Transcript MOAB017 – Epidemic Pediatric Malaria In Ezo County, South Sudan

Microscopic prevalence, treatment
choices and prevention of malaria in
under-five children at Ezo PHCC, WES,
South Sudan
Moses Girish N. Felix
Cohort 2 post graduate/CHD Office Ezo County
24th -26th November 2014
Amref Conference Safari Hotel Nairobi
Presentation Outline
•
•
•
•
•
•
•
•
Introduction
Problem Statement
Objectives and research questions
Methodology
Findings
Discussion
Recommendation
References
Introduction and Background
• Morbidity and mortality of children under age
of five is estimated to be 135 per 1,000 live
births (UNDP 2006).
• Most of these deaths are due to malaria.
• Ezo County estimated population of 95,000
Excluding IDPs and refugees.
• The natives are peasant farmers and the
general climate is tropical rain forest.
Problem Statement
• Malaria is leading cause of morbidity & mortality in
children under five years in Ezo County (W.E.S)
• Despite favorable climate for malaria, there seems to
be no clear malaria treatment guidelines, sufficient
treatment is often lacking and preventive measures
inadequate at Ezo PHCC.
Objective
• Main Objective; To find out malaria prevalence,
treatment choices and preventive measures for malaria
in children under five at Ezo PHCC
Specific Objectives:
To find out laboratory and clinical prevalence malaria for
under five
To evaluate accessibility and availability of malaria
treatment for under five
To assess treatment protocols and adherence to treatment
regimen.
To find out whether appropriate preventive measures are
used in the household
Methodology
• Quantitative and qualitative non-parametric method
was used.
• Data was obtained through desk reviews of
laboratory microscopic register and OPD treatment
registers.
• Questionnaire guided interviews was conducted to
purposively sampled mothers and caretakers of
children under age of 5 attending OPD and ANC
clinics at Ezo PHCC.
• Key informant interviews of clinicians and other
health personnel – check list/interview guide
Results/findings
• Between September 2013 and January 2014,
1135 microscopic tests conducted. 643 were
positive giving positive testing rate of 56.7%.
• All the children testing positive were treated
for malaria.
• 643 children were treated presumptively for
malaria.
• Of 100 mothers interviewed, only 27 had nets,
73 used them consistently.
Findings
• Children respondent, 643 (56.7%%) admitted to
not providing complete doses of previously
prescribed anti- malaria drugs.
• complete doses of previously prescribed antimalaria drugs.
• Insecurity of Lord Resistance Army (LRA)
• Poor road network
• Boarder Restriction of goods
• Lack of information and traditional brief.
Map of South Sudan
Ezo PHCC- Ward Under
Reconstruction
Surgical Ward
OPD- Waiting Area
Findings
Graph shows total malaria and positive
from September to January 2014
400
350
300
Microscopy
Total
Positives
250
Sep
250
115
Total
200
Oct
363
Positives
230
150
Nov
217
136
100
Dec
124
64
50
Jan
180
98
0
Sep-13
Oct-13
Nov-13
Dec-13
Jan-14
Discussion
• South Sudan, new country, CPA 2005,
Independence July 2011
• Lack of resources due decades of war still
hindering service provision
• Insecurity, border restrictions, inaccessibility, and
poor roads network affect logistics and supply
• Information, literacy levels, cultural practices
hindering uptake of services
Discussion Cont.
 Recent interventions: August – September 2014 by
PSI/WVSS-USAID/WHO
Training of HHPs (WVSS)
Community awareness or sensitization (WVSS
_USAID)
Distribution of nets (PSI)
Clinicians trained on standard treatment protocols
and guidelines (WHO)
Conclusion and recommendation
• Emergency drug procurement and distribution
be set
• Carry out study on the impact of these recent
interventions on malaria prevalence
Acknowledgements
•
•
•
•
•
CHD
SMoH
Community Heath Workers
Ezo PHCC management and staff
CMMB, World Vision-JPHIEGO/USAID, PSIUSAID
• Mothers and caregivers who participated in
the evaluation.
References
• Malaria in South Sudan; South Sudan Medical
Journal accessed 2013 Feb
• Malaria control in South Sudan, 2006–2013:
strategies, progress and challenges; Malaria
Journal 2013
• Amref South Sudan; About us
• South Sudan Household Survey 2006
THANKS
• SUKULAN
• ASANTI SANA
• TAMBUAHE