Limits...
Namibia's path toward malaria elimination: a case study of malaria strategies and costs along the northern border.

Smith Gueye C, Gerigk M, Newby G, Lourenco C, Uusiku P, Liu J - BMC Public Health (2014)

Bottom Line: Indoor residual spraying is the main intervention, but coverage varies, related to acceptability, mobility, accessibility, insecticide stockouts and staff shortages.Bed net distribution was scaled up beginning in 2005, assisted by NGO partners in later years, but coverage was highly variable.Distribution of rapid diagnostic tests in 2005 resulted in more accurate diagnosis and can help explain the large decline in cases beginning in 2006; however, challenges in personnel training and supervision remained during the expenditure study period of 2009 to 2011.

View Article: PubMed Central - PubMed

Affiliation: UCSF Global Health Group, San Francisco, CA, USA. cara.smith@ucsf.edu.

ABSTRACT

Background: Low malaria transmission in Namibia suggests that elimination is possible, but the risk of imported malaria from Angola remains a challenge. This case study reviews the early transition of a program shift from malaria control to elimination in three northern regions of Namibia that comprise the Trans-Kunene Malaria Initiative (TKMI): Kunene, Omusati, and Ohangwena.

Methods: Thirty-four key informant interviews were conducted and epidemiological and intervention data were assembled for 1995 to 2013. Malaria expenditure records were collected for each region for 2009, 2010, and 2011, representing the start of the transition from control to elimination. Interviews and expenditure data were analyzed across activity and expenditure type.

Results: Incidence has declined in all regions since 2004; cases are concentrated in the border zone. Expenditures in the three study regions have declined, from an average of $6.10 per person at risk per year in 2009 to an average of $3.61 in 2011. The proportion of spending allocated for diagnosis and treatment declined while that for vector control increased. Indoor residual spraying is the main intervention, but coverage varies, related to acceptability, mobility, accessibility, insecticide stockouts and staff shortages. Bed net distribution was scaled up beginning in 2005, assisted by NGO partners in later years, but coverage was highly variable. Distribution of rapid diagnostic tests in 2005 resulted in more accurate diagnosis and can help explain the large decline in cases beginning in 2006; however, challenges in personnel training and supervision remained during the expenditure study period of 2009 to 2011.

Conclusions: In addition to allocating sufficient human resources to vector control activities, developing a greater emphasis on surveillance will be central to the ongoing program shift from control to elimination, particularly in light of the malaria importation challenges experienced in the northern border regions. While overall program resources may continue on a downward trajectory, the program will be well positioned to actively eliminate the remaining foci of malaria if greater resources are allocated toward surveillance efforts.

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Related in: MedlinePlus

P. falciparumtransmission and predictions of receptivePfPR2–10. Map of Namibia showing the spatial limits of P. falciparum transmission and predictions of receptive P. falciparum parasite rate (for age range 2–10 years, or PfPR2–10) at health district within the stable limits. The receptive risks were computed as the maximum mean population adjusted PfPR2–10 predicted for the years 1969, 1974, 1979, 1984 and 1989 for each health district [13].
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Fig1: P. falciparumtransmission and predictions of receptivePfPR2–10. Map of Namibia showing the spatial limits of P. falciparum transmission and predictions of receptive P. falciparum parasite rate (for age range 2–10 years, or PfPR2–10) at health district within the stable limits. The receptive risks were computed as the maximum mean population adjusted PfPR2–10 predicted for the years 1969, 1974, 1979, 1984 and 1989 for each health district [13].

Mentions: Despite the overall reduction of malaria, there remains low to moderate transmission in the northern regions bordering Angola [12]. Figure 1 describes the spatial limits of Pf transmission and predictions of receptivity. Of the three study regions, Ohangwena has the highest transmission receptivity potential, followed by Omusati and Kunene [13]. While the western coast of Kunene is unsuitable for malaria transmission, the northeastern area has stable controlled low-endemic transmission (PfPR2–10 < 1%) and the southeast has hypoendemic 1 transmission (PfPR2-101 to <5%). Most of Omusati has hypoendemic 1 transmission, while the border area between Omusati and Ohangwena has hypoendemic 2 transmission (PfPR2–10 5 to <10%). The eastern parts of Ohangwena have mesoendemic transmission (PfPR2-1010 to 30%). See Appendix A for methods used to generate Figure 1.Figure 1


Namibia's path toward malaria elimination: a case study of malaria strategies and costs along the northern border.

Smith Gueye C, Gerigk M, Newby G, Lourenco C, Uusiku P, Liu J - BMC Public Health (2014)

P. falciparumtransmission and predictions of receptivePfPR2–10. Map of Namibia showing the spatial limits of P. falciparum transmission and predictions of receptive P. falciparum parasite rate (for age range 2–10 years, or PfPR2–10) at health district within the stable limits. The receptive risks were computed as the maximum mean population adjusted PfPR2–10 predicted for the years 1969, 1974, 1979, 1984 and 1989 for each health district [13].
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4255954&req=5

Fig1: P. falciparumtransmission and predictions of receptivePfPR2–10. Map of Namibia showing the spatial limits of P. falciparum transmission and predictions of receptive P. falciparum parasite rate (for age range 2–10 years, or PfPR2–10) at health district within the stable limits. The receptive risks were computed as the maximum mean population adjusted PfPR2–10 predicted for the years 1969, 1974, 1979, 1984 and 1989 for each health district [13].
Mentions: Despite the overall reduction of malaria, there remains low to moderate transmission in the northern regions bordering Angola [12]. Figure 1 describes the spatial limits of Pf transmission and predictions of receptivity. Of the three study regions, Ohangwena has the highest transmission receptivity potential, followed by Omusati and Kunene [13]. While the western coast of Kunene is unsuitable for malaria transmission, the northeastern area has stable controlled low-endemic transmission (PfPR2–10 < 1%) and the southeast has hypoendemic 1 transmission (PfPR2-101 to <5%). Most of Omusati has hypoendemic 1 transmission, while the border area between Omusati and Ohangwena has hypoendemic 2 transmission (PfPR2–10 5 to <10%). The eastern parts of Ohangwena have mesoendemic transmission (PfPR2-1010 to 30%). See Appendix A for methods used to generate Figure 1.Figure 1

Bottom Line: Indoor residual spraying is the main intervention, but coverage varies, related to acceptability, mobility, accessibility, insecticide stockouts and staff shortages.Bed net distribution was scaled up beginning in 2005, assisted by NGO partners in later years, but coverage was highly variable.Distribution of rapid diagnostic tests in 2005 resulted in more accurate diagnosis and can help explain the large decline in cases beginning in 2006; however, challenges in personnel training and supervision remained during the expenditure study period of 2009 to 2011.

View Article: PubMed Central - PubMed

Affiliation: UCSF Global Health Group, San Francisco, CA, USA. cara.smith@ucsf.edu.

ABSTRACT

Background: Low malaria transmission in Namibia suggests that elimination is possible, but the risk of imported malaria from Angola remains a challenge. This case study reviews the early transition of a program shift from malaria control to elimination in three northern regions of Namibia that comprise the Trans-Kunene Malaria Initiative (TKMI): Kunene, Omusati, and Ohangwena.

Methods: Thirty-four key informant interviews were conducted and epidemiological and intervention data were assembled for 1995 to 2013. Malaria expenditure records were collected for each region for 2009, 2010, and 2011, representing the start of the transition from control to elimination. Interviews and expenditure data were analyzed across activity and expenditure type.

Results: Incidence has declined in all regions since 2004; cases are concentrated in the border zone. Expenditures in the three study regions have declined, from an average of $6.10 per person at risk per year in 2009 to an average of $3.61 in 2011. The proportion of spending allocated for diagnosis and treatment declined while that for vector control increased. Indoor residual spraying is the main intervention, but coverage varies, related to acceptability, mobility, accessibility, insecticide stockouts and staff shortages. Bed net distribution was scaled up beginning in 2005, assisted by NGO partners in later years, but coverage was highly variable. Distribution of rapid diagnostic tests in 2005 resulted in more accurate diagnosis and can help explain the large decline in cases beginning in 2006; however, challenges in personnel training and supervision remained during the expenditure study period of 2009 to 2011.

Conclusions: In addition to allocating sufficient human resources to vector control activities, developing a greater emphasis on surveillance will be central to the ongoing program shift from control to elimination, particularly in light of the malaria importation challenges experienced in the northern border regions. While overall program resources may continue on a downward trajectory, the program will be well positioned to actively eliminate the remaining foci of malaria if greater resources are allocated toward surveillance efforts.

Show MeSH
Related in: MedlinePlus