Progress report:the national LF and STH programme

in Bangladesh

By Dr. Rouseli HaqProgram Manager

Filariasis Elimination STH Control Program, DGHS, MoHFW2014

RPRG MeetingWHO Region

Background Information

• Geography and Population– 155 Million (WHO)– 142 Million (2011 National Census)– Tropical Rainforest (Ecological zones)

Political & Health Administrative Divisions:

Divisions : 7

Districts : 64

Sub-districts (Upa-zila): 485

Unions: 6,766

Wards (3 in each union)

Villages : 87,316

Municipalities :223

LF Burden Bangladesh • Population at risk: 70 million at baseline

• Total no of endemic districts: 34

• Mf rate baseline: 10.8% (Range >1% to 15%)

• Estimated morbidity status: 2% to 3.9%

(in endemic districts)

• Total no of districts requiring Mass Drug Administration (MDA): 19

• MDA using Albendazole and DEC started: in 2001

• MDA scale-up to reach all districts: in 2008

• MDA to be stopped in 18 districts by 2014 September.

MAP

LF parasitic species: Wuchereria bancrofti

Main mosquito vector: Culex quinquefaciatus

Estimated burden: 70 million at risk

Lymphatic filariasis (LF) in Bangladesh

National programme overviewIndicator LF STH

Year of inception of the national programme

2001 2008

Target date for elimination 2015

Name of administrative unit for implementation of PC

District District

Total # administrative units requiring PC at the start of the programme

19 64

Total population requiring PC in the country

33.29 million 26 Million (5-12) all primary school aged children

PC Programme Financing

• Contributors to the 2013 programme costs (and rough estimate of contributions by each if available):

Contributor Funding (US$)National government 9.5 MillionSub-national government N/AInternal donors (___) N/AExternal donors (_USAID/CNTD/WHO__)

.33 Million

• Others (Children Without Worm, USA, (CWW) Johnson & Johnson (J&J) Vermox 500_)

1.38 Million

PC programme achievements 2013

Indicator Targeted Achieved

M&E

Total # sentinel and spot check sites surveyed (LF) 16 16Total # sentinel sites surveyed (STH) 12 12

Total # IUs where stopping-MDA TAS implemented (LF) 5 5Total # IUs which passed TAS and stopped MDA (LF) 5 5Total # IUs where surveillance TAS implemented (LF) 5 5

MMDP# IUs where hydrocele surgeries performed 3 3# IUs where lymphedema and ADLA management provided 7 5

Activities

Targeted Achieved#

administrative units for PC

# people#

administrative units for PC

# people

PCMDA2 (DEC + ALB) 4 8,660,332 4 7,133,685T3 (ALB/MBD) for STH 1st round 64 25,740,459 64 25,326,154T3 (ALB/MBD) for STH 2nd round 64 26,072,380 64 25,680,788

Progress Towards LF Elimination

DefinitionsStarted MDA ≥5 MDA rounds Surveillance MMDP access

MMDP access

Surveillance post-MDA

≥5 MDA rounds

Started MDA

0% 20% 40% 60% 80% 100%

37%

53%

100%

100%

Progress Towards STH scale up

5100694251812939*Coverage =

2008 2009 2010 2011 2012 201391.00%

92.00%

93.00%

94.00%

95.00%

96.00%

97.00%

98.00%

99.00%

100.00%

94.00%

97.50%

98.48%99.00% 99.00%

98.44%

% Coverage

PC coverage, 2013

*65% for LF and 75% for STH**reported coverage was verified by coverage survey or similar independent activity

PC type#

administrative units receiving

PC

# administrative units with

reported coverage above target*

# administrative units where

coverage was verified**

MDA2 (DEC + ALB) 4 4 4

T3 (ALB/MBD) for STH 1st round 64 64 64

T3 (ALB/MBD) for STH 2nd round 64 64 64

Impacts of MDA in Sentinel Sites (LF)# SS/SC sites

Sentinel Sites<1% mf

Sentinel Sites≥1% mf

Spot Check sites

<1% mf

Spot Check sites

≥1% mf

Baseline surveys 4 18 43 3

Latest surveys (post-MDA)

4 0 12 0

PC Monitoring and Evaluation

• Fifteen supervision trips in each round has performed by the staff from the National Program in order to better supervise the management of the De-worming week at all lower levels primary school

• Identify problems for implementation of MDA and facilitate problem solving

• Ensure the child awareness on the De-worming week• Observe ingestions drugs among the eligible children’s• Observe any adverse affect and reports to take necessary

action.

Three Tires of Supervision For STH

Supervision done in school

Supervisors from

Sub-dist.

Supervisors from Dist.

Level

Supervisor from

Central Level

PC Monitoring and Evaluation• SAE protocol

It is in place and being used, and managed within NTD programme. SAE is included in preparation of PC intervention.

Progress to date in assessing transmission #

# administrative units currently eligible for surveys to stop mass treatment 4

# administrative units where surveys to stop mass treatment were conducted 4

# administrative units where criteria was passed and mass treatment stopped 3

• Justification for stopping MDA without TAS in the above IU s N/A

• Integrated assessment of STH considered? N/A

LF Transmission Assessment Survey to stop MDA

LF Transmission Assessment: Forecasting

YearNumber of IUs to

be coveredTAS1 TAS2 TAS3

Total number of EUs

ICT/LF ST Required*

2014 4 6 10152

2015 9 5 20 33840

2016 4 6 10152

2017 9 13 21996

2018 4 6 10152

2019

2020

*sum of the total sample size required for each EU assessed;

Integrated Vector Management (LF)

• Describe any activities targeted to control LF vectors (including those conducted by other programmes)

N/A• Describe monitoring and evaluation of such

activities

LF MMDP – StrategyLF

National policy exist? Yes

Organizational placement within the government (who is responsible?)

Program Manager

How integrated with the health service? Provide morbidity management service through community clinic at community level

Training of service providers conducted (by who? How frequent?)

By the program trainers, twice in a year.

Patient mobilization and registration (by who? How?)

By local health staffs (Health assistant, CHCP)

LF MMDP – monitoring and evaluation

LFDescribe how MMDP services are currently monitored and reported to the national programme

Recently program has initiated the MMDP services to the patient at community clinic, Every Tuesday patients are coming to the CC for morbidity management.

How is “access” determined? N/A

Is there any quality assessment of provided services?

N/A

Best Practices

• MDA done among 35 million populations of 19 districts with >80% coverage.

• 7,908 Lymphoedema patient s were trained on morbidity control management.

• 20,000 Kit Box were distributed among Lymphoedema patients of 10 districts.

• Training of Doctors, District & Upa-zila manager, Paramedic, Health worker, Formal/ informal leaders, Teachers, NGOs workers, Medical Technologist were conducted.

• Social awareness through IEC activities-– i) Advocacy meeting– ii) Audiovisual- Documentary spot, duco-drama, TV spot, Radio jingel– iii) Advertisement through Mass media- Newspaper, Radio, Television– iv) Poster, leaflet, festoon, Bill board, Newsletter, Training module etc.

• 15 districts stopped MDA in 2011, 2012 & 2013 other 4 districts is ready for stop MDA in 2014 s a part of elimination of the disease.

Challenges and “Issues” for LF

• Strengthening IEC program• Evaluation of non endemic district• Developing sustainable surveillance• Capacity building-Human resource, training• Strengthening monitoring and evaluation• Morbidity control by using Community Clinics as Bangladesh

has very good Primary Health Care (PHC) infrastructure• Funding for Community Clinic, home based morbidity

control programme • New technology for morbidity control and expansion of

program with involving NGOs, Volunteers• Elimination of Lymphatic Filariasis through MDA by 2015

Challenges and “Issues” for STH

• Reaching “out of School” ,working , street children• Lack of awareness due to inadequate IEC activities• Mass Psychogenic illness during de-worming

week• Improvement of water, sanitation, and hygiene

and health education through school based approach for parasite control

• Coordination with partners working on STH control

Programme Plan Activities

2014 target 2015 target# administrative

units for PC # people # administrative units for PC

# people

PC

MDA2 (DEC + ALB) 1 3010132 0 0

T3 (ALB/MBD) for STH 1st round 64 26,032,032 25,840,035

T3 (ALB/MBD) for STH 2nd round 64 26,032,032 25,840,035

Activities 2014 Target 2015 Target

M&E

# districts/IUs where coverage surveys are planned for any PC diseases 1 0

# IUs where pre-TAS sentinel site and spot checks planned (LF) 4 0

# IUs where TAS for stopping MDA is planned (LF) 4 0# IUs where STH survey integrated with LF TAS planned 0 0

# IUs where MMDP is to be evaluated (LF) 7 4# IUs where surveillance activities are to be carried out (LF) 10 14

MMDP # IUs where MMDP services newly initiated (LF) 4 5IVM # IUs where IVM coordinated to target LF vectors 0 0

PC medicine request for 2015　 ALB (LF) ALB (STH) MBD DEC

required 51,680,070

in stock

in pipeline

requested to WHO 51,680,070

requested toMDP (IVM) or ITI (AZI)

Procured from other sources(source, # tablets and target age group)