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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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Malaria program organization. Within the Government Republic of Namibia Ministry of Health and Social Services, the National Vector-borne Diseases Control Programme is part of the Directorate of Special Programmes (DSP). At the national level, the program supervises malaria activities at the regional and district level, providing them with trainings and supplies for vector control. The Central Medical Store provides all medicines and clinical supplies required to carry out malaria case management. Regional DSP Programme Administrators and Environmental Health Officers organize and support activities at the regional and district levels.
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Fig2: Malaria program organization. Within the Government Republic of Namibia Ministry of Health and Social Services, the National Vector-borne Diseases Control Programme is part of the Directorate of Special Programmes (DSP). At the national level, the program supervises malaria activities at the regional and district level, providing them with trainings and supplies for vector control. The Central Medical Store provides all medicines and clinical supplies required to carry out malaria case management. Regional DSP Programme Administrators and Environmental Health Officers organize and support activities at the regional and district levels.

Mentions: Established in 1991, the NVDCP is based in both Windhoek, the capital of Namibia, and Oshakati, in the northern malaria endemic area. The Directorate of Special Programmes (DSP) is a directorate of the Ministry of Health and Social Services (MoHSS) that oversees all activities related to HIV/AIDS, tuberculosis, and vector-borne diseases, including malaria. FigureĀ 2 depicts the organizational structure of the NVDCP. At the regional level, malaria services are managed by the Environmental Health Unit and DSP focal persons. At the district level, malaria activities (i.e. indoor residual spraying (IRS), diagnosis and treatment, and community outreach) are executed by the Primary Health Care supervisors and Environmental Health Officers (EHOs). At health centers and clinics, nurses provide case management services and distribute long-lasting insecticide-treated nets (LLINs). In some areas, non-governmental organizations (NGOs) help conduct information, education and communication (IEC) campaigns and distribute LLINs. All public health facilities receive clinical supplies from the Central Medical Store, which is housed separately under the Directorate of Tertiary Health Care and Clinical Support Services [14]. The National Institute of Pathology (NIP), which is state owned, conducts malaria microscopy in 37 laboratories throughout the country.Figure 2


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)

Malaria program organization. Within the Government Republic of Namibia Ministry of Health and Social Services, the National Vector-borne Diseases Control Programme is part of the Directorate of Special Programmes (DSP). At the national level, the program supervises malaria activities at the regional and district level, providing them with trainings and supplies for vector control. The Central Medical Store provides all medicines and clinical supplies required to carry out malaria case management. Regional DSP Programme Administrators and Environmental Health Officers organize and support activities at the regional and district levels.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Malaria program organization. Within the Government Republic of Namibia Ministry of Health and Social Services, the National Vector-borne Diseases Control Programme is part of the Directorate of Special Programmes (DSP). At the national level, the program supervises malaria activities at the regional and district level, providing them with trainings and supplies for vector control. The Central Medical Store provides all medicines and clinical supplies required to carry out malaria case management. Regional DSP Programme Administrators and Environmental Health Officers organize and support activities at the regional and district levels.
Mentions: Established in 1991, the NVDCP is based in both Windhoek, the capital of Namibia, and Oshakati, in the northern malaria endemic area. The Directorate of Special Programmes (DSP) is a directorate of the Ministry of Health and Social Services (MoHSS) that oversees all activities related to HIV/AIDS, tuberculosis, and vector-borne diseases, including malaria. FigureĀ 2 depicts the organizational structure of the NVDCP. At the regional level, malaria services are managed by the Environmental Health Unit and DSP focal persons. At the district level, malaria activities (i.e. indoor residual spraying (IRS), diagnosis and treatment, and community outreach) are executed by the Primary Health Care supervisors and Environmental Health Officers (EHOs). At health centers and clinics, nurses provide case management services and distribute long-lasting insecticide-treated nets (LLINs). In some areas, non-governmental organizations (NGOs) help conduct information, education and communication (IEC) campaigns and distribute LLINs. All public health facilities receive clinical supplies from the Central Medical Store, which is housed separately under the Directorate of Tertiary Health Care and Clinical Support Services [14]. The National Institute of Pathology (NIP), which is state owned, conducts malaria microscopy in 37 laboratories throughout the country.Figure 2

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