REPORT OF THE INFORMAL CONSULTATIVE MEETING ON ROLL BACK MALARIA TECHNICAL SUPPORT NETWORKS IN SOUTH-EAST ASIA
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REPORT OF THE INFORMAL CONSULTATIVE MEETING ON ROLL BACK
MALARIA TECHNICAL SUPPORT NETWORKS IN SOUTH-EAST ASIA - extracted text
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REPORT OF THE INFORMAL CONSULTATIVE MEETING ON ROLL BACK
MALARIA TECHNICAL SUPPORT NETWORKS IN SOUTH-EAST ASIA
Chiang Mai, Thailand
13-17 March 2000
CONTENTS
Executive Summary
1. Introduction
2. Objectives
3. Proceedings
4. Institutional Arrangement
5. Strategy development
5.1 TSN-TRR
5.2 TSN-SIE
5.3TSN-DRP
6. RBM Network and TDR Task Force on Drug Resistance and PolicyJoint Meeting
7. Conclusions and Recommendations
Annex 1 - List of Participants
Annex 2 - Standard Case Definitions and Core Indicators
Annex 3 - Work Plan 2000-2003
2
Executive Summary
Technical Support Networks (TSNs) were set up in the WHO South-East Asia
Region with national chapters in respective Member Countries.
TSNs
comprise the following networks: (i) Transmission Risk Reduction (TRR), (ii)
Surveillance, Information Management and Epidemic Preparedness and
Response (SIE), and (iii) Drug Resistance and Policy (DRP). These networks
will serve as technical resource to support Roll Back Malaria in South-East
Asia. The secretariat of the TSNs is initially based in WHO/SEARO and will
rotate within Member Countries. The national chapter of each network (TRR,
SIE, DRP) will have two focal persons, one from the malaria control
programme and another one from a research or technical institution who will
be responsible for its coordination and functioning.
There will be an overall
national coordinator nominated by the government.
The work plan of each
TSN for 2000-2003 reflects the identified priorities to be addressed by each
TSN.
1. INTRODUCTION
Roll Back Malaria (RBM) was initiated by the Director-General of WHO in May
1998 aiming at reducing malaria burden by 50% by the year 2010.and a WHO
RBM Cabinet Project was established in 23 July 1998 to support this initiative.
RBM was launched on 31 October 1998 by WHO, UNICEF, UNDP and WB
as the founding partners, and
supported by member countries, bilateral
agencies, NGOs and other sectors of society. Since then, several advocacy
3
and consensus meetings have been conducted in the SEA Region. It was
recognized that RBM in this Region should draw its strength through
networking of the existing technical resources at national and regional levels
to address priority issues related to Transmission Risk Reduction(TRR),
Surveillance,
Information
Management,
Epidemic
Preparedness
and
Response (SIE), and Drug Resistance and Policy (DRP).
In an informal consultative meeting held from 13-17 March 2000 in Chiang
Mai, Thailand, the technical support networks were organized to address the
above technical areas.
2. OBJECTIVES
(1)To discuss the role and develop terms of reference of the technical
support networks on TRR, SIE and DRP;
(2) To identify institutions, core groups and individuals from the SEA Region,
and specific areas that require strengthening;
(3) To identify programme needs on TRR, SIE and DRP;
(4) To develop working mechanisms within and outside the resource network,
and
(5) To develop a regional work plan for each TSN for 2000-2001 and 20022003.
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3. PROCEEDINGS
The meeting was commenced with a message from the Regional Director,
WHO/SEARO read by the WHO Representative in Thailand followed by the
inaugural
address
by
the
Deputy
Director-General,
Department
of
Communicable Disease Control, Ministry of Public Health, Thailand. The
Director, Malaria Division, Bangkok, Thailand made the introductory remarks.
Representatives from RBM/CDS/WHO and RBM partners (USAID, Faculty of
Tropical Medicine / Mahidol University/SEAMEO-TROPMED, JICA Philippines
Office, and Tokyo Women’s University) delivered their remarks.
The participants were from seven SEARO Member Countries (Bangladesh,
India, Indonesia, Myanmar, Nepal, Sri Lanka and Thailand), and two WPRO
Member Countries (Philippines and Papua New Guinea) as well as from
partner agencies. See Annex 1 for list of participants.
Dr. Krongthong Thamasarn (Thailand) was elected Chairperson of the
meeting while the co-chairperson was Dr Myint Lwin (Myanmar). Dr. V P
Sharma (India) and Dr. Enrique Tayag (Philippines) were the rapporteurs.
Three groups corresponding to the three technical support networks met
simultaneously with joint sessions during the first and last day. Each group
selected their respective chairperson and rapporteurs. TDR’s Task Force on
Research on Drug Resistance and Policy had its meeting during the same
period at the same venue. They joined the plenary sessions and had joint
sessions with the TSN on DRP.
X-
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The terms of reference of each TSN were developed and finalized by the
respective group.
Basically, the TSNs will serve as technical resource not
only to the national malaria control programmes and WHO/SEARO but also to
RBM partners in the Region and in the Member Countries. The TSNs will
function and address relevant technical issues according to their comparative
strengths. Institutional arrangement to facilitate work was also discussed.
The three groups had technical sessions wherein relevant topics were
presented and discussed. Based on these discussions, major technical areas
and some specific issues that each TSN will work on were identified. It was
envisaged that the TSNs would have significant contributions in rolling back
malaria by addressing the technical areas listed in their plan of work for 2000 -
2003.
4. INSTITUTIONAL ARRANGEMENT
4.1 Regional network:
The regional network comprises a core of experts in various disciplines
relevant to TRR, SIE, and DRP from Member Countries of the WHO SEA
Region. It will co-opt members from outside the Region as and when the need
arises. The network has two focal persons each on TRR, SIE and DRP from
each Member Country - one from the malaria control programme and another
from a research institution or from other institution with technical expertise.
6
Initially the network secretariat will be based in WHO-SEARO and function in
collaboration with and within the framework of the RBM project in SEARO and
HQ every two years, the secretariat will rotate within the Member Countries.
4.2 National Chapters
Two core members identified from each country will serve as the focal points
who will initiate and facilitate the establishment of national chapters of the
TSNs in their respective countries. The Director (National Malaria Control
Programme Manager) or a more senior official in the Ministry of Health will be
the overall national coordinator. The national core group members would
include representatives from various disciplines, key staff from the control
programmes, professional associations, research institutes, medical colleges,
private
health
care
providers,
pharmaceutical
industries,
consumer
associations, etc. Where similar technical committees or groups already exist
in the country, the national chapter should be built on these existing structures
and not duplicate them. The members and partners of each TSN will develop
the working mechanisms after the network is established.
5. STRATEGIC DEVELOPMENT
5.1 Technical Support Network on Transmission Risk Reduction (TSNTRR)
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The group considered two modalities of transmission risk reduction- vector
based and parasite-based. Within the framework of TRR network, the group
agreed to focus only on vector-based transmission risk reduction.
Within the RBM partnership, technical support to national malaria control
programmes is an essential component. Technical support networks (TSNTRR) provide the necessary mechanism.
5.1.1 Terms of Reference
(1) To provide technical assistance to RBM partners in the Region in support
of the development and establishment of integrated vector management
programmes for routine control and the prevention of adverse impacts of
development projects.
(2) To assist in the establishment of an agenda of relevant research questions
in this area, coordinate multidisciplinary research efforts and ensure that
research outcomes reach the appropriate authorities.
(3) To review the status of the integrated vector management, compile
information on experience in and outside the Regions on the promotion of
integrated vector management and make this information available to the
RBM partners.
(4) To assess capacity-building needs in support of integrated vector
management and develop capacity building programmes in response to
these needs.
8
(5) To assist Member Countries in the Regions in the process of developing
policy review and adjustment, both in the health sector and in other
development sectors, and to harmonize sectoral policies.
5.1.2 Scope and Focus
TSN-TRR will address the following general issues:
•
Methods currently available for achieving a reduction in the transmission
potential ranging from personal protection methods (e.g., insecticidetreated bednets and repellents) to vector control based on non-chemical
and chemical methods;
•
Selective and integrated use of the available methods in the most effective
and efficient manner, based on the best evidence at the local level;
•
Methods and procedures for strategic health risk assessment and health
impact assessment;
•
Institutional strengthening for training on integrated public health measures
against vector-borne diseases;
•
Optimal use of national, regional and global expertise and resources in
transmission risk reduction, and
•
Coordination of transmission risk management efforts as a basis for the
sustainability of RBM achievements.
5.1.3 Actions for RBM
Regional trends and strategic responses
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•
Identify regional issues, define problems and assess needs to overcome
these problems.
•
Inventory the existing expertise in the Region.
•
Document and exchange information and experience.
•
Interface with other regional technical networks (e.g. TSN-SIE and TSN-
DRP) to provide fully integrated technical advice for RBM implementation
in countries.
Research & Development
•
At regular intervals, review and update a research agenda in transmission
risk reduction.
•
Mediate the transfer of knowledge gained by research for application in
control programmes.
•
Disseminate information on up-to-date technologies and methods by
reviewing the latest developments in the field.
Framework for a generic capacity-building strategy
•
Formulate regional policies and guidelines on transmission risk reduction
for adoption by Member Countries.
•
Develop capacity to monitor and evaluate the impact of interventions
directed at transmission risk reduction.
•
Link scientists and institutions with expertise to counterparts in disease
control operations at district and national levels.
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•
Afford
training
opportunities
to
a
younger
generation
of
health
professionals and scientists within ongoing implementation activities of
RBM.
Assistance to Member Countries
•
Identify issues, define problems and assess needs to overcome these
problems at the national level;
•
Assist in the planning and implementation of selective transmission risk
reduction methods as an integral part of the health system;
•
Facilitate the establishment of national level networks to support district
level RBM activities;
•
Utilize national centres of excellence as collaborating centres and network
national experts as a regional resource for the effective implementation of
RBM;
Assist
in
setting
standards
to
ensure
quality
assurance
of
products/materials used in TRR, and
•
Assist in reorienting the role of entomological services and support
services for TRR, including advocacy for partnerships.
5.1.4 Regional Issues
The group identified the following general issues across the Region.
•
The role of entomological services needs to be redefined for the Region to
address RBM.
•
Clearly defined partnership mechanisms should be established in the
Region to ensure sustainable support for RBM.
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•
Lack of coordination between countries in insecticide policy towards the
control of border malaria is a common problem.
•
Comprehensive approach should be adapted towards integrated vectorborne disease control.
•
Knowledge
transfer
on
sociocultural
aspects
in
vector
control
operationalization needed.
5.1.5 Priorities to be addressed by the TSN-TRR
(1) Mosquito nets: In order to promote treated mosquito nets in the
communities the following areas required emphasis and focused work, (i)
Inventory
the
information
on
ITN
operationalization
(standardize
parameters, identify knowledge gaps); (ii) formulate evidence-based
guidelines for programme implementation (decision making criteria for
ITN purchase, logistics for focused delivery and maintenance); (iii) set a
research agenda and strategy for resource mobilization to implement it;
and (iv) social marketing of ITN and private sector involvement.
(2) Insecticides: It was realized that insecticides would continue to play an
important role in malaria control. TSN would focus on institutional
strengthening to develop training capacity for integrated public health
measures against vector-borne diseases. Therefore, there is a need to:
review the knowledge base and decision making procedures for judicious
use of pesticides; advise on the modalities for the operationalization of
selective/integrated approaches with optimal complimentarity of chemical
and non-chemical transmission risk reduction interventions; and inventory
12
regional insecticide resistance and provide guidance on resistance
management strategies.
(3) Targeting Training: Manpower training in medical entomology in the
malaria endemic countries should receive priority, with emphasis on
identification of training needs and resources at different levels and
development of curricula, training modules and advocacy, and IEC
materials to address the acute shortage there.
(4) Research:
(a) Studies on cytotaxonomy and vector biology (special
problems related to An. dims, An. minimus and An. fluviatilis') should be
directed to: (i) complete a regional picture (including islands) of sibling
species; (ii) develop a strategic approach to filling knowledge gaps; (iii)
coordinate,
stimulate and document at least 5 case studies on
ecosystem- based TRR approaches that can serve as regional prototype;
and (iv) develop mapping and possible TRR interventions in dirusfluviatilis-minimus
settings,
and
(b)
Research
agenda
on
TRR
interventions through intersectoral action.
(5) Monitoring and evaluation: TSN-TRR should support malaria control
programmes reviewing the regional situation using TRR indicators, and
assess the potential to upgrade information system (both health
sector/outside the health sector) for decision-making based on the
Geographical Information System (GIS).
(6) International Borders: Malaria control at the international borders should
be organized by providing technical support and assistance in the
synchronization of field operations in the border areas, and malaria
control programmes should review and promote experience-sharing of
13
existing mechanisms and partnerships for cross border collaboration in
TRR operations, TRR & SIE coordination using GIS technology.
(7) Health Impact Assessment/ Health Risk Management: National activities
(assessment workshops) to review, adjust and harmonize development
policy frameworks to promote HIA/HRM and adapt existing generic HIA
guidelines for specific use at the country level should be coordinated; and
a research agenda on TRR interventions through intersectoral action set.
In addressing these issues, the TRR would consider: RBM's pathfinder role in
health sector-wide development; on-going processes and decentralization
and structural adjustment, and a strengthened role of the health sector in
the works of other public and private sectors.
Technical
5.2
Support
Networks
on
Surveillance,
Information
Management and Epidemic Preparedness and Response (TSN-SIE)
The group identified the need for TSN-SIE to: develop a reliable and rapid
information
management system;
standardize the core indicators for
monitoring and surveillance; assist countries to develop early warning
systems and to mobilize resources for epidemic preparedness and control.
5.2.1 Terms of Reference
(1)To
formulate
policies,
strategies
and
guidelines
on
surveillance,
information management, and epidemic preparedness and response;
14
(2) To identify common core indicators for monitoring and evaluation of the
implementation of RBM in Member Countries and the Region.
(3) To strengthen the regional, national and sub-national capacity for RBM
related to SIE by
promoting the better use of collaborating centres / centres of excellence
through networking;
creating training opportunities for health professionals and scientists, and
improving links between institutions/scientists and the control programme.
(4) To establish appropriate channels of communication among Member
Countries and stakeholders;
(5) To identify priorities and promote research related to SIE and ensure
transformation of research findings into policies and practices, and
(6) To maintain interface with other regional networks.
5.2.2 Scope and focus
The SIE group agreed on five major technical areas and some specific issues
that will be addressed by the SIE network. The number one priority activity is
to validate the core indicators that were recommended during the WHO
Biregional Meeting in Kunming, China in 1999 for monitoring and evaluation of
RBM implementation.
(1) Surveillance system
•
Identifying and validating core indicators;
•
Improving reporting of deaths, and
•
Involving the private sector/other systems of health care
15
(2) Information management system
•
Timeliness of reporting and feedback;
•
Introducing information technology, and
•
Information-based decision-making.
(3) Epidemic preparedness and response
•
Early warning and detection systems;
•
Emergency drugs and insecticides;
•
Rapid response teams (RRT);
•
Collaboration with other sectors for prevention of epidemics and rapid
response, and
•
Investigation and analysis of epidemics.
(4) Information exchange and networking
•
Define priority information for sharing, and
•
Level of networking.
(5) Operational research
•
Validation of core indicators;
•
Evaluation of use of information technology;
•
Establishment of early warning and detection systems;
•
Community based surveillance (lay reporting), and
•
Identify weaknesses (including delays) of the existing surveillance
system.
16
5.2.3 Actions for RBM
(1) Selection of indicators to be validated in RBM districts and to be used in
SEA Region based on those agreed upon during the SEA/WPR Biregional
Meeting on Malaria Control, Kunming, Yunnan Province, China in 3-5
November 1999. See Annex 2 for standard case definitions and core
epidemiological and operational indicators adopted and recommended for
the countries in the Mekong area which are to be validated in other SEA
countries.
(2) Efficient information management system focusing on information-based
decision-making and introduction of new technology such as "Health
Mapper" at district levels.
(3) Epidemic preparedness and response focusing on the progressive setting
up of early warning and early detection systems, as well as rapid response
teams at district level.
(4) Improving the exchange of agreed information between SEA countries.
(5) Field researches focusing on the selection of community-based monitoring
indicators and the development of a methodological guideline for
surveillance and monitoring of RBM interventions at the periphery.
The networks on SIE and TRR should be linked up to address interrelated
technical issues, for example in early warning system and forecasting of
epidemics, with the application of geographical information system (GIS).
Since the use of GIS in malaria control is still under development, the two
networks should work together.
17
5.3 Technical Support Network on Drug Resistance and Policies (TSN-
DRP)
The DRP group highlighted the need for drug resistance monitoring,
standardized protocols, pre-packaging of drug combination, early diagnosis
using dip-stick, pediatric formulation (drug combination), quality assurance,
and sharing information on "fake drugs".
5.3.1 Terms of Reference
(1)To formulate the regional anti-malarial drug policies and guidelines on
drug resistance and policy for adaptation by the Member Countries.
(2) To facilitate the planning and implementation of anti-malarial drug policy
and drug resistance monitoring as an integral part of RBM initiative within
the context of national health development through a national level DRP
networking, and provision of technical expertise.
(3) To assist the nationals programme in the development of evidence-based
drug policy and facilitate or conduct research in support of policy-making.
(4) To assist the national programme in the development of a strategic plan in
the area of capacity-building and operational research through optimal
utilization of the network of national and regional expertise in DRP.
5.3.2 Scope and Focus
The issues identified by DRP were grouped into four major areas as listed +
18
elow.
Some are not technical per se, such as the procurement and
distribution system of anti-malarial drugs. However, the group felt that this
area has very significant bearing on rolling back malaria, and the TSN-DRP
would be able to provide some assistance in improving it.
(1) Data banking and information exchange
•
Drug policies and drug regimens;
•
Drug resistance data;
•
Directory of national experts relevant to DRP;
•
Activities of the network, and
•
Standardization of the format for reporting and exchange of information
(2) Capacity-building
•
Support for infrastructure development for monitoring drug resistance;
•
Training on development of anti-malarial drug policy;
•
Anti-malarial drug guality assurance, and
•
Institutional strengthening in drug monitoring and sharing information
on "fake drugs".
(3) Procurement and distribution system for anti-malarial drugs
•
Review of existing systems;
•
Explore the feasibility of pooled procurement, and
•
Social marketing of anti-malarial drugs.
(4) Priority Operational Research Issues
19
•
Large scale trials on the impact of drug combinations on transmission
potential
and
on
delaying
emergence
of
resistance:
probable
combinations artesunate and schizonticides (Sulfadoxine or Sulfalene
Pyrimethamine / Chloroquine / Mefloquine);
•
Research on the impact of early diagnosis and effective treatment with
existing anti-malarial drugs regimens;
•
Pediatric formulation with drug combination;
•
Operational use of more sensitive tools for monitoring of P. falciparum
drug resistance, and
•
Initiation of P. vivax drug-resistant studies.
5.3.3 Actions for RBM
(1) Anti-malarial supply management should ideally be a part of the national
essential drugs supply system.
(2) The regional network on drug resistance and policies should address the
issue of anti-malarial quality in South-East Asia.
(3) As drug quality and supply are critical for RBM, country and drug supply
managers should, from time to time,
participate in national and
international fora.
(4) Studies are required on access to anti-malarial drugs for the poor in South-
East Asia, as malaria control managers largely overlook this subject.
6. RBM Network and TDR Task Force on Drug Resistance and PolicyJoint Meeting
20
A TDR Task Force meeting on Drug Resistance and Policy was held on the
same dates to facilitate interaction with the Technical Support Network (TSN).
In a joint meeting the TDR Task Force addressed many issues raised by the
countries of the SEA Region, and in general advised that:
•
Any new anti-malarial should be deployed in combination;
•
Combining sulfadoxine-pyrimethamine and chloroquine will, in principle,
delay the development of resistance, as their mechanisms of action are
different;
•
Studies now underway will clarify many of the outstanding issues and
provide the evidence required by countries for decision-making.
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7. CONCLUSIONS AND RECOMMENDATIONS
(1) Three technical support networks
(TSNs) are established in the WHO
South-East Asia Region: (i) Transmission Risk Reduction (TRR); (ii)
Surveillance, Information Management and Epidemic Preparedness and
Response (SIE), and (iii) Drug Resistance and Policy (DRP).
(2) The network will basically serve as technical resource to rolling back
malaria in the South East Asia Region. Each TSN has terms of reference
and identified priority technical areas on which future activities will be
based. The work plan of each TSN for 2000-2003 was developed See
Annex 3. The work plan needs to be translated into a country plan with
more specific details for implementation.
(3) At the regional level the TSNs shall have a secretariat to coordinate the
activities, which will be initially based in WHO/SEARO and would rotate
within Member Countries every two years thereafter.
(4) Two focal persons, one each from the Ministry of Health and from another
institution, have been identified, who are responsible for initiation and
facilitation of the establishment of national TSNs. The Malaria Control
Programme (MCP) Manager or a superior officer shall be the overall
coordinator of the national TSNs.
(5) The TSNs are encouraged to establish linkage with partners within the
framework of RBM to mobilize resources to support its activities.
Mechanisms for partnership and linkages with other organization such as
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Annex 1
LIST OF PARTICIPANTS
BANGLADESH
Dr A. Mannan BANGALI
Deputy Programme Manager
Malaria and Vector Borne Disease Control
Directorate-General of Health Services
Mohakhali, Dhaka 1212
Tel: (00-880-2) 606326
Fax: (00-880-2) 988-6415
E-mail: vbdc@bdonline.com
Dr Md. Jalil MONDAL
Deputy Programme Manager (DPM)
Disease Surveillance, ESP
Directorate-General of Health Services
Mohakhali, Dhaka 1212
Tel: (00-880-2) 600259 (Off.), 900-7716 (Res.)
Fax: (0088-02) 988 6915
E-mail: vbdc@bdonline.com
Dr Md. Mushfiqur RAHMAN
Evaluator
Malaria and Parasitic Diseases Control
Directorate-General of Health Services
Mohakhali, Dhaka 1212
Tel: 0088-02-606326, 605516
Fax: 0088-02-988 6915
E-mail: vbdc@bdonline.com
CAMBODIA
Dr Jan ROZENDAAL
Malaria Expert
P.O. Box 91, Phnom Penh
Cambodia
Fax: 855 23 214-310
E-mail: ,irozendaal@BIGPONb, COM. KH
CHINA
Prof. LI Guo Qiao
Sanya Institute of Tropical Medicine
24
Guangzhou University of Tropical Medicine
12 Airport Road, Guanphon
People’s Republic of China
Tel: 86 20 863-7356
Prof. WANG Xin-Hua
Sanya Institute of Tropical Medicine
Guangzhou University of Tropical Medicine
12 Airport Road, Guanphon
People’s Republic of China
Tel: 86 20 863-7356
E-mail: gzzywxh@public.quongzhou,gd.com
INDIA
Mr N.L. KALRA
A-38, Swasthya Vihar
Vikas Marg,
Delhi-110 092
Tel: 91-11-220 9210 (Residence)
E-mail: c/o aruna@ndf.vsnl.net.in
Or arunasrivastava@hotmail.com
Dr J.R. SHARMA
Head & Project Director
Regional Remote Sensing Service Centre
Department of Space, Government of India
CAZRI Campus, JODHPUR - 342 003
Tel: 91-291-740004 / 744647
Fax: 91-291-741516
E-mail: rrsscj@vsml.com
jrsharma@hotmoil .com
DrV.P. SHARMA
CII/55, Satya Marg
Chanakyapuri
New Delhi-110 021
Tel: 91-11-6885195/4674587
Fax: 91-11-2215086
E-mail: y p ..sharma@hotmaiLcom
Sharmci vp@ whosea. org
DrG.P. SINGH
Joint Director
In-Charge of Epidemiology
National Anti Malaria Programme
22, Shamnath Marg,
Delhi-110 054
Tel: 3918576 (Off.), 6123526 (Res.)
E-mail: gqjinder@bol.net.in
GQgandhillon@hotmail .com
25
Dr S. Sarala K. SUBBARAO
Director
Malaria Research Centre
22, Shamnath Marg,
Delhi-110 054
Tel: 91-11-3981690/3981905
Fax: 91-11-2946150/7234234
E-mail: sks@ndt. vsnl, net. in
INDONESIA
Dr Ferdinand J. LAIHAD
Chief
Sub-Directorate of Malaria
CDC & EH
Ministry of Health, Jakarta
Tel: 62-21-424 7608 ext. 150
Fax: 62-21-424 7573
E-mail: laihQd@centrin.net. id
Dr Muhammad NADHIRIN
Head of Data Analyzing
Sub-Directorate of Epidemiological Surveillance
Directorate of Epidemiology & Immunization
Directorate-General of CDC & EH
Ministry of Health, Jakarta
Tel: 62-21-426 5974 (Office), 864 3810 (Home)
Fax: 62-21-426 6919
E-mail: nestppm@cbn.net. id
Dr Sustriayu NALIM
Vector Control Specialist
Vector and Reservoir Control Research Unit
Salatiga, Semarang.
Tel: 62-29827096
Fax: 62-29822604
Dr Soejono H. SKM.
Chief
Provincial Health Office in Central Java
JL Madukoro Blok AA-BB no.8
Samarang.
Tel: 62-24 613633
Fax: 62-24 613330
Dr Emiliana TJITRA
Researcher
Communicable Diseases Research Centre
National Institute of Health Research and
Development
Ministry of Health
Jakarta
Tel: 62-21-425 9860
Fax: 62-21-424 5386
26
E-mail: email©jnyapura,wasminra.net,id
LAOS
Dr Valery GILBOS
Consultant Health-Anthropology
Vila Zarafa
Vat Ban Khoy
Sangkhalohk
Luang Prabang.
Tel: 856-71-212750
Fax: 856-71-212750
E-mail: valery@gilbos.com
MYANMAR
Dr Khin Aung Cho
State Health Director
Shan State, Taunggyi
Dr Maung Maung
Senior Medical Officer
Disease Control Division
Department of Health
Yangon
Dr Maung Maung Thein
Team Leader
Vector Borne Disease Control
Bago Division
Dr Myint Lwin
Director General
Department of Medical Research
Upper Myanmar, Mondalay
Tel: 095-01-39382, 549351
Dr Saw Lwin
Program Manager
Vector Borne Disease Control Unit
Department of Health
Yangon
Tel: 095-01-663730 / 640749
Dr Saw Maung
Senior Medical Officer
Disease Control Division
Department of Health
Yangon
Tel: 095-01-549191
Dr Thein Tun
Director
Health Department
27
Mandalay Division
Mandalay
Tel: 952-33173
Fax: 951-210652
Dr Ye Htut
Deputy Director (Research)
Department of Medical Research
(Lower Myanmar)
Yangon
Tel: 951-251508 ext. 153
Fax: 951-251514
NEPAL
Dr Manas Kumar BANERJEE
Chief of Disease Control Division
Epidemiology and Diseases Control Div.
Department of Health Services
Ministry of Health
Kathmandu, Nepal
Tel: 255-796
Fax: 262-268
Dr Mahendra Bahadur BISTA
Director
Epidemiology and Diseases Control Divi.
Department of Health Services
Ministry of Health
Teku, Kathmandu
Tel: 255796 (Office), 470739 (Home)
Fax: 262268
PAPUA NEW GUINEA
Dr Vella BAGITA
Technical Advisor
National Malaria Control Programme
Papua New Guinea
Tel: (675) 301-3737 / 301-3736
Fax: (675) 301-3769
E-mail: vbagita©health .gov, pg
Dr Francis HOMBHANJE
Faculty of Medicine
University of Papua New Guinea
P.O. Box 5623
Boroko.
Tel: (675) 324-3811 / 324-3812
Fax: (675) 324-3827
E-mail: hombanfr©upng.ac.pg
Mr Julius KUNDI
28
Malaria Surveillance & Control Unit
P.O. Box 778
Goroko, Eastern Highlands Province
Tel: 731-2215
PHILIPPINES
Dr Ma. Dorina BUSTOS
Medical Specialist
Research Institute for Tropical Medicine
Department of Health
Alabang Metro Manila
Muntinlupa City.
Tel: (632) 809-7599 / 807-2628, 32, 36, 37
Fax: (632) 842-2245
E-mail: dbustos@ritm.gov.ph
Ms Norma JOSON
Entomology Adviser
Malaria Control Service
Department of Health
Manila
Tel: (632) 781-8943
(632) 743-8301
Fax: (632) 781-8943
Dr Cleo Fe TABADA
Medical Officer IV
Malaria Control Programme - Davao
DOH Regional Health Office No. 11
Davao City
Tel: (6384) 217-3483
E-mail: cleo.tabQdQ@eudorQmQil.coin
Dr Enrique TAYAG
Head
Infectious Diseases Centres for Disease
Control and Prevention
Department of Health
Manila
Tel: (632) 732-2493
Fax: (632) 741-7048 / 732-2493
E-mail: e tQyQg@doh.gov. ph
SOUTH AFRICA
Prof. Peter Ian FOLB
Department of Pharmacology
University of Cape Town Medical School
Health Sciences Faculty,
K45 Old Main Building
Observatory (K/C)
7925, South Africa
29
Tel: (27-21)406 6286
Fax: (27-21) 448 1989
E-mail: pfolb@uctgshl.uct,ac.zq
SRI LANKA
Dr Felix P. AMERSINGHE
International Water Management Institute
No. 127, Sunil MAWATHA
Pelawatte, Battaramulla
Tel: 94-1-867404
Fax: 94-1-866854
E-mail: f,amerasinghe@cgiar.org
Dr Punsiri FERNANDO
Director
Anti-Malaria Campaign
Colombo 5
Tel: 94 581918/588408
Fax: 94 585360
Dr Latha HAPUGODA
Director
Health Education & Publicity
Bureau of Health Education
Ministry of Health
No.2, Kynsey Road
Colombo 8
Tel: 94 1 692613, 696142
Fax: 94 1 692613
Dr Pushpa R.J. HERATH
18, Ayurvedha Road
Pallekelle, Kundasale
Kandy
Tel: 94 8 420 876
Fax: 94 8 420 876
E-mail: pusherat@sltnet Jk
Dr Willem Van derHOEK
International Water Management Institute
No. 127, Sunil Mawatha
Battaramulla
Tel: 94-1-867404
Fax: 94-1-866854
E-mail: w. van - der - hoek@cgiar. org
Dr A.R. WICKREMASINGHE
Department of Community Medicine
and Family Medicine
Faculty of Medical Sciences
University of Sri Jayewardenepura
Gangodawila, Nugegoda
30
Colombo
Tel: 94-1-598014
Fax: 94-1-598014
E-mail: ra.jwicks@slt Jk
Dr (Mrs) AMGM YAPABANDARA
Regional Malaria Officer
Matale
Tel: 066-22295/30358
Fax: 066 - 22777
E-mail: malmalal@sitnet. ik
THAILAND
Dr Apinun ARAMRATTANA
Department of Family Medicine
Faculty of Medicine
Chiang Mai University
Chiang Mai
Tel: 66-53-945462
Fax: 66-53-217144
E-mail: apinun@mail. med.emu.oc.th
Ms Elizabeth ASHLEY
Faculty of Tropical Medicine
Mahidol University
Hospital for Tropical Medicine
420/6 Rajvithi Road
Bangkok 10400.
Tel: (66 2) 246 0832
Fax: (66 2) 246 7795
E-mail: e, ashley@correspondence .co.uk
Dr Virasakdi CHONGSUVIVATWONG
Epidemiologist/GIS Specialist
Epidemiology Unit
Faculty of Medicine
Prince Songkhla University
Songkhla
Tel: 66 74 429754
Fax: 66 74 212900
E-mail: cvirasQk@ratree.psu.oc.th
Dr Jirapat KANLAYANAPHOTPORN
Field Epidemiology Training Programme
Epidemiology Division
Ministry of Public Health
Bangkok
Tel: (02) 590-1734-5
31
Fax: (02) 591-8581
E-mail: j i rapQt@health. moph. go. th
Prof. Sornchai LOOAREESUWAN
Dean
Faculty of Tropical Medicine
Mahidol University
Bangkok
Tel: (66 2) 247-1688
Fax: (66 2) 245-7288
E-mail: tmslr@mahidol.ac.th.
Dr F. NOSTEN
SMRU
Mahidol University
Bangkok.
Tel: +66 55 531 531
Fax: +66 55 544 442
E-mail: ghokco@cscoms.com
Dr Lorrin PANG
Armed Forces Research Institute
Of Medical Sciences
USA Army Medical Component
APO Pacific 96546
Bangkok 10400.
Tel: (66 2) 644 6125 / 644 7135
Fax: (66 2) 247 6030
E-mail: PangL@mozart, inet.co.th
Ms Wirichada PONGTAVORNPINYO
Mahidol University
Wellcome Unit, Faculty of Tropical Medicine
420/6 Rajvithi Road
Bangkok 10400.
Tel: (66 2) 246-0832 / (55 2) 644-4541
Fax: (66 2) 246-7795
E-mail: fnnjw@diQmond. mahidol. qc ,th
Dr Somsak PRAJAKWONG
Director
Vector Borne Disease Office No.2
Chiang Mai 50200
Tel: (053) 894271
Fax: (053)212389
E-mail: malar@chmai.loxinfo.co.th
Dr Pratap SINGHASIVANON
Epidemiologist/GIS Specialist
Faculty of Tropical Medicine
420/6 Rajvithi Road
Mahidol University
Bangkok
01) 7^9 O cn)
--
32
Tel: (662) 644 7483, 246-0056 ext. 682
Fax: (662) 644 4436, 246-8340
E-mail: tmpsh©mahidol,ac.th
Dr Jeeraphat SIRICHAISINTHOP
Director
Vector Borne Disease Control Office 1
Prabuddhabat, Saraburi
Tel: (66 36) 266162
Fax: (66 36) 267586
E-mail: jrp@cdcnet. moph .go. th
Dr Sombat TANPRASERTSUK
Director
Epidemiology Division
Ministry of Public Health
Bangkok
DrSuwit THAMAPALO
Medical Officer and Epidemiologist
Office of Vector Borne Disease Control 4
428 Saiburi Road
Muang District, Songkhla 90000
Thailand
Tel: (074)311411, 311578
E-mail: suwich@hotmail .corn
Dr Krongthong THIMASARN
Director
Malaria Division
Department of Communicable Disease Control
Ministry of Public Health
Nonthaburi 11000.
Tel: (662) 591-8420, 590-3121, 590-3135
Fax: (662) 591-8422
E-mail: krongtho@health.moph.go.th
Prof. Nicholas WHITE
Mahidol University
Faculty of Tropical Medicine
Hospital for Tropical Diseases
420/6 Rajvithi Road
Bangkok 10400.
Tel: (66 2) 246-0832
Fax: (66 2) 246-7795
E-mail: fnnjw@diamond.mahidol .ac.th
USA
Dr Malcolm CLARK
Management Sciences for Health (MSH)
33
Drug Management Program
Suite 710, 1515 Wilson
Boulevard, Arlington VA 22003
Tel: 1 703 248 1603
Fax: 1 703 524 7898
USA
E-mail: mQlark@msh.org
Dr Mary ETTLING
Malaria / Infectious Disease Advisor
USAID Bureau for Africa
1325GSteet NW #400
Washington, DC 20005
USA
Tel: 1 202 219-0486
Fax: 1 202 219-0507
E-mail: mettIinq@afr-sd.org
Dr Ramanan LAXMINARAYAN
Resources for the Future
1616 P St NW
Washington DC 20036
USA
Tel: (202) 328 5085
Fax: (202) 939 3460
E-mail: Ramanan@rff.orq
VIETNAM
Dr Tran Tinh MIEN
Center for Tropical Diseases
190 Ben Ham Tu Q5
Ho Chi Minh City-Ville Quan 5
Viet Nam VN-15000
Tel: 84 - 8 - 835 0475 / 835 3804
Fax: 84 - 8 - 835 3943 / 835 3904
E-mail: tthien@hcm.vnn.vn
OBSERVERS
Ms Supawadee KONCHOM
Technical Officer
Malaria Division
CDC Department
Ministry of Public Health
Nonthaburi 11000, Thailand
Tel: (02) 590-3126-7
Fax: (02) 591-8422
E-mail: supawade@health.moph.go.th
Ms Pornpimol NGARMTAO
34
Chief of Surveillance Section
Epidemiology Sub-division
Maralia Division
Ministry of Public Health
Nonthaburi 11000, Thailand
Tel: (02) 590-3127
Fax: (02) 591-8422
E-mail: pornpim@health.moph.go.th
Ms Ketsiri SOMBATWATANANGKUL
Vector Borne Disease Control
Office 2 Chiangmai
18 Boonreungrit Road, Muang District
Chiangmai 50200, Thailand
Tel: (053) 221 529
Fax: (053)212389
PARTNERS
Dr James CAMPBELL
Director
U.S. Naval Medical Research Unit No.2
(U.S. NAMRU-2)
Kompleks P2M/PLP, LITBANGKES R.l.
JI. Percetakan Negara No. 29
Jakarta 10560, Indonesia
Tel: 62-21-421-4457 through 4463
Fax: 62-21-424-4507
E-mail: co@namru2.com
campbel l@smtp. namru2. go. id
Dr Denis CAROLL
Senior Public Health Advisor
Office of Health and Nutrition
U.S. Agency for International Development
Global Bureau
Center for Population,
Health and Nutrition
G/PHN/HN
1300 Pennsylvania Ave., N.W.
Washington, D.C. 20523-3700
USA
Tel: 202 712-5009
Fax: 202 216-3702
E-mail: dcarroll@usaid.qov
Dr Frederick GAY
35
Regional Co-ordinator
European Commission
Regional Malaria Control Programme
In Cambodia, Laos and Vietnam
34 Hang Bai Street
Hanoi Vietnam
Tel: (84 4) 934 1642
Fax: (84 4) 934 1641
E-mail: ec-rmcp@hn.vnn.vn
Website: http:Z/www. mekong-malaria.org
Dr Akira KANEKO
Department of Tropical Medicine
Tokyo Women’s Medical University
8-1 Kawada-cho, Shinjuku-ku
Tokyo 162-8666
Japan
Tel: 81 3 5269 7422
Fax: 81 3 5269 7422
E-mail: akirak@research.twmu.ac.jp
Mr Masatoshi NAKAMURA
JICA Philippines Office
12th Floor, Pacific Star Building
Makati City, Philippines
P.O. Box 1026 MCPO Makati city
Tel: 063-2-893 3081
Fax: 063-2-816 4222
E-mail: bednet@pacific.net.ph
WHO SECRETARIAT
WHO, GENEVA
Dr Robert BOS
PEEM/SDE/HQ
World Health Organization
Avenue Appia 20
1211 Geneva 27
Switzerland
Tel: 41 22 791 3555
Fax: 41 22 791 4159
E-mail: bosr@who.int
Dr Charles DELACOLLETTE
RBM/CDS/HQ
World Health Organization
Av. Appia, 20
1211 Geneva
Tel: 41 22 791 2766
Fax:41-22-791 4824
E-mail: delacollettec@who.int
36
Mr Jean-Pierre MEERT
WHO/CDS/CSR
Healthmap
20 Avenue Appia
1211 Geneva, Switzerland
Tel: 41 22 791-3881
Fax: 41 22 791-4777
E-mail: meerti@who.ch
Dr Kamini MENDIS
Roll Back Malaria
World Health Organization
27 Avenue Appia,
1211 Geneva, Switzerland
Tel: 4122 791 3751
E-mail: mendisk@whgJnt
Dr Piero OLLIARO
Manager
Drug Resistance and Policies
Special Programme for Research
and Training in Tropical Diseases (TDR)
World Health Organization
27 Avenue Appia
1211 Geneva, Switzerland
Tel: 4122 791-3734 / 791-3735
Fax: 4122 791-4774 / 791-4854
E-mail: olliarop@who.int
Dr Leonard ORTEGA
RBM/CDS/HQ
Tel: (41 22) 791-2661
Fax: (41 22)791-4824
E-mail: orteqal@who.ch
Dr Jean REGAL
Drug Resistance and Policies
Special Programme for Research
And Training in Tropical Diseases (TDR)
World Health Organization
27AveAppia, 1211 Geneva
Switzerland
Tel: 4122 791-3959
Fax: 4122 791-4774 / 791-4854
E-mail: rigal.i@who.int
37
Dr Pascal RINGWALD
Anti-Infectious Drug Resistance
Surveillance and Containment
World Health Organization
27 Avenue Appia, 1211 Geneva
Switzerland
Tel: 41 22 791-3469
Fax: 41 22 791-4878
E-mail: ringwQldp@who ,ch
Dr Murtadda SESAY
Essential Drugs and Medicines Policy Dept.
Health Technology and Pharmaceuticals
Cluster, World Health Organization
27 Avenue Appia, 1211 Geneva
Switzerland
Tel: 41 22 791-3676 / 791-3893
E-mail: sesQym@who.int
Dr Walter TAYLOR
Drug Resistance and Policies
Special Programme for Research
And Training in Tropical Diseases (TDR)
World Health Organization
27 Avenue Appia, 1211 Geneva
Switzerland
Tel: 4122 791-3959
Fax: 4122 791-4774 / 791-4854
E-mail: tQylorw@who.int
WHQ/AMRO
Dr Renato GUSMAO
PAHO/AMRO Regional Advisor
525 Twenty-third St. N.W.
Washington, D.C. 20037
USA
Tel: (202) 974-3259
Fax: (202) 974-3688
E-mail: qusmaoreQpaho.org]
WHO/SEARQ
Dr Hadi ABEDNEGO
Consultant RBM
WHO SEARO
World Health House
M. Gandhi Marg
New Delhi 110002
India
Tel: (91-11)331-7804/331-7823
38
Fax: (91-11) 332-7972
E-mail: habednego@hotmqil.com
abednegoh© whoseo. org
Dr P.R. ARBANI
Regional Office for South East Asia
World Health House
Indrapshtra Estate
Mahatma Gandhi Road
New Delhi 110002, India
Tel: (9111) 331-7804
Fax: (9111) 331-8607
E-mail: arbanip©whoseo.org
Dr E.B. DOBERSTYN
WR Office Thailand
Ministry of Public Health
Tiwanond Road, A. Muang
Nonthaburi 10110, Thailand
Tel: (66 2) 591-1524, 590-1514 (direct)
Fax: (66 2) 591-8199
E-mail: registry@whothai. mo ph .go .th
Dr Methsiri V.H. GUNARATNE
Regional Advisor - Communicable Diseases
World Health Organization
Regional Office for South East Asia
World Health House
I.P. Estate, Ring Road
New Delhi 110 002
India
Tel: 331-7804 to 331-7823
Fax: 91 11 331-8607/331-8412 (Dir)
E-mail: GunaratneM©whosea.org
Dr Chusak PRASITTISUK
Regional Advisor
Vector Borne Disease Control (VBC)
World Health Organization
Regional Office for South East Asia
World Health House
I.P. Estate, Ring Road
New Delhi 110 002
India
Tel: (91 11) 331 7804 to 331-7823
Fax: (91 11) 331 8412 / 332-7972
E-mail: chusakp©whosea.org
39
WHO/WPRO
Dr Kelvin PALMER
RA-MVP
World Health Organization
P.O. Box 2937, Manila 1000
Philippines
Tel: (632) 528 9725
Fax: (632) 521 1036
E-mail: PALMERK@wpro.who.int
Dr Allan SCHAPIRA
Regional Adviser - Malaria
World Health Organization
Western Pacific Regional Office
P.O. Box 2932, Manila 1099
Philippines
Tel: (632) 528-8001 / 528-9945 (direct)
Fax: (632) 521-1036
E-mail: SCHAPIRAwpro.who. inf
ANNEX 2
40
STANDARD CASE DEFINITIONS AND CORE EPIDEMIOLOGICAL AND OPERATIONAL
INDICATORS AS RECOMMENDED BY THE MEETING FOR THE MEKONG COUNTRIES
A. Case definitions
In areas without access to laboratory-based diagnosis:
■ Probable severe malaria', a patient who requires hospitalization for symptoms of
severe malaria and receives antimalarial treatment, or a patient who is hospitalized
2
for symptoms of malaria and receives antimalarial treatment ”
■ Probable uncomplicated malaria, a patient with symptoms of malaria who is
prescribed3 antimalarial treatment, but is not classified as severe malaria
■
Probable malaria death: Death of a patient classified as probable severe malaria.
In areas with access to laboratory-based diagnosis:
■ Confirmed severe malaria', a patient with laboratory confirmation of diagnosis
who requires hospitalization for symptoms of severe malaria, or is hospitalized for
malaria2
■ Confirmed uncomplicated malaria, a patient with symptoms of malaria with
laboratory-based confirmation of diagnosis, who is not classified as severe
malaria.
■
■
Confirmed malaria death: death of a patient classified as confirmed severe malaria.
Asymptomatic malaria'. A person with no fever or recent history of fever who has a laboratory
confirmed parasitaemia.
Definition of auxiliary categories
■
Suspected malaria case', a patient with symptoms of malaria, who is either
prescribed antimalarial treatment without being tested, or examined for malaria
with a laboratory-based method.
■
Patient testedfor malaria-, a patient with symptoms of malaria, who has a slide or "dipstick" taken
and examined.
4
B. Data items that should be provided annually by each national programme for each
geographical unit in the Mekong Region for calculation of all core indicators
Based on the definitions (A.), the data items that must be recorded
for calculation of the core indicators (C.) can be tabulated as follows:
1 Microscopy, rapid diagnostic test ("dipstick") or other reliable method
2
Countries that currently distinguish severe from uncomplicated malaria in their surveillance should
continue to do so. Countries reporting complicated malaria only, rather than severe malaria, may continue to do
so. using complicated malaria as a substitute for severe malaria. Countries that do not currently make any
distinction of severe/complicated malaria in surveillance may use hospitalized malaria as substitute.
3
The word prescribed is used instead of receives, because the patient is a malaria case irrespective of
the presence of antimalarial drugs at the facility where the diagnosis is made. The word prescribe does not
necessarily imply the involvement of a medical practitioner
4
In programmes that do not use "dipsticks", this figure may be approximately equal to the number of
slides examined.
41
A
Data item__________
Mid-year population
B
Population at risk of malaria
C
Q
No. of suspected malaria cases
No. of patients tested for malaria_____________
No. of confirmed malaria cases (severe +
uncomplicated) (among D)__________________
No. of falciparum malaria cases (among E)_____
No. of probable malaria cases (severe +
uncomplicated) (C - D)____________________
No. of severe malaria cases (probable +
confirmed)_______________________________
No. of confirmed severe malaria cases (among H)
No. of malaria deaths (probable + confirmed)
No. of confirmed malaria deaths (among J)_____
No. of asymptomatic patients tested___________
No. of asymptomatic malaria cases (among L)
No. of asymptomatic falciparum cases (among N)
Number of epidemics not timely detected or not
controlled_______________________________
Number of epidemics early detected and
controlled________________________________
Doses of antimalarial drugs distributed
R
S_
T
No. of nets treated in at least one round
Average number of persons per net__________
Number of persons protected by house spraying
5
E
£
G
H
I
J
K
L
M
N
O
P
Comment___________________________
Best estimate of real (not administrative)
population__________________________
Nationally applied definition of population
at risk should be stated
Slides and rapid diagnostic tests.
If many rapid tests : separate reporting
Including P.f mixed with other parasites
Only if active case detection.
Inform location, time, cases, deaths
Calculated for each treatment as drug
quantity distributed by public system to
health facilities/adult dosage. Sum for all
treatments.
Tally reports from operations
Survey-based______________________
Sum of tallies of persons in each house
sprayed
Currently, some programmes will not distinguish how many of the severe cases and
deaths are confirmed and how many are probable. In that case, they should only fill in the
total number of severe cases and malaria deaths. Some programmes only record confirmed
cases, and should show this by filling in for example H = I and J = K. Most of the
programmes that include Active Case Detection do not currently distinguish between
confirmed malaria cases and asymptomatic carriers. Over time, they are expected to
introduce this distinction and fill in L, M and N, instead of including asymptomatic cases
under D, E and F.
C. Core epidemiological and operational indicators
42
Category
Incidence
Mortality
Prevalence/
Burden
Severity
Case fatality
Disease
management
Prevention
Indicator
Calculation
Incidence of probable malaria (uncomplicated + severe)________
Incidence of confirmed malaria (uncomplicated + severe)_______
Annual Parasite Incidence (confirmed malaria + asymptomatic
carriers)________________________________________________
Incidence of falciparum malaria (confirmed falciparum malaria +
asymptomatic falciparum carriers)___________________________
Malaria mortality (probable + confirmed)____________________
Slide (test) positivity rate ((confirmed cases + asymptomatic
carriers)/(persons tested by slide or "dipstick"))________________
Proportion of severe cases (probable + confirmed) among all
malaria cases (probable + confirmed)________________________
Case fatality rate of severe malaria (probable + confirmed)_____
Case fatality rate of falciparum malaria (confirmed malaria
deaths/falciparum cases)___________________________________
Number of doses of antimalarial treatment distributed by public
health system to curative services (public/ private/ communitybased)_________________________________________________
Number of suspected malaria cases recorded per year related to
at-risk population
G/A
E/A
Number of persons tested by slide or "dipstick" per year related
to at-risk population
D/B
Number of nets treated per year___________________________
Proportion of population at risk covered by insecticide-treated
nets, or by insecticide treated nets or spraying
R________
RxS/B
(RxS +T)/B
(E+M)/A
(F+N)/A
J/A
(E+M)/(D+L)
H/(E+G)
J/H
K/F
Q
C/B
Population denominators
For all incidence rates (including mortality), the population denominator is the total
mid-year population living in the area covered by the report, including migrants and
temporary visitors irrespective of nationality. The population at risk is not a suitable
denominator for international reporting of incidence rates, although it is important in
malaria control planning and as a denominator for operational indicators.
Rates and ratios
'Incidence' and 'mortality' are used here as meaning reported incidence (morbidity) and
mortality rates. Conventionally in malaria control, incidence rates are calculated per 1 000
person-years and mortality rates per 100 000 person-years. Ratios (e.g. case fatality rates) are
expressed as percentages.
From data elements in B. Multipliers (100. 1 000 or 100 000) omitted.
6 As long as most programmes record few results of rapid diagnostic tests, these can be included in the
calculation of the slide positivity rate. However, if a substantial number of rapid diagnostic tests are included, it
is preferable to separate a slide positivity rate and a rapid test positivity rate. This is particularly important, if
the tests are positive only for P.falciparum.
43
D. Recommended geographical units for international malaria reporting in the Mekong Region
by country
7
Country
Geographical unit
Cambodia
Province
China
County
Lao PDR
Province
Myanmar
District
Thailand
Province
Vietnam
Province
Anne
Annex 3
WORKPLAN 2000 - 2003
TSN ON TRANSMISSION RISK REDUCTION
PRIORITY AREAS AND ACTIVITIES
2000
EXPECTED OUTCOMES
Q
1
Q
2
Q
3
2001
Q
4
1. Establishment of regional core groups on
TSN-TRR
1,1 Identification of core group of experts
7
Composition of regional
Mekong Malaria. Southeast Asian Journal of Tropical Medicine and Public Health,
30, Supp. 4, 1999
Q
1
Q
2
Q
3
44
TSN-TRR established
1.2 Establishment of effective communication
links
Communications
Established
>
2. Establishment of functional national TSNTRR
2.1 Identification and networking of institutions,
organizations, and experts
TSN-TRR functional in each
Member Country
2.2 Development of detailed work plan in each
Member Country and annual update of the plan
Work plan developed and
updated yearly
2.3 Unking with partners for resources
Partners support TSN-TRR
PRIORITY AREAS AND ACTIVITIES
EXPECTED OUTCOMES
►
>
2000
Q
1
Q
2
Q
3
2001
Q
4
Q
1
3. Development of regional guidelines on
prioritized issues
3,1 Monitoring and evaluation of interventions
Guidelines developed
3.2 Insecticide-treated net programme
Guidelines developed
>
3.3 Insecticide policy
Guidelines developed
>
3.4 Stratification and selective targeting of
house- spraying
Guidelines developed
>
3.5 Vector resistance monitoring and
management
Guidelines developed
>
3.6 Minimum requirements for health impact
assessment of development projects
Guidelines developed
3.7 Integrated vector control_____________
4. Common framework to initiate action at
country level
Guidelines developed
►
4.1 Mosquito nets
4.1.1 Inventorize information on ITN
operationalization (standardize parameters,
identify knowledge gaps)
Inventory report available
4.1.2 Formulate evidence-based guidelines for
programme implementation (decision-making
criteria for ITN purchase, logistics for focused
delivery and maintenance)
Guidelines developed
>
4.1.3 Set a research agenda and strategy for
resource mobilization to implement it
Research conducted
>
>
Q
2
Q
3
45
PRIORITY AREAS AND ACTIVITIES
EXPECTED OUTCOMES
2001
2000
Q
1
Q
2
Q
3
Q
4
Q
1
Q
2
Q
3
4.2 Insecticides
4.2.1 Review the knowledge base and decision
making procedures for judicious use of
pesticides
4.2.2 Advise on the modalities for the
operationalization of selective/integrated
approaches with optimal complementarity of
chemical and non-chemical TRR interventions
4.2.3 Inventorize regional insecticide resistance
and provide guidance on resistance
management
Knowledge gaps identified
>
Recommendations provided
Guidelines on insecticides
resistance management
developed
4,3 Targeted training
4.3.1 Identification of training needs and
resources at different levels
Recommendations for
training
4.3.2 Development of curricula, training modules
and advocacy and IEC materials
Training materials developed
4.4 Cytotaxonomy and vector biology
(special problems relating to An. dirus, An.
minimus, and An. fluviatilis
>
46
4.4.1 Complete a regional picture of sibling
species and develop a strategic approach to fill
knowledge gaps
Knowledge gaps identified
and strategy developed
4.4.2 Coordinate, stimulate and document at
least five case studies on ecosystem-based TRR
approaches to serve as regional prototypes
Regional prototypes on
ecosystem-based TRR
approaches developed
4.4.3 Develop mapping and possible TRR
interventions in dirus/ fluviatilis/minimus settings
Interventions developed
PRIORITY AREAS AND ACTIVITIES
EXPECTED OUTCOMES
2001
2000
Q
1
Q
2
Q
3
Q
Q
4
1
Q
2
4.5 Monitoring and evaluation
4.5.1 Review the regional situation with respect
to TRR indicators and their use, and assess the
potential to upgrade and/or harmonize indicators
Consensus on core
indicators
4.5.2 Inventorize GIS resources (both health
sector/outside the health sector) for ongoing and
potential monitoring/ evaluation activities
Inventory of GIS resources
>
4.6 International borders
4.6.1 Technically support and assist in the
synchronization of field operations in the border
areas.
Improved cross-border field
operations
4.6.2 Review and promote experience-sharing of
existing mechanisms and partnerships for crossborder collaboration in TRR operations.
Improved cross-border field
operations
4.7_Health Impact Assessment/Health Risk
Management
4.7.1 Coordinate national activities
(assessments, workshops) to review, adjust and
harmonize development policy frameworks to
promote HIA/HRM
Recommendations on
HIA/HRM
4.7.2 Adapt existing generic HIA guidelines for
specific use at the country level
Local adaptation of generic
HIA guidelines
4.7.3 Set a research agenda on TRR
interventions through intersectoral action
Research agenda available
>
Q
3
47
WORKPLAN 2000 - 2003
TSN on SURVEILLANCE, INFORMATION MANAGEMENT AND EPIDEMIC PREPAREDNESS
AND RESPONSE
PRIORITY AREAS AND ACTIVITIES
2001
2000
EXPECTED OUTCOMES
Q
1
Q
2
Q
3
Q
4
Q
1
Q
2
Q
3
1. Networking at country level
1.1 Identify institutions and experts that will
comprise the TSN-SIE and establish working
mechanisms
TSN-SIE in each Member
Countries functional
1.2 Develop detailed country plans based on the
generic regional SIE plan and update yearly as
necessary
Country plans developed
and updated yearly
1.3 Linking with partners for resources
Partners support TSN-SIE
2. Surveillance System
2.1 Develop protocol and provide technical
assistance in piloting and validating the
indicators in selected RBM districts
Finalized set of core
indicators
2.2 Review and if necessary, recommend
modification of existing format for reporting of
malaria deaths
Modified reporting format in
use
►
2.3 Develop mechanisms to strengthen hospitalbased reporting of malaria deaths (CFR)
Improved reporting of
malaria deaths (CFR)
>
2.4 Develop strategies to collect malaria data
from private sector for incorporation into the
surveillance system
Improved coverage and
accuracy of surveillance
>
PRIORITY AREAS AND ACTIVITIES
EXPECTED OUTCOMES
>
2000
Q
1
Q
2
Q
3
2001
Q
4
Q
1
Q
2
Q
3
48
3. Information Management
3.1 Identify and link up with centres of
excellence
Linkage with centres of
excellence established
3.2 Comprehensive needs assessment and
planning for computerized information
management system
Plan for computerized
information management
system developed
2.3 Develop methodology for piloting test
parameters in at least one district per country
Methodology developed
2.4 Develop training modules
Training modules developed
2.5 Provide technical assistance in training of
personnel on information management
Personnel trained
3. Epidemic preparedness and response
3.1 Determine thresholds for epidemics
Epidemic thresholds
established
3.2 Set up early warning system
Early warning system
established
3.3 Evaluate and improve the early warning
system
Early warning system
improved
3.4 Develop guidelines on rapid response team
and assist and evaluate its implementation
Rapid response team
functional
>
>
49
PRIORITY AREAS AND ACTIVITIES
2000
EXPECTED OUTCOMES
Q
1
Q
2
2001
Q
3
Q
Q
1
4
Q
2
Q
3
4. Information exchange and networking
4.1 Identify information needs for sharing
Information needs for
sharing identified
4.2 Publication of SIE information at RBM web
site
SIE information available at
RBM web site
4.3 Sharing of RBM experiences through annual
regional meetings
SIE network strengthened
►
5. Research
5.1 Identify priority research needs
Research agenda
5.2 Develop standardized research proposals
Research proposals
developed
5.3 Conduct priority research
Research conducted
>
►
WORKPLAN 2000 - 2003
TSN on DRUG RESISTANCE AND POLICIES
PRIORITY AREAS AND ACTIVITIES
2000
EXPECTED OUTCOMES
Q
1
Q
2
Q
3
2001
Q
4
Q
1
Q
2
Q
3
1. Establishment of TSN-DRP in member
countries
1.1 Identification and networking of experts and
institutions who will comprise the TSN-DRP
TSN -DRP functional in each
Member Countries
1.2 Development of detailed country plan of
work to be updated yearly
Country plan of work
developed
1,3 Linking with partners for resources
Partners support TSN-DRP
►
>
2. Data banking and information exchange
on:
2.1 Directory of national experts relevant to DRP
Directory established
►
50
2.2 Drug policies and drug regimens
Drug policies shared
2.3 Drug resistance data
Data utilized
2.4 Standardization of the format for reporting
and exchange of information
Improved information
exchange
2.5 Activities of the network
Network activities monitored
PRIORITY AREAS AND ACTIVITIES
EXPECTED OUTCOMES
2001
2000
Q
1
Q
2
Q
3
Q
4
Q
1
Q
2
Q
3
3. Capacity building
3.1 Facilitate training professional staff in
malaria
control
programmes
and
at
province/district
levels
on
programme
management in the context of anti-malarial drug
policy
Key staff trained
3.2 Train staff on drug resistance monitoring
Improved monitoring of drug
resistance
3.3 Support infrastructure development for
monitoring drug resistance
Improved monitoring of drug
resistance
3.4 Build national capacity on anti-malarial drug
quality assurance
Drug quality monitored
4. Procurement and distribution system for
anti-malarial drugs and rapid diagnostic tests
4.1 Review of existing systems
Recommendations made
4.2 Explore the feasibility of pooled procurement
at regional level
Recommendations made
4.3 Social marketing to promote the use of
affordable and effective anti-malarial drugs and
rapid diagnostic tests
Improved access to drugs
and RDTs
>
5. Operational research
5,1 Setting of research agenda
Research agenda available
5.2 Review and facilitate research funding
Research funded
5.3 Conduct operational research
Research conducted
5.4 Develop and evaluate strategies to contain
the spread of drug resistance
Containment of drug
resistance
>
>
►
- Media
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