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Malaria Prevention and Control in Ethiopia

Abdi Ahmed Program Asst., Health Sector, PC-E Daniel Allen Malaria Initiative Coordinator, PC-E

Ethiopia: The Roof of Africa Africa’s second most‐populous country(2007) ~

74 million Predominantly rural 84% (decreasing trend) Poor access to safe water, housing, sanitation,

food, and health services Per capita income : $232 USD Malaria mortality rate 1.9% among inpatients

with malaria (5.6% of all inpatients)

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Epidemiological Profile –Malaria Burden

Malaria is a major public health problem in Ethiopia Consist ~4% of all cases in Africa 75% of the land is malarious (altitude < 2000 m), >50 million (68%) of the population at risk Malaria was the leading cause of OPD visits, health

facility admissions, and inpatient deaths, accounting for 12% of reported OPD visits and nearly 10% of admissions( 2008/2009)

Malaria Burden

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Ep.cal Profile

Transmission is unstable and seasonal

– Divers Eco-climate condition /altitude and climate are determinant factor

– Seasonal transmission occurs in highland fringe areas (1500-2500m) affected by frequent epidemic

– Relatively longer transmission duration in lowland areas, river basins and valleys area (below 1500m) .

Ep.cal Profile Cont …

- Major transmission season occurs in the period September - December following June -Sept rains

- Minor transmission season occurs in April – May following the February – March rains.

Coincide with major planting and harvesting season for farmers - aggravate economic loss

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The spatial distribution of Plasmodium falciparum malaria stratified by endemicity class map in 2010 in Ethiopia

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Ep.cal Profile Cont …

Vector and Parasite Major malaria vector / Anophelas species

– Mainly Anopheles arabiansis .

pharoensis , funestus and nilli also play secondary role

Major parasite/plasmodiam species – Plasmodium falciparum (60%)

– P. vivax (40%)

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Ep.cal Profile Cont …

Epidemic History Epidemics first documented in the 1930s by

Italian investigators Most notable epidemic of malaria occurred in

1958 resulted in 3 million cases and 150,000 deaths Since 1958, major epidemics of malaria

occurred at intervals of approximately 5-8 years Recently there has been a trend towards smaller-scale, more

frequent, sporadic epidemics and seasonal case build ups.

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Intervention Polices and Strategies

History of Malaria control in Ethiopia 1959 - Malaria Eradication Service established with funding

support by USAID along with Zimbabwe and South Africa

– One year after major malaria epidemic

1976 - The country shifted from an ‘eradication’ program to a

‘control’ program known as the National Organization for the

Control of Malaria and Other Vector-Borne Diseases.

1993 – Malaria control was integrated into general health system

and decentralized

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Current Strategy

Ethiopia recently developed Five-year National Strategic Plan for Malaria Prevention and Control (2011 – 2015)

Goals By 2015, achieve malaria elimination within

specific geographical areas with historically low malaria transmission;

By 2015, achieve zero deaths due to malaria in the remaining areas with malaria transmission.

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Strategies Cont…Starting from 1997 Ethiopia have been applying almost all

Recommended and Optional WHO Policies and strategies

1) Main strategies: Early diagnosis and effective treatment using RDTs and/or

microscopy and treating according to national guidelines. Vector control

• Insecticide treated nets/ LLINs – Free of charge and for targeting all groups

• Indoor Residual Spray– primary vector control• Environmental management activities

Epidemic prevention and control

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Anti-malaria Drugs (adopted 2004)

1st line - unconfirmed malaria - AL 1st line - P. falcifram (confirmed) - AL Treatment of severe malaria - QN Treatment failure of P. falcifram - QN Treatment of P. vivax - CQ

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Implementing Malaria Control

More than 20 million ITNs were distributed between 2005 and 2009;

15 million were distributed in 2010 and 2011 to replace ITNs distributed previously.

In 2010, 646,619 structures were sprayed and more than 2.1 million residents protected with IRS.

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Coverage of IRS and ITN

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Major sources of funds

Global Fund: - Round 2 (2002 - 2008; $73 million) - Round 5 (2005 - 2010; $140 million)- Round 8 (2008 – 2013; $276 million).

And recently applied for Global Fund Round 10

President’s Malaria initiative/PMI. In 2007, Ethiopia became one of the PMI

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Major sources of funds...

Funding increased from $2.7 million USD in 2001 to over $200 million USD between 2004 and 2007, mainly from the Global Fund and the United States President’s Malaria Initiative (PMI).

The program has secured over $150 million USD for the next five years.

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Cont….

Sources of funds GFATM USAID/PMI UNICEF WHO CIDA/CANADA The Carter Centre PSI The World Bank Japan/JICA Other partners

PMI Implementing Partners

Colombia University ICUP University of North Carolina John Snow Inc(JSI)DELIVER

TO3 MSH UNICEF FHI360 C-Change FIDO Pathfinder International Malaria Consortium United state Pharmacopeia/ USP Abt Association

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FINANCING – Government and external financing

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Considerations for Ethiopia Malaria Preventiono Lots of implementing partnersoHealth Extension Program

o2005: 2737 HEW and 776 health officerso2009: Over 30,000 HEW and 1606 health officersoOver 10,000 health posts (2 HEW per post, 5 posts per HC)

o Free diagnosis, free anti-malarial drugs, free distribution of ITNs and IRS

o ITP is not used in Ethiopia

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Trend in Malaria Morbidity & Mortality

Historically there have been an estimated 10 million clinical malaria cases annually,

Cases have reduced trend since 2006.

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Reported malaria cases, per 1000 (2010)

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History of Peace Corps in Malaria Prevention PC came in Ethiopia first in 1962 with an education sector,

then closed in 1977 due to political unrest during Derg socialist regime.

PC returned to Ethiopia in 1995 and then closed again in 2000 at the beginning of the Ethiopia-Eritrea War.

PC returned to Ethiopia in 2007 to work in the fight against HIV/AIDS.

2010: Environmental sector added 2011: Education sector added, HIV/AIDS sector shifts to

Health All 3 sectors can be informally involved in malaria

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Malaria training provided during PST Partnering with organizations such as PMI Volunteer-led activities such as:

Participate in environmental management activities with community health workers at community-level

Participate in Mass LLIN distribution and education campaigns

Social behavior change communication (SBCC)

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Current Malaria Activities

Following this training, a 3rd year PCV will join the Ethiopia head office staff as Inter-

Sectoral Malaria Initiative Coordinator.

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Distribution and Seasonality of Malaria in Ethiopia

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