Major Strategic Issues and Control Strategies

Malaria had historic reputations in hampering development and is a major threat to the development of the region. Our agriculture traditionally had been dependent almost entirely on unreliable rainfall, and because of this agricultural yield had been erratic. In an effort to address these problems of recurrent drought, famine, and food insecurity; the Regional Government is currently intensifying water harvest at household level in addition to the development of micro-dams initiated in 1994. Implementation of the major rural development program to change the agrarian system to widespread irrigation by water harvest using ponds, river diversions, micro-dams together with new volunteer settlement programs are mushrooming. These are expected to supplement rain-fed agriculture, and to gradually ensure food security at household level. This vision is impossible without concurrent health safe guards to ensure that these developmental efforts will not be jeopardized by disease outbreaks especially malaria. Most of our anti-malaria measures are trying to keep paces with the changing environment notably the ITNs coverage and the use effective anti-malaria drugs. Another major issue is uncertainties related to maintaining the donor driven programs such distribution of ITNs and provision of effective anti-malaria drugs and simple diagnostic facilities.

Major Achievements

Community possession of permanent protective tools, long lasting Insecticide treated nets has minimized the risk of failing to intervening proactively with residual insecticide house spraying operations at least in high priority areas. Reliance on DDT is minimized and kept constant for long period which will eventually start to decline when the ITNs strategy is proved to be effective and sustainable. Initial survey results (table-1B) on ITNs use seems promising. Another major success was that a significant proportion (about 70%) of the population at risk had been treated at village by volunteer CHWs until recently; this service is now compromised with introduction of the new and expensive first line drug which remains suspended at the peripheral formal health institution.

<Table-1. A. Characteristics & Findings> No. of ITNs Districts surveyed 3 No. of ITNs Tabias surveyed 19 No. of ITNs Villages surveyed 27 No. of Households surveyed 675 Total household(HH) population 3,246 Mean/HH (±SD) 4.8 ± 2 Total <5 children HH population 660 Mean/HH (±SD) 0.989 ± 0.84 Total pregnant wowen 71 Mean/HH (±SD) 0.11 ± 0.31 Limitations of the new first line drug (Coartem) Infants <5kg (3months) are not benefiting from the new drug Artemether Lumefantrine; Pregnant mothers are not benefiting ; Preliminary subjective assessment indicate adherence seems a major problem due to fast relief of patients; Pediatric formulation is a priority,   <Table-1. B. Indicators> No. Remark Expected No. of nets to be used Vs No. hung 871 Vs 641 74% utilization Households(HH) with at least 1 ITN hung 531 79% of the total HH Total old nets identified & reimpregnation status 113 Treated 62(55%), Not Treated 51(45%) Total population slept under ITN (Mean ±SD) 1807(2.7±1.9) 56% of the total population No. of <5 children who slept under ITN 491 74% of the <5 children No. of pregnant women who slept under ITN 51 72% of the pregnant women No. of nets with 1 or more un-repaired holes 73 8% of the total nets Total No. of un-repaired holes in nets hung (Mean ±SD) 159(0.25±0.9)   No. of nets washed after distribution/re-impregnation 8 0.9% of the total nets

Other Major Constraints Government new taxation regulations on medical supply; Deteriorations of quantity and quality of RDTs in the supply process (Global fund procurement); Policy restriction on the use of quinine IM at peripheral institutions.

The most important challenges are to: Encourage WHO to expedite efficacy testing on cheaper permanently impregnated ITNs; Expand meteorological monitoring and epidemic warning system; Train water development institutions, development agents and agriculturists regarding health safeguard incorporation into construction and operation of ponds and irrigation systems; Ensure better access to early diagnosis and treatment with the new first line drug Artemether Lumefantrine and simple RDTs; Institute sentinel site drug resistance and insecticide resistance monitoring Extend ITN distribution to high risk areas with education on appropriate use; Expand education efforts to the migrant labor community regarding need for prevention and early treatment of febrile illness. Enforce regional regulations regarding investers responsibility in relation to health care of employee (particularly migrant labors in high malaria transmission areas) Develop partnerships with collaborating institutions for operational research to improve quality of service.