KZN Malaria Crisis Progress Report - Department of Health · PARASITE PREVALENCE MAPS Swaziland...

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PRESENTATION OUTLINE• SITAUTIONAL ANALYSIS• LOBBYING FOR ADDITIONAL FUNDING• ITEMS PURCHASED• INTERVENTION • IMPACT• LUBOMBO SPATIAL DEVELOPMENT

INITIATIVE• SUMMARY• CONCLUSION

SITUATIONAL ANALYSIS IN KZN

• MALARIA ON THE INCREASE SINCE 1996• AFFECTS ALL SECTORS OF THE POPULATION• PREVALENCE VERY HIGH IN NORTHERN KZN• INGWAVUMA DISTRICT AFFECTED MOST• MOSQUITO RESISTANCE DETECTED• DRUG RESISTANCE REPORTERD• SHORTAGE OF FUNDS TO RUN AN

EFFECTIVE PROGRAMME

INCREASING DISEASE TREND

0

5000

10000

15000

20000

25000

30000

35000

40000

96 97 98 99 0 1

INCREASING MORTALITY TREND

0

5 0

10 0

15 0

2 0 0

2 5 0

3 0 0

3 5 0

9 6 9 7 9 8 9 9 0 1

MALARIA BURDEN

• Annual malaria death incidence : 8.2/1000 population

• % hospital OPD attendance : 18.3%• % malaria admissions : 48.8%• Vulnerable age group : 0-9 = 28%• Age specific mortality: 21-30 yrs =

16.2%

PARASITE PREVALENCE MAPS

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South AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth AfricaSouth Africa

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79.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.379.3NamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaachaNamaacha

BoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoane

ChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalaneChangalane

MatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuineMatutuine

SalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamangaSalamanga

MhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeniMhlumeni

MambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambaneMambane

BoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoaneBoane

MakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisMakanisNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumu

Plasmodium falciparumDecember 1999 June 2000

Percentage Positive

> 7550 to 7525 to 505 to 25

< 5

INCIDENCE MAPIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavuma

TembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembeTembe

NdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuNdumuMOZAMBIQUE

SWA

ZIL

AN

D

Kosi Bay Kosi Bay Kosi Bay Kosi Bay Kosi Bay Kosi Bay Kosi Bay Kosi Bay Kosi Bay Kosi Bay

St LuciaSt LuciaSt LuciaSt LuciaSt LuciaSt LuciaSt LuciaSt LuciaSt LuciaSt Lucia

> 500 (7)101 to 500 (32)51 to 100 (54)20 to 50 (60)

< 20 (59)Produced by: Malaria Research Programme MRC , Durban , August 2000Source: Tourism KwaZulu-Natal and (MIS)

FIGURE 2 : FIGURE 2 : FIGURE 2 : MALARIA CASE INCIDENCE FOR 1999 AND MALARIA CASE INCIDENCE FOR 1999 AND MALARIA CASE INCIDENCE FOR 1999 AND

TOURIST FACILITY DISTRIBUTIONTOURIST FACILITY DISTRIBUTIONTOURIST FACILITY DISTRIBUTION

MRC

0 10

kilometers20

Indian OceanUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbomboUbombo

MkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuzeMkuze

Sodwana Bay Sodwana Bay Sodwana Bay Sodwana Bay Sodwana Bay Sodwana Bay Sodwana Bay Sodwana Bay Sodwana Bay Sodwana Bay

HlabisaHlabisaHlabisaHlabisaHlabisaHlabisaHlabisaHlabisaHlabisaHlabisa

HluhluweHluhluweHluhluweHluhluweHluhluweHluhluweHluhluweHluhluweHluhluweHluhluwe

MkhuzeMkhuzeMkhuzeMkhuzeMkhuzeMkhuzeMkhuzeMkhuzeMkhuzeMkhuze

JoziniJoziniJoziniJoziniJoziniJoziniJoziniJoziniJoziniJozini

IngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavumaIngwavuma

Malaria Incidenceper 1000 population

Main Towns

Tourist Facilities

Magisterial Districts

Nature Reserves

Sections

Areas

500

LOBBYING FOR ADDITIONAL FUNDS

• THE MEC FOR HEALTH VISITS JOZINI & LISTENS TO PROBLEMS EXARCEBATING THE MALARIA BURDEN

• VISITS THE AFFECTED CLINICS

• VISITS THE HOMESTEADS• LAUNCHES THE R18

MILLION FROM PROVINCIAL GOVT.

NDUMU CLINIC - WORSE AFFECTED

AT A HOMESTEAD IN NDUMUONE OF THE HIGH RISK AREAS

UTILIZATION OF R18 MILLION– SUMMARY OF EXPENDITURE

• PERSONNEL R 310 522• ADMINISTRATION R1 424 878• STORES AND LIVESTOCK R9 906 584• EQUIPMENT R 228 191• PROFESSIONAL & SPEC SERVICES R 54 242• OFFICIAL VEHICLES R2 530 877

R14 455 294

ITEMS PURCHASED WITH R18 MILLION• HIRING OF CASUAL SPRAYMEN• PROTECTIVE

– CLOTHING• SPRAY PUMPS• INSECTICIDE

ITEMS PURCHASED WITH R18 MILLION• Total of 24 vehicles• 13 Malaria• 1 District• 2 Enviro.• 2 Bethesda• 2 Manguzi• 2 Mosvold• 2 Mseleni

TRAILERS IN COMPLIANCE WITH DDT USAGESPRAYMEN IN FULL PROTECTIVE CLOTHING

ITEMS PURCHASED WITH R18 MILLION• Diagnostics and treatments

PROMOTIONAL MESSAGES

BEDNETS

TRAINING ON BEDNET IMPREGNATION

• SELF AND INDIVIDUAL IMPREGNATION

INTERVENTION MEASURESINDOOR SPRAYING WITH DDT

LARVICIDES TO ELIMINATE VECTOR MOSQUITOES

INTERVENTION MEASURES• DDT SPRAYING• HEALTH EDUCATION• ENTOMOLOGICAL

SURVEYS• LARVICIDING• BEDNETS @ R20/NET• FREE FOR PREGNANT

MOTHERS

INTERVENTION MEASURES

• RANDOMISED SCREENING AND TREATMENT OF CONFIRMED CASES

• PROMOTIONAL MASSAGES ON CORRECT TREATMENT-SEEKING BEHAVIOUR

• HOSPITALIZATION OF SEVERE CASES

IMPACT AFTER DDT USE IN KZN

0

1000

2000

3000

4000

5000

6000

7000

J F M A M J J A S O N D

98 99 2000

DUKUDUKUSpraying started in March

050

100150200250300350400450500

J F M A M J J A S O N D

2000 2001

INGWAVUMA DISTRICT

0

500

1000

1500

2000

2500

3000

3500

4000

J F M A M J J A S O N D

98 99 2000

OVERALL IMPACT ON MALARIA• BEFORE INTERVENTION

• Death incidence rate : • 8.2/1000 population• % hospital OPD attendance

18.3%• % malaria admissions :

48.8%• Vulnerable age group

0-9yrs = 28%• Highest age specific mortality:

21-30 yrs = 16.2%

• AFTER INTERVENTION

• 7.08/1000

• 11.5%

• 13.6%

LEBOMBO SPRATIAL DEV. INITIATIVE• CO-OPERATION HAS BEEN GOOD• PARASITE PREVALENCE SURVEYS WILL BE

CONTINUED 6 MONTHLY FOR EVALUATION • SPRAYING WAS COMPLETED IN ZONE 1 AND

DUE FOR COMPLETION IN ZONE 1 A. (MOZAL)

• POSITIVE INTERVENTION IMPACT IS FELT BY NEIGHBOURING COUNTRIES

• POLITICAL PRESSURE NEEDED FOR DDT TO BE INTRODUCED IN MOZAMBIQUE

SUMMARY• CONTINUED COMMITMENT IN HUMAN AND

FINANCIAL RESOURCES BY PROVINCIAL CABINET

• SUPPORT BY ALL STAKEHOLDERS FROM THE DEPARTMENT OF HEALTH

• APPLIED RESEARCH TO DETERMINE IMPEDIMENTS I.E. DRUG AND INSECTICIDE RESISTANCE

• COLLABORATION AT ALL LEVELS• SUCCESS AS HAS BEEN SHOWN

CONCLUSION • GOOD CABINET• GOOD MEC FOR

HEALTH• GOOD HEAD OF

DEPARTMENT• EFFECTIVE

INSECTICIDE (DDT) AND EFFECTIVE DRUG (COARTEM)

• EXCELLENT SUPPORT FROM OTHER ROLE PLAYERS & LSDI

• SUCCEESFUL TEAM

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