by Dr Samlane Phompida, Director Centre of … Dr Samlane Phompida, Director Centre of Malariology Parasitology and Entomology P.phetsouvanh malaria situation update 2008 objectives

P.phetsouvanh malaria situation update 2008

Malaria control in Lao PDR : Malaria control in Lao PDR : progress report update 2009progress report update 2009

Vientiane CapitalVientiane Capital1616--1818thth March 2008March 2008

by Dr Samlane Phompida, Director by Dr Samlane Phompida, Director Centre of Centre of MalariologyMalariology ParasitologyParasitology and and

EntomologyEntomology


objectives• To reduce malaria mortality by 80%• To reduce malaria morbidity by 80%• To protect 3.6 Mio under ITN/LLN• To expand EDAT until the grass root

village level• Re-stratification of malaria control to adjust

malaria strategies and interventions


Annual Parasite Incidence (API) per 1,000 population: Provincial trend : 2005-2007

0

5

10

15

20

25

30

35

40

45

VT.Capita

lPhongs

alyLuan

gnamtha

Oudomxa

yBoke

oLuan

gpraban

gHuap

hanh

Xayab

uryXieng

khuan

gVienti

ane

Borikham

xay

Khammouan

eSav

annak

hetsa

ravan

ese

kong

Champa

sack

Attapeu

API

/100

0

API 2005 API 2006 API 2007


ACT+ADT 2005-2006

ACT+ADT 2004-2005

N

90 0 90 180 270 Kilometers

ACT/RDT coverage


comparison between malaria suspected cases vs confirmed cases

0

50000

100000

150000

200000

250000

300000

350000

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

year

mal

aria

cas

es

malaria casesconfirmed malaria cases


Villages under ITN in 2008

90 0 90 180 270 360 450 Kilometers

N

EW

S

%targetvillagecovered with IBN

%target_villages _covered

> 100%>80 %

Legend


83

96

52

78

64

108

166

13155

105

96

10578

96

43

36

44

100 0 100 200 Kilometers

N

EW

S

IBN_treatment rate

IBN_treatment rate> 50 %80 % > 80 %

ITN treatment rate in 2008


Number of IBN impregnated, population protected and person per net:

Trend: 2003-2008

8994

80

1 090

957

1386

241

1486

622

8135

39

9686

34

2353797 2443801 2360744 2599962

3292573 34075722.6

3.0

2.4 2.4 2.4 2.3

0500000

100000015000002000000

2500000300000035000004000000

2003 2004 2005 2006 2007 2008

Popu

latio

n pr

otec

ted

0

0.5

1

1.5

2

2.5

3

3.5

Pers

on p

er n

et

Net impregnated People protected Person/net


Luangorabang Province2007: Artesunate + LumefantrineSS= 5, FU= 28, ACPR= 100%

Vientiane Province1999: Chloroquine SS= 39, TF= 46%, RII/RIII: 33%

Khammouane Province2005-2006: Artesunate + LumefantrineSS= 42, FU= 28, ACPR= 100%2007: Artesunate + LumefantrineSS= 18, FU= 28, ACPR= 94.4%

Attapeu province2001: Chloroquine SS= 65, FU= 14, TF= 45-55%2002: FansidarSS= 33, FU= 14, TF: 15%Chloroquine + Fansidar SS= 55, FU= 14, TF= 15-25%MefloquineSS= 26, FU= 14, ACPR= 100%2005: Artesunate + LumefantrineSS= 43, ACPR= 100%2006: Artesunate + LumefantrineSS= 24, FU= 28, ACPR= 100%

Luangnamtha Province2001-2002: ChloroquineSS= 36, FU= 14, TF= 30-55%Fansidar SS= 39, FU= 14, TF= 18%2003: Artesunate + MefloquineSS= 53, FU= 42, ACPR= 100%Artesunate + LumefantrineSS= 47, FU= 42, ACPR= 93%

Champasack & Savannakhet2001-2002: ChloroquineSS= 78, FU= 14-42, TF= 30-55%FansidarSS= 122, FU= 14-42, TF= 10-18%Chloroquine + FansidarSS= 109, FU= 42, TF= 8 %2002-2003: Artesunate + MefloquineSS= 108, FU= 42, ACPR= 100%Artesunate + Lumefantrine SS= 107, FU= 42, ACPR= 97%

Saravane Province2003: FansidarSS= 21, FU= 28, S= 76.2%, RI=9.5%, RII/RII= 14.3%

Sekong Province1999: ChloroquineSS= 50, FU= 28, S= 38%, RII= 42.5%, RIII= 6%

Trend of anti - malarial drug resistance in the last 5 years

SS= Sample sizeFU= Follow up daysTF= Treatment failure (total)ACPR= Adequate Clinical & Parasitological Respons

Legend

100 0 100 200 Kilometers

N


ການແຈກຢາຍຂອງຍຸງນຳເຊື້ອ

A n . m in im u sA n . m a c u la t u sA n . d ir u s

A n .m in im u sA n .m a c u la t u s

A n .m i n i m u sA n .m a c u l a tu sA n . je yp o r i e n s i s

A n .m in i m u sA n .m a c u la tu sA n .d i r u s

A n . m in im u sA n . d ir u sA n . m a c u la tu s

A n .m in im u sA n .d i ru sA n .m a c u la t u sA n .je y p o r ie n s is

A n .m in im u sA n .d i ru sA n .m a c u la t u s

A n .m in im u sA n .d i ru sA n .je y p o r ie n s isA n .m a c u la t u s

A n .m in im u sA n .m a c u la t u sA n .d i ru s

A n .m in im u sA n .d iru sA n .m a c u la t u s

A n .m in im u sA n .m a c u la t u sA n .je y p o r ie n s is

A n .m in i m u sA n .m a c u la tu s

H O U A P H A N

S A V A N N A K H E T

S A Y A B O U R Y

K H A M M O U A N E

C H A M P A S S A K

O U D O M X A Y

L U A N G P H R A B A N G

B O L I K H A M X A Y

S A R A V A N E

X I E N G K H O U A N G

S E K O N G

V I E N T I A N E

DISTRIBUTION OF MALARIA DISTRIBUTION OF MALARIA VECTORSVECTORS


--

100100100100100100100100Saloy(XeponeSaloy(Xepone))An.dirusAn.dirus1616

Napho(NongNapho(Nong))An.dirusAn.dirus1515

100100100100100100100100Phiamayfarm(LamamPhiamayfarm(Lamam))An.dirusAn.dirus1414

--100100100100

100100100100100100

--100100100100

--100100100100

Toungnor(ThatengToungnor(Thateng))Toungnor(ThatengToungnor(Thateng))Toungnor(ThatengToungnor(Thateng))

An.dirusAn.dirusAn.aconitusAn.aconitusAn.maculatusAn.maculatus

1313

100100100100100100100100Pakvane(HilheupPakvane(Hilheup))An.nivipesAn.nivipes1212

100100100100100100100100NaNa--AngAng ((FuangFuang))An.minimusAn.minimus1111

100100100100100100100100Nampa(PaksaneNampa(Paksane))An.nivipesAn.nivipes1010

100100------NaNa--May(BolykanMay(Bolykan))An.nivipesAn.nivipes99

----

100100100100

100100--

100100--

Thamlay(XeybanfayThamlay(Xeybanfay))Thamlay(XeybanfayThamlay(Xeybanfay))

An.vagusAn.vagusAn.nivipesAn.nivipes

88

100100--

100100100100

94.7394.73--

100100--

KounephavanKounephavan((ThakeekThakeek))KounephavanKounephavan

An.vagusAn.vagus77

100100100100100100100100NaphoNapho ((PaksengPakseng))An.muculatusAn.muculatus66

--100100--100100NaNa--Yang (Yang (NambarNambar))An.minimusAn.minimus55

100100--

100100100100

----

--100100

Panekom(XayabulyPanekom(Xayabuly))An.jeyporiensisAn.jeyporiensisAn.maculatusAn.maculatus

44

100100100100100100--PakkemPakkem ((KenethaoKenethao))An.jeyporiensisAn.jeyporiensis33

100100--

100100++

100100--

100100--

Huangkuang1(Long)Huangkuang1(Long)An.maculatusAn.maculatusAn.minimusAn.minimus

22

100100100100100100100100DoneDone--May(SingMay(Sing))An.jeyporiensisAn.jeyporiensis11

ALPHACYPERMATHRINALPHACYPERMATHRIN30mg/m30mg/m22

DELTAMETHRINDELTAMETHRIN0.05%0.05%

DDTDDT4%4%

PERMETHRIN PERMETHRIN 0.75%0.75%

MORTALITEIS IN BIOASSAYS WITHMORTALITEIS IN BIOASSAYS WITHSTUDY SITESTUDY SITESPECIESSPECIESNoNo


Achievements• Malaria is not ranking in the top ten diseases reported by

MoH• Malaria network is expanded from central down to village• A total of 3.4 Mio. People were protected under ITN• 88,38% of uncomplicated Pf were tested and treated

accordingly with RDT/CoArtem• 95,51% of severe Pf received Artesunate inj.• Malaria R4 was proposed for RCC.


New innovatives• Initiation of PPM in 4 provinces of Laos (3 South

and 1 North)• Re-stratification of Malaria endemic areas with

NIMPE, Vietnam• Set up sentinel sites for malaria in 3

provinces(central, North and South)• Bed net survey under plan• Scaling up malaria control for EMG from 1

province to 5.• Quality assurance of RDT and ACT


New innovatives(Cont’)• Set up QA on microscopy at 3 regional sites:

North, Central and South• Combat anti-malarial fake and substandard drug

under collaboration with FDD• Initialize motivation mechanism for VHV in

working for malaria.• Improve MIS and LIS at village, HC level, district

and province level.


conclusions• Malaria has been much reduced and is not among the

10 to be reported diseases of MoH• New policies and strategy and intervention tools need to

be revised as malaria drops• Need for re-stratification of malaria endemic areas as

soon as possible• Concentrate all the efforts, budget and tools in high

malaria endemic foci in the South of Laos• Apply findings from new innovations to malaria

implementation


Thank you

KHOP CHAYTHANK YOUKHOPKHOP CHAYCHAYTHANK YOUTHANK YOU

Documents

by Dr Samlane Phompida, Director Centre of … Dr Samlane Phompida, Director Centre of Malariology Parasitology and Entomology P.phetsouvanh malaria situation update 2008 objectives