progress report: t he national lf and sth programme in maldives
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Progress report:the national LF and STH programme
in MALDIVES
Mohamed Faisal2014
RPRG MeetingWHO Region
Geography and Population◦ Total population: 371,507 (Census 2006)
◦ Ecological zones – next slide
Political & Health Administrative Divisions:- First level :Central Level - HPA- Second level : Regional (political
but not for health sector) - Atoll Level
- Third level : Island Level
Background Information
REPUBLIC OF MALDIVES
• Maldives comprises of 1190
Islands
• Administrative natural atolls 20
• Total inhabited Islands 197
• Country population (2013 projected) 371,507
• Av. flow of expatriate workers per year 44,845
• Av. flow of visitors (tourist) per year 395,320
• Climate (monsoon) (NW
&SW)
• Av. temperature 25-31 deg
C
Filaria was considered as a public health problem in the Maldives, 50 years ago.
First survey was carried in 1951, in southern most 5 atolls. Seenu Ghaviyani Gaaf Alif Gaaf Dhaal Laamu
Disease incidence rate was 24% (1951). National control programme was launched on 1968 in
Male’. Filaria control programme in atolls was started on 1974
and continued till 1997.
History of LF
10 known endemic islands by 1998. National filaria elimination plan was
developed. (2002-2007) A re-assessment survey of the 10 islands
were conducted in 2003. Only Laam Fonadhoo(island) was found to
be endemic. MDA 5 rounds completed
◦ First round of MDA in Laam Fonadhoo started in 2004.
◦ Fifth round of MDA in Laam Fonadhoo completed on 23rd June 2008.
History of LF
Disease under elimination since 2008
No local cases since 2008 Imported cases: (2011-13) nil
Vector – Culex Quinquefasciatus still exists
Surveillance rounds ongoing since 2008
Treatment provided free for any new cases
History of LF
PC programme achievements 2013
Indicator Targeted Achieved
M&E
Total # sentinel and spot check sites surveyed (LF) 5 (2012)
Total # IUs where stopping-MDA TAS implemented (LF) 0
Total # IUs which passed TAS and stopped MDA (LF) 0
Total # IUs where surveillance TAS implemented (LF) 0
MMDP
# IUs where hydrocele surgeries performed
No recent data
Describe how coverage is monitored Surveys conducted every year ~4 atolls
SAE protocol
Monitoring and Evaluation
Progress Towards LF Elimination
Definitions
Started MDA
≥5 MDA rounds Surveillance MMDP
access
MMDP access
Surveillance post-MDA
60% 80% 100%
85%
100%
Conducting awareness programmes about LF and vector control methods
Reporting through health facilities to HPA on vector control programmes conducted by atoll level.
Integrated Vector Management (LF)
LF MMDP – StrategyLF
National policy exist? yes
Organizational placement within the government (who is responsible?)
Health protection Agency/ Ministry of health
How integrated with the health service? Ministry of education/school health programme
Training of service providers conducted (by who? How frequent?)
Health protection Agency/ Ministry of health
Patient mobilization and registration (by who? How?)
Health protection Agency/Ministry of health
Describe interventions and/or M&E activities that worked welli. Integrated activities
i. Elimination activitiesii. Disease-specific activities: ICT surveys every
year for 4 atollsiii. At present, activities (surveys) are low.
Best Practices
For each disease, list the specific challenges/issues that need advice from RPRG
For LF, ◦ Now low priority as it is under elimination, so less
resources for continuing activities◦ Need programs for preventing re-entry of the
disease as vector is still present. e.g. Testing migrants, vector surveillance and IVM
Challenges and “Issues”
MNS (Micro nutrient survey) 2007:4% of children 6 months to 5 years of age were found having any kind of worm infestation.(stool examination)
Prevalence in all age groups: 6.1%
History of STH
Government provides deworming syrups to all children under the age of 2-5 years
Government provides deworming tablets (albendazole) to all children under the age of thirteen years.(6-13 years)
Public health awareness programs are conducted in all the schools
Public awareness programs are conducted through media
IEC materials are developed and distributed in all health centers and schools
Conduct awareness programs on personal hygiene
History of STH
National programme overviewIndicator LF STH
Year of inception of the national programme
1968Elimination plan:
2002-2007
1999
Target date for elimination 2010
Name of administrative unit for implementation of PC
Central Central
Total # administrative units requiring PC at the start of the programme
10 56
Total population requiring PC in the country
Eliminated since 2008Mainly migrants
PC programme achievements 2013
Indicator Targeted Achieved
M&E Total # sentinel sites surveyed (STH) 0
Activities
Targeted Achieved
# administrative units
for PC
# people
# administrative units
for PC
# people
PC
MDA2 (DEC + ALB) 0
T3 (ALB/MBD) for STH 1st round
56 54822 56 44998
T3 (ALB/MBD) for STH 2nd round
56 54822 56 44479
2009 2010 2011 2012 20130
10
20
30
40
50
60
Coverage- School Age Children
Coverage- School Age Children
Progress Towards STH scale up
2009 2010 2011 2012 20130
10
20
30
40
50
60
Coverage- School Age Children
Coverage- School Age Children
Progress Towards STH scale up
2011 2012 20130
10
20
30
40
50
60
70
Coverage- Pre school
Coverage- Pre school
Progress Towards STH scale up
PC coverage, 2013
*65% for LF and 75% for STH**reported coverage was verified by coverage survey or similar independent activity
PC type
# administrat
ive units receiving
PC
# administrative units with
reported coverage
above target*
# administrati
ve units where
coverage was
verified**
MDA2 (DEC + ALB) 0 0 0
T3 (ALB/MBD) for STH 1st round
56 17
T3 (ALB/MBD) for STH 2nd round
56 20
Patients detected through health facilities◦ Management
Treatment provided free of charge from Nutrition programme
◦ Reporting – through health facilities to HPA (Central Level)
Monitoring and Evaluation
For each disease, list the specific challenges/issues that need advice from RPRG
STH: ◦ Since the programme started in 2000, there is an
need to review and strengthen the deworming programme.
Challenges and “Issues”
Programme Plan
Activities
2014 target 2015 target
# administrative units for
PC
# people
# administrative units for
PC
# people
PC
MDA2 (DEC + ALB) Not required Not required
T3 (ALB/MBD) for STH 1st round
56 55376 56 55979
T3 (ALB/MBD) for STH 2nd round
56 55376 56 55979
PC medicine request for 2015
ALB (LF) ALB (STH) MBD DEC
required 61064
in stock 65200
in pipeline -
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