A rational decision-making process for optimal use of resources for vector control
Cross sector collaboration
Integrated approach Advocacy, social mobilization and
legislation
Evidence-based decision-making
Capacity-buildingAMPBCC Workshop Bamako September 2010
Insecticide Resistance Sources of Selection
Agriculture Vector Control Pollutants in larval habitats Domestic
Resistance Management
The spread of knockdown rate has NOT been followed by immediate and obvious control failure.
Ideally rotate to non-pyrethroid for IRS Need to build capacity and fill data gaps Support IVM
AMPBCC Workshop Bamako September 2010
Thanks to Vincent Corbel
AMPBCC Workshop Bamako September 2010
AMPBCC Workshop Bamako September 2010
Public Private, Commercial
CBOs, NGOs
RBM
Consumer Information
Clinical Services
PolicyStandards/NormsRegulatoryTrainingM&E
Clinical Services
Drug Sellers
Marketing
ITNs Distribution
Equity & Vulnerable Groups
DistributionSustainability
Clinical Services;
Prevention and Environmental Health activities;
Household and Community Demand Creation
Other Health/community Development Services
AMPBCC Workshop Bamako September 2010
Agriculture
Education
Economic DevelopmentCommunications
Environmental Health
Malaria HIV/AIDS
Livelihood
AMPBCC Workshop Bamako September 2010
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