Malaria Case management

1. Malaria Case management KPA conference

2. Presentation outline • Introduction • National malaria strategy • Case management targets • AMFm subsidy • The treatment policy • The health worker’s role

3. INTRODUCTION Annual burden of falciparum malaria in SSA - 365 million clinical episodes (Hay et al., 2005) Over 1 million fatal cases, mostly in children <5 yrs ( Snow et al., 2005).

4. INTRODUCTION Malaria - leading cause of mortality and morbidity in Kenya It accounts for 5% - 25% of deaths 34,000 under fives die annually due to malaria 30% of outpatient and 19% of inpatient attendance. An estimated 28 million Kenyans are at risk of infection of which 1.5 million are pregnant women.

5. Introduction ~ 170 million working days are lost annually to the disease, control and management of malaria – multi pronged Sound severe management presents the ” final arsenal” of defense for the particular patients Parasitemia in the presence of features like anaemia, convulsions, comma, hypoglycaemia

6. National malaria strategy • Interventions- • Vector control • Case management • Surveillance, monitoring and evaluation and operations research • Advocacy, communication and social mobilisation • Intermittent presumptive treatment

7. Case management objective • Objective 2: To have 80% of all self managed fever cases receive prompt and effective treatment and • 100% of all fever cases who present to health facilities receive parasitological diagnosis and effective treatment by 2013

8. Strategies • Strategy 2.1 Capacity building for malaria diagnosis and treatment • Strategy 2.2 Access to affordable malaria medicines through the private sector • Strategy 2.3 Strengthening Home Management of Malaria using the community strategy • Strategy 6.7 Strengthen procurement and supply management systems for malaria drugs and commodities

9. Targets • Scale up capacity for parasite based diagnosis countrywide in all public and mission health care facilities • Implement community based case management in high burden districts where community strategy is under implementation • Private sector capacity building beginning with major private hospitals and, pharmacies

10. Challenges • Procurement delays resulting in stock outs of anti malarials • Lack of diagnostic tools for universal implementation of the RDT policy • Irrational medicines use and non adherence to guidelines • Access to prompt and effective treatment 4% KMIS 2007

11. The AMFM • Global subsidy hosted by the GFATM to increase access to antimalarials in the private sector • Two year pilot 2010-2012 with a promise of extension if successful • Main objective is to subsidise cost of ACTs in the private sector

12. SUPPORTING INTERVENTIONS • Training of private sector workers • Deployment of ACTs to community health workers • Major IEC campaign • Inspection visits • Quality assurance of medicines and pharmacovigilance • Quality of care • Monitoring and evaluation

13. The policy • Uncomplicated malaria – first line ACTs • Second line – Dihydroartemisinine Piperaquine • Severe malaria – Quinine or alternatively artemisinines • WHO recommendations to change to artemisinines and government on the move to change policy (cost?)

14. Diagnosis • Confirmatory diagnosis for all age groups • Microscopy at higher levels • Rapid diagnostic tests for lower levels and where diagnosis by microscopy isn’t accessible. • Roll out at the community level 2013

15. ACTs • A group of schzonticidal drugs of which one is an artemisinine and which have different modes of action and biochemical targets • Advantages; • Rapid parasite clearance • Gametocytocidal effects • Slow development of resistance • Options- AL, DHAP, ASAQ.

16. Conclusion- health workers role • Enforcing diagnosis • Adhering to treatment policy • Encourage patient compliance • Refer severe cases • Monitor for treatment failure