Overview Of Role Back Malaria In Nigeria Current Treatment

OVERVIEW OF RBM IN NIGERIA IN NIGERIA: CURRENT TREATMENT POLICY DR. T. O. SOFOLA NATIONAL COORDINATOR

PREAMBLE 

Generally, malaria causes 300-500 million illnesses and 1-2 million deaths every year.

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In Nigeria Malaria is responsible for 60% of Out Patients visits 30% of childhood mortality 25% of infant mortality 11% of maternal deaths

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N132 billion is lost to Malaria annually in form of treatment costs, prevention, loss of man-hours, etc.

CONTROL OF MALARIA IN NIGERIA 

Several initiatives and programmes

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RBM now on ground since 1999

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Historic Summit in Abuja, April 25, 2000 (Abuja Declaration and Targets)

ROLL BACK MALARIA 

A partnership involving governments, private sector, research organizations, civil society, media.

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Aim to reduce malaria by half in 2010

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Abuja Targets (By 2005); 60% prompt access to appropriate treatment in 24hrs 60% of (children Under 5yrs and pregnant women) use insecticide treated nets (ITNs) 60% pregnant women to use Intermittent Preventive Treatment (IPT) with SulfadoxinePyrimethamine

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RBM STRATEGIC PLAN 

PRIORITY ISSUES:

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Case management including Home Treatment

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Promotion of ITN Use

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Intermittent Preventive Treatment (IPT) for Malaria in Pregnancy

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Partnership

RBM PROCESS IN NIGERIA 

Inception Phase  Consensus Building Meetings  Deskwork analysis  Situation Analysis  Collection of baseline data for monitoring and evaluation  Fostering of effective Partnership through formation of Partners forum and National Malaria Control Committee  Development of National and States Plans of Action, Strategic Plan.  Development of time-bound implementation plans with specific Interventions and products.

RBM PROCESS IN NIGERIA 

Implementation Stage: Focusing on these 1.

2.

Disease Management – improve access to quality affordable anti-malaria drugs, encouraging home care and training of health care providers. Disease Prevention – Promote use of ITNs, environmental management, and intermittent preventive treatment of malaria in pregnancy.

RBM PROCESS IN NIGERIA CONTD. 1.

IEC/Social Mobilization – for community action

3.

Operational Research to discover new tools and better interventions

5.

Health systems development – Improve quality of care and make facilities able to handle / refer cases

ITNs COVERAGE ITN Coverage, 2001-2005 60 50 40 coverage (%) 30 20 10 0 2001

2002

2003

2004

year

2005

Abuja

ACCESS TO TREATMENT Access to Treatment, 2001-2005 60 50 40 Cov (%) 30 20 10 0 2001

2002

2003

2004

year

2005

Abuja

INTERMITTENT PREVENTIVE TREATMENT – (IPT ) Coverage IPT, 2001-2005 60 50 40 Cov (%) 30 20 10 0 2001

2002

2003

2004

year

2005

Abuja

CASE MANAGEMENT 

Improving Case Management involves: •

•

• •

•

Instituting evidence based treatment Policy through monitoring resistance trends. Capacity building to improve prescription practices among health professionals Encouraging Home Management of Malaria Making effective and affordable quality agespecific anti-malaria drugs at community and home levels Building capacity of community based health support personnel e.g. PMVs

ACCESS TO TREATMENT 

ACHIEVEMENTS TO DATE           

Policy on PPD accepted by Govt. PPDs produced by private sector (Public / Private Partnership ensured) PPDs in the market Capacity building of health professionals through cascade training Work on orientation of health workers and community agents has started Monitoring of drug efficacy through studies at sentinel sites were instituted DTET carried out in 2002, previous one was done in 1987 Social marketing of PPD has been piloted in three States. Guidelines on use of PPD produced Rapid assessment on the use of anti-malarial drugs conducted Consensus Meeting on Drug Policy Review

National Treatment Policy  

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First line drug – Chloroquine Second line drug – Sulphadoxine Pyrimethamine Criteria for second line drug:  Ineffectiveness of the first line drugs  Adverse Reaction to first line  Resistance problems

National Treatment Policy Contd

MALARIA MGT WITH PRE-PACKAGED DRUG (PPD) REASONS FOR PPD

All patients grouped in 4 age-groups Chloroquine

•Reduce adulteration/fake drug Colour •Improve patients´compliance Yellow *Simplify dosage regimen no breaking of tablets etc.)

Agegroup

•Although drugs are best given according to bodyweight, in practice majority of the population do not have weighing-scales. Age is therefore used for PPD

Day 1

Day2

Day3

Below 1yr 75mg(1tab) 75mg(1tab)

75mg(1tab)

Blue

1 – 6yrs

150mg(1tab)

White

>6–12yrs

150mg x2tabs 150mg x2tabs 150mg x2tabs

Pink

>12 years

300mg x 2tabs 300mg x2 tab 300mg x1tab

150mg(1tab) 150mg(1tab)

Patients in 4 age-groups Sulphadoxine-pyrimethamine Colour Agegroup Single dose Paracetamol*

•It is colour coded, age specific to aid recognition by less educated

Yellow 2–24months 250+12.5mg x1tab 125mg x1tab Blue

2-6yrs

500+25mg x1tab

•It is labelled for manufacturers to protect and maintain quality & standards of their product

White

>6-12yrs

500+25mg x2tabs 500mg x1tab

500mg x1tab

Pink >12yrs 500+25mg x3tabs 500mg x2tab * Paracetamol is co-packed with SP and may be given thrice daily for 3 days 7

LESSONS LEARNED 

Local production of PPDs feasible

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PPDs available in the market

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PPDs acceptable

CHALLENGES 

There is need to: Work out a framework to update policy in line with results of the DTET  Sustain and indeed improve on the public private collaboration through the process  Use available evidence and lessons from other countries to go through the process efficiently  Move through this process fast in collaboration with all relevant stakeholders 

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