View
220
Download
2
Category
Tags:
Preview:
Citation preview
Bi-national Commission on HealthGuyana Suriname
Neglected Tropical Diseases
Dr. Shamdeo PersaudChief Medical Officer
GUYANA
NTD Control• Guyana on 1 of four in the Americas where LF still
endemic and 3 other NTD• Development of National Plan• Identification of Priorities
– LF – Targeted for elimination by 2016– STH – Targeted for control by 2015– Chagas – Elimination of vertical and Blood Transfusion
transmission; control of Oral and vector transmission – Leprosy – Elimination– ONCO and SCH not transmitted – Dengue, Leptospirosis and Malaria remain endemic in
selected Regions
Region Neglected Diseases
Region 1 – Barima Wine Chagas, Malaria, STH
Region 2 – Pomoroon/Supername Chagas, STH, LF, Leprosy, Rabies
Region 3 – West Demerara/Essequibo LF, STH, Leprosy, Dengue, Leptospirosis
Region 4 – East Bank Demerara LF, STH, Leprosy, Dengue, Leptospirosis
Region 4 – East Coast Demerara LF, STH, Leprosy, Dengue, leptospirosis
Region 4 – Georgetown LF, STH, Leprosy, Dengue, Leptospirosis
Region 5 – West Berbice/Mahaica LF, STH, Leprosy
Region 6 – East Berbice Corentyne LF, STH, Leprosy, Rabies
Region 7 – Cuyune/Mazurini Malaria, STH, Malaria, LF
Region 8 – Pataro/Sepurini Malaria, STH
Region 9 – Upper Essequibo/Upper Takatu
Malaria, STH, LF, Dengue
Region 10 – Upper Demerara/Upper Berbice
STH, LF, Malaria, Leprosy, Dengue
SEROLOGY PREVALENCEOF LF ANTIGEN
Ministry of Health, Guyana
Key: PrevalenceRed=20%-50%Yellow=4-20%Green< 4%
Plan for Transmission Interruption
• Phase one (2003 – 2007)– Social Mobilization– Develop, distribute, promote and use DEC salt– Monitoring and evaluation progress at sentinel sites
• Phase two (2008 – 2015)– Synergies with other neglected diseases– Evaluation of Phase one– Identify “Hot Spots” using surveillance information– Implement MDA with DEC and Albendazole– Monitor and evaluation progress at sentinel and spot
check sites
Ministry of Health, Guyana
Endemic LF IUs in Guyana
Ministry of Health, Guyana
Region/province
Total population
Source of population
data
Year of first round of MDA
Current Status
Region II 49,254 Cencus 2002 2003-DEC SaltDEC/Alb 2009
Eliminated
Region III 103,061 “ 2003-DEC Salt Endemic
Region IV 310,320 “ 2003-DEC Salt2012– DEC/ALB
Endemic
Region V 52,428 “ 2003-DEC Salt2008–DEC/Alb
Endemic
Region VI 123,694 “ 2003-DEC SaltDEC/Alb 2009
Eliminate
Region X 41,112 “ 2003-DEC Salt Endemic
Other Ares 11,000 Estimated 2003 – DEC Salt
Eliminate
Total 690,869
Phase oneSalt Fortification
• Adding beneficial chemical to salt• Does not alter taste or other qualities of salt• To combat public health problems (IDD, Dental Caries, Malaria, LF)
Iodine Deficiency Disorder (IDD)• Inadequate iodine in the body• Disease observed as enlarged thyroid, Mental retardation and
Cretinism, but several stages of physical sluggishness, learning disability, growth retardation and childhood morbidity
Iodized Salt- successful in eliminating these problems
Ministry of Health, Guyana
DEC-Salt for Mass Treatment • Program Launched in July 2003
– 2003 to early 2004 - 480 tons imported • Hurricane in Jamaica disrupted production, New
plant commissioned in March 2005• Salt became blue in 2006• Production recommenced in August 2005
– 2005 – 49 tons– 2006 – 80 tons – 2007 – 290 tons
• Production stop in August 2007
Ministry of Health, Guyana
Phase IIMass Drug Administration
Region 5 – Annually form 2009 - 2015◦Population - 52,428◦Eligible Pop – 47,000◦Population Treated - (2008 =81.7) (2010 =84%)
Region 2 – one round 2009Region 6 – one round 2010Region 4 – 2010 -2015
Georgetown/East Bank/East Coast360,000*Eligible 300,000*
Ministry of Health, Guyana
Phase IIMass Drug Administration
• Region 3 – Annual 2012 – 2016◦Population - 103,061◦Eligible Pop – 91,000
◦Region 10 – Annual 2012 – 2016◦Population – 41,112◦Eligible Pop – 37,200
Integrated NTD ProgramBackground
• The Georgetown Sanitation Improvement Project (GSOP) was developed by the Government of Guyana to improve the sanitation in the Capital City
• Project was supported by Inter-American Development Bank (IDB)
• Guyana Water Incorporated is the executing Agency a
Sentinel Monitoring
Ministry of Health, Guyana
Sentinel Site
Microfilaria%
Antigen(ICT) %
YEAR 2003 2006 2008 2012 2003 2006 2008 2012
LodgeRegion 4
11.2 7.2 NA 2.9 38 17.7 18.2 8.6
TucburRegion 6
2.6 2.9 1.7 NA 17.5 10.9 12 NA
Spot Check Sites
MelanieRegion 4
NA NA 1.7 27 NA NA 7.9
Bush LotRegion 5
NA 3,7 NA NA NA 14.6 NA
GSIP
The aims of the program are:i. Improve the operational performance of the
Georgetown sewerage system through the reconstruction of its most critical components;
ii. Strengthen GWI operational and financial performance by improving asset management and decreasing energy consumption;
iii. Limit the transmission of the water-related diseases lymphatic filariasis and intestinal helminthiasis.
Results of Baseline StudySentinel
SiteSample ICT
PrevalenceMicrofilara STH
(KATOKAT)
Lodge 462 8.6 2.9 1.7
Melanie Damishana
448 7.9 1.7 2.1
Totals 910 8.25 2.3 1q.9
Training
• Develop MDA guidelines in accordance with the Program Managers Guidelines
• Procure all essential medicines (DEC, albendazole) and supplies
• Training and orientation of health workers
• Requirement and training of community volunteers and supervisors
Mass Drug Administration
• Packaging of medication• Implement MDA (door to
door, Booths at Health Centers and Outreach teams)
• Collect and analysis program data on Coverage
• Conduct Coverage survey (post treatment survey)
Mass Drug Administration
Implementation Unit – Demerara/Mahaica (Region IV)– Population – 310, 320 (41.3%
Guyana's Population)– Eligible population – 301,000– Divided into 3 areas
• The City of Georgetown – Prevalence 28% (ICT)
• East Coast Demerara – Prevalence 16.5 % (ICT)
• East Bank Demerara – Prevalence -10.8% (ICT)
Age/height ALB DEC
By age group 2-5 years 400mg (1 tablet)
100mg(2 tablets)
6-15 years 400mg (1 tablet)
200mg(4 tablets)
> 15 years 400mg (1 tablet)
300mg(6 tablets)
Guyana Mass Treatment ChartNTD (LF/STH)
Coverage – Region IVYear 1
Treatment Area
Target population
HouseholdTargets
Adults Children Total
East Coast A-57,000C-8,000
T-65,000
15,476 39,482 6,109 45,591(70.1%)
East Bank A-41,000C-6,000
T-47,000
11,190 27,921 4,977 32,898(70%)
Georgetown A-152,000C-15,600
T-167,000
39,761 87,134 11,924 99,05859.4
Total A-250,000C-19,000
T-269,000
66,427 154,537 23,010 177, 54766%
Monitoring and evaluation
– Program coverage – Data management
– Survey coverage – Post treatment cluster surveys
– Morbidity– Reporting
• IDB and GWI• National and Regional
Programs
– Impact evaluation • Surveillance• National feedback
Challenges
• Capacity – Technical and administrative (PAHO/WHO and MOH assisted), Training (University Interns)
• Supervision and Data management – PAHO supported training and coordination
• Administrative and Logistic Support – Transport, Office space, Medicine storage and packaging (MOH provided all support)
• Procurement and supplies chain – DEC Procurements from Brazil, ALB donation from GSK
• Social Mobilization – Mass Media program was late and did not reach target population, MOH and GWI used their individual to enhance SM and HW conducted community Mobilization
Innovations
• Training of Volunteers from Community and Faith Based Organization
• Target large employers – Ministries, work places and Institutions
• Establishment of Distribution Points mainly at Health facilities
• Special Outreaches and “Mop-up” Exercises• Public Education – opportunities to “talk health”• Integrated Vector management.
Leprosy situation at national level,2011
Prevalence 0.9 per 10,000 pop
Number of new cases 24
% of multibacillary cases amongst new cases
70.8%
% of cases with grade 2 disability amongst new cases
4.2%
% of cases in children under 15 amongst new cases
12.5%
Detection rate(x 100.000 population)
3.2 x 100,000
Prevalence at first sub-national administrative level, 2011
1 2 3 4 5 6 7 8 9 100
0.5
1
1.5
2
Prevalence at first subnational level-
2011, GUYANA
Thank You
Recommended