Systematic review: 24. studies. ian parasite rate = 26% 2% to 81%: Medi. ween 1989 and 2005 in 15 different. conducted betw

(1)

Impact of vector c

diagnostics on AC

t d b presented by

Dr A. Bosman, Global Malaria Prog

Artemisinin Conference 2010

12 O t b 2010 A t i M

12 October 2010, Antananarivo, M

ontrol and malaria

CT consumption

ramme M d Madagascar

(2)

Malaria decrea

effecti

Systematic review: 24 conducted betw i 15 diff t Systematic review: 24 conducted betw i 15 diff t in 15 different including 15’33 in 15 different including 15’33 Proportion of malaria a 2% to 81%: Medi Proportion of malaria a 2% to 81%: Medi Median PfPR 198 d f Median PfPR 200 D'Acrémo

ase in Africa due to

ve control

d d 4 studies ween 1989 and 2005 t Af i t i 4 studies ween 1989 and 2005 t Af i t i t African countries 1 patients t African countries 1 patients

among fevers highly variable: ian parasite rate = 26%

among fevers highly variable: ian parasite rate = 26%

85-1999_2-10 = 37% % 00-2007_2-10= 17%

(3)

Reduction o

29 countries ou

Reduction o

29 countries ou

(a) Americas (high incidence)

20 50

Honduras

(c) Eastern Mediterranean 1.0

ource: World Malaria Report 2009)

29 countries ou

8 10 12 14 16 18 20 30 40 0 p o p u la ti o n ( S u rin a m e ) Honduras Belize Nicaragua Peru Suriname 0 4 0.6 0.8 r 10 00 pop ul a ti on S a udi A ra b ia ) 0 2 4 6 8 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 0 10 20 C ases per 100 0 0.0 0.2 0.4 1997 1998 1999 2000 2001 2 C a ses pe (Ira n ,

(b) Americas (low incidence)

0.5 0.03 n a) El Salvador Mexico (d) Europe 1 5 0.2 0.3 0.4 0 01 0.02 1 000 po p u la ti o n ( A rg en ti n Mexico Argentina 1.0 1.5 e s pe r 1 0 0 0 popul a ti on b a ij a n, G e or gi a , Tur k e y ) 0.0 0.1 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 0.00 0.01 C ases p e r 1 0.0 0.5 1997 1998 1999 2000 2001 Ca s e (A ze rb

of >50% in cases:

utside of Africa and

of >50% in cases:

utside of Africa and

0.010

(e) South-East Asia

25 6

utside of Africa and …

0 004 0.006 0.008 e r 10 00 po pul a ti o n c o, O m a n , Sy ri a ) Iran Oman Saudi Arabia Morocco Syrian AR 15 20 r 1 000 p opula tion a n, S ri L a nk a ) 3 4 5 Sri Lanka Bhutan Thailand India 2002 2003 2004 2005 2006 0.000 0.002 0.004 C a s es p e (Mo ro c c 0 5 10 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 C a s es p e r (B h u ta 0 1 2 5 6 s ta n ) Turkey (f) Western Pacific 25 3 Lao PDR 2 3 4 5 1000 popul at ion ( T aj ik is Georgia Azerbaijan Tajikistan 10 15 20 s per 1000 pop ul at io n (L a o P D R ) 2 3 Viet Nam Malaysia Philippines 2002 2003 2004 2005 2006 0 1 C a ses p e r 0 5 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 C ase 0 1 GLOBAL

(4)

Reduction o

in 9 Af

Reduction o

in 9 Af

12000 Malariainpatient cases Malariainpatient deaths Eritrea

…. in 9 Af

6000 8000 10000 Ca se s 0 2000 4000 Acceleration started 0 2001 2002 2003 2004 2005 2006 2007 2008 Malariainpatient cases Malariainpatient deaths 14000 16000 18000

Sao Tome and Principe

6000 8000 10000 12000 M al ar ia in pat ie nt ca se s 0 2000 4000 6000 2000 2001 2002 2003 2004 2005 2006 2007 2008 Acceleration started

of >50% in cases:

frican countries

of >50% in cases:

frican countries

140 Malariainpatient cases Malariainpatient deaths 12 000 14 000 250 300 Rwanda

frican countries

80 100 120 De at hs 6 000 8 000 10 000 12 000 Cas es 150 200 250 De at hs 0 20 40 60 0 2 000 4 000 2001 2002 2003 2004 2005 2006 2007 2008 0 50 100 Acceleration started 0 160000 180000 200000 6000 7000 Malariainpatient cases Malariainpatient deaths 300 350 Zambia 80 000 100000 120000 140000 M al ar ia in pa ti en tca se s 3000 4000 5000 M al ar ia in pat ie nt de at hs 150 200 250 M al ar ia in pat ie nt de at hs 0 20 000 40 000 60 000 2001 2002 2003 2004 2005 2006 2007 2008 0 1000 2000 Acceleration started 0 50 100

(5)

Impact of free ACT an Impact of free ACT an & pregnant women) on & pregnant women) on Impact of free ACT an Impact of free ACT an & pregnant women) on & pregnant women) on & pregnant women) on & pregnant women) on & pregnant women) on & pregnant women) on

Bhattarai et al (2007) PLoS Med 4(11): e309 Bhattarai et al (2007) PLoS Med 4(11): e309 Bhattarai et al., (2007). PLoS Med 4(11): e309 Bhattarai et al., (2007). PLoS Med 4(11): e309

P it t d d 2

P it t d d 2 f ld i 2005 d f ld i 2005 d thth Parasite rate reduced 2

Parasite rate reduced 2--fold in 2005 and anothefold in 2005 and anothe Under

Under--5 malaria outpatients, inpatients and dea5 malaria outpatients, inpatients and dea The climate in Zanzibar remained favourable to The climate in Zanzibar remained favourable to

nd free LLIN (to children U5 nd free LLIN (to children U5 n malaria burden in Zanzibar n malaria burden in Zanzibar nd free LLIN (to children U5 nd free LLIN (to children U5 n malaria burden in Zanzibar n malaria burden in Zanzibar n malaria burden in Zanzibar n malaria burden in Zanzibar n malaria burden in Zanzibar n malaria burden in Zanzibar

ACT

ACT LLINLLIN

ACT

ACT _LLIN_LLIN

10

10 f ld i 2006 f ld i 2006 r 10

r 10--fold in 2006 fold in 2006 aths reduced 4

aths reduced 4--fold in 2005 compared to 2003 fold in 2005 compared to 2003 malaria throughout the same period

malaria throughout the same period GLOBAL

(6)

Adoption of policies f

p

Policy AFRO AMRO

No. endemic countries 43 23

42 11

Pf endemic countries _(98%)42 _(48%)11

f D i bli t 25 13

free Dx in public sector _(58%)25 _(56%)13

Dx test: all age groups _(77%)33 _(65%)15

Dx test: all age groups _{(77%) (65%)}

Dx test: only > 5yrs old _(23%)_(23%)10 0

RDT at community _(35%)15 _(30%)7

for malaria diagnosis (Dx)

g

( )

EMRO EURO SEARO WPRO Total

12 9 10 10 107 9 1 9 9 81 9 (75%) 1 (11%) 9 (90%) 9 (90%) 81 (76% 8 8 10 9 73 8 (67%) 8 (89%) 10 (100%) 9 (90%) 73 (68% 5 (42%) 8 (89%) 8 (80%) 7 (70%) 76 (71% (42%) (89%) (80%) (70%) (71% 1 (8%) 0 0 0 11 (10% (8%) (10% 3 (25%) 0 5 (50%) 5 (50%) 35 (33%

(7)

Diagnosis of ma in public sector with

Diagnosis of ma in public sector with in public sector with in public sector with

. 60% 80% 100% rm e d di a gnos is 20% 40% c a se s w ith c o n fi 0% Euro pe Am eri cas h-E % r e por te d c So uth

Based on cases reported to countries reporting tend to

laria: % reported cases

h parasitological diagnosis laria: % reported cases

h parasitological diagnosis h parasitological diagnosis h parasitological diagnosis h-E ast A sia Afr ica dite rra nea n tern Pa cifi c h Ea ste rn M ed We ste

to WHO: African % biased upwards since o undertake more case confirmation.

(8)

Rwanda: prelimina

pp

Malaria cases

Malaria cases & ACT annual orders& ACT annual orders

Malaria cases

Malaria cases & ACT annual orders& ACT annual orders

3000000 3500000 2000000 2500000 1000000 1500000 2000000 500000 1000000 LLIN distributio LLIN distributio 0 2001 2002 2003 2004 200

ary analysis (WMR 2010)

y

(

)

% malaria positive % malaria positive % malaria positive % malaria positive % % 50 60 % malaria positive % malaria positive % malaria positive % malaria positive % malaria outpatien % malaria outpatien % malaria outpatien % malaria outpatien % malaria inpatients % malaria inpatients % malaria inpatients % malaria inpatients % % 40 Malaria cases ACT orders 20 30 _{Positivity rate} % malaria OPD % malaria IPD 10 % malaria IPD on on 5 2006 2007 2008 2009 0

(9)

Countries with pro

Community C

Malaria Consortium PSI/TDR Malaria Consortium

Save the Children

IRC Catalytic Initiative PMI/MCH

ojects on (integrated)

Case Management

GLOBAL

(10)

Con

z Malaria trends reducing due t and LLINs - often combined z Major impact of malaria diagnj p g

(reporting suspected "fever c z Reduction of ACT consumpti z Reduction of ACT consumpti malaria diagnostics (e.g. test z At global level limited impact z At global level limited impact

– low use of malaria diagnostics

– expansion of community casep y

– variable of coverage of vector

nclusions

to increasing use of RDTs, ACTs nostics on malaria surveillance cases" → malaria confirmed cases)

on in areas with high level of use of on in areas with high level of use of ting >80% of suspected cases)

on ACT consumption because: on ACT consumption because:

s, esp. in countries with high burden

management with ACTs and AMFm (Phase Ig (