Background

As shared vision of the general health service our vision is to roll back malaria to a level of no public health significance, through provision of the malaria control interventions services to the population at risk with excellence in community based household anti-malaria interventions with special emphasis to ITNs use promotion & expansion including early diagnosis and treatment services thereby decreasing morbidity, disability, mortality, poverty and sustain a cycle of health and wealth. The department us a major arm of the bureau has the following mandate: National/Regional Malaria Prevention & Control Policy implementation; Formulate malaria other vector-borne diseases prevention and control strategies; conduct operational research and training; Standardizing & regulating quality of anti-malaria and other vector control intervention services; Formulate anti-malaria and other vector control intervention directives and guidelines;

The majority of the region lies within altitude range of less than 2000 m above sea level, more precisely according to United States Geological Survey (USGS) digital elevation model 78% of the districts’ majority terrain lies within less than 2000 meters above sea level (Map-2 below). Similar proportion of the population is at risk. Average temperatures ranges from about less than 16 °C at higher altitudes to 22 °C in areas below 2,400 meters. Although the altitudinal limit of malaria was marked as 2000 m during the malaria eradication era, it may transcend this boundary during extreme weather events that favor the force of transmission. The high degree of variability in landscape, altitude and climate of villages, makes the force of malaria transmission temporally and spatially variable over short distances. Therefore malaria situation in the region is unstable with most of the populations having little or no immunity. Most of the lowland areas have an average temperature of about 27 °C and following the big rain is a seasonal transmission of malaria during the months September through November. Following the small rain is another minor transmission in May/June in areas with bimodal rainfall pattern (some eastern and southern districts). These seasonal transmissions at times show high peaks, excess of the norm to cause epidemics with very high levels of morbidity and mortality. According to the 2001/2002 health profile of the region, Malaria is number one cause of death (19%), number one cause of admission (15%), and number one cause of outpatient visits (15%). The later figure excludes about 70% febrile patients who are clinically treated by community health workers (CHWs) at village level.

Stratification of the Region The basis for stratification of districts boundaries to clusters is the most recent 5 years malaria morbidity data, 2004-2005. Color delineated clusters indicate status of homogeneity in terms of intensity of malaria. Similar distribution of the malaria burden is observed when community health workers’ (CHWs’) Clinical treatment of Malaria at village level is overlaid on the digital elevation model of the USGS Map-2. The presence of such robust evidence for prioritizing areas of great concern has following additional advantages: To intervening proactively as opposed to reacting "fire-fighting". Decision support for enhancing the efficiency in allocating scarce resources; Minimizes errors in targeting; To ensure equity and avoid claims of sharing on the basis of non relevant formulas. Such stratification of malaria burden is laying the basis for early warning system in the region.