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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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Related in: MedlinePlus

Malaria program expenditures in study regions, 2009–2011. PAR = population at risk; CLM = controlled low-endemic malaria; M&E = monitoring and evaluation. All figures are reported in 2011 USD. Note: Figures A, B, and C contain different scales in US$ per PAR.
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Fig4: Malaria program expenditures in study regions, 2009–2011. PAR = population at risk; CLM = controlled low-endemic malaria; M&E = monitoring and evaluation. All figures are reported in 2011 USD. Note: Figures A, B, and C contain different scales in US$ per PAR.

Mentions: From 2009 to 2011, total annual expenditures on malaria in Kunene declined by 28.0%, from US$ 5.61 per population at risk per year (PPY) to US$ 3.46 PPY in 2011 (see Figure 4, Panel A). Expenditures in the study include both government funding and the government funding provided from the GFATM grants. In 2009, diagnosis and treatment accounted for half of the total expenses (50.4%), followed by vector control and prevention (23.5%). By 2011, spending on diagnosis and treatment declined to 24.8%, most likely due to the decrease in treatment expenditures, but spending on vector control increased to 45.4%. Spending on personnel declined from 73.8% in 2009 to 66.5% in 2011, largely due to less time spent on diagnosis and treatment by health workers (see Table 1). Conversely, because of expanded IRS activity, spending on consumables increased from 9.3% to 20.6% over the same time period.Figure 4


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 expenditures in study regions, 2009–2011. PAR = population at risk; CLM = controlled low-endemic malaria; M&E = monitoring and evaluation. All figures are reported in 2011 USD. Note: Figures A, B, and C contain different scales in US$ per PAR.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: Malaria program expenditures in study regions, 2009–2011. PAR = population at risk; CLM = controlled low-endemic malaria; M&E = monitoring and evaluation. All figures are reported in 2011 USD. Note: Figures A, B, and C contain different scales in US$ per PAR.
Mentions: From 2009 to 2011, total annual expenditures on malaria in Kunene declined by 28.0%, from US$ 5.61 per population at risk per year (PPY) to US$ 3.46 PPY in 2011 (see Figure 4, Panel A). Expenditures in the study include both government funding and the government funding provided from the GFATM grants. In 2009, diagnosis and treatment accounted for half of the total expenses (50.4%), followed by vector control and prevention (23.5%). By 2011, spending on diagnosis and treatment declined to 24.8%, most likely due to the decrease in treatment expenditures, but spending on vector control increased to 45.4%. Spending on personnel declined from 73.8% in 2009 to 66.5% in 2011, largely due to less time spent on diagnosis and treatment by health workers (see Table 1). Conversely, because of expanded IRS activity, spending on consumables increased from 9.3% to 20.6% over the same time period.Figure 4

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