Transcript Guidelines for the treatment of malaria

Malaria Case Management
Dr Peter Olumese
Global Malaria Programme
WHO/HQ, Geneva
RBM Case Management
Working Group Meeting
8-9 July 2009
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CMWG Meeting 8-9 July 2009
The WHO Guidelines
for the treatment of malaria...
...provide comprehensible, global and
evidence-based guidelines for the formulation of policies and
protocols for the treatment of malaria
 provide a framework for development of specific diagnosis and
treatment protocols in countries
– Taking in account national and local malaria drug resistance pattern
and health services capacity
 Currently being revised – publication September 2009
www.who.int/malaria/docs/TreatmentGuidelines2006.pdf
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CMWG Meeting 8-9 July 2009
Parasitological diagnosis of Malaria
 Prompt parasitological confirmation by microscopy or alternatively
by RDTs is recommended in all patients suspected of malaria before
treatment is started.
Note:
Treatment solely on the basis of clinical suspicion may be considered in
areas of high transmission where parasitological diagnosis is not
available or is likely to delay treatment, particularly in high risk groups
such as:
• in severe malaria cases,
• in children under 5 yrs of age and
• in pregnant women.
* Update in 2009 Revised Guidelines
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CMWG Meeting 8-9 July 2009
ACTs for uncomplicated falciparum malaria
The following ACTs are recommended:
–artemether-lumefantrine
–artesunate - amodiaquine
–artesunate + mefloquine
–artesunate + sulfadoxine-pyrimethamine
–dihydroartemisinin – piperaquine*
efficacy of ACTs depend on the efficacy of the partner medicine
The artemisinin derivatives (oral formulations) and partner medicines of
ACTs should not be used as monotherapy in the treatment of uncomplicated
malaria
*Update in 2009 Revised Guidelines
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CMWG Meeting 8-9 July 2009
What is in the Package for HMM?...
 Trained community providers (CHWs, Medicine
Sellers or Retailers) should be provided with:
– ACTs for treatment of uncomplicated malaria.
– *Rectal artemisinin suppositories for pre-referral treatment
of severe malaria.
– *Rapid diagnostic tests where applicable.
– Information, Education and Communication materials.
– simple patient registers and reporting forms.
*Update in 2009 Revised Guidelines
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CMWG Meeting 8-9 July 2009
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CMWG Meeting 8-9 July 2009
Goal of Malaria Case Management
 To cure infection and reduce morbidity and mortality
 The Public health goal is to reduce the infectious reservoir
Specifically
– Early detection and prompt effective treatment to cure the infection and prevent
progression to severe disease
– Proper management of severe disease to prevent death
– Prevent drug resistance
– Reduce malaria transmission
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CMWG Meeting 8-9 July 2009
Components of Malaria Case Management
 Prompt diagnosis or recognition of malaria
 Treatment with effective drugs,
 Referral (and pre-referral treatment when indicated),
 Counselling and Follow up of patient
 Issues related to diagnosis: policy and quality assurance,
 Drug: supply and managment; safety (PV) quality (regulation
issues); therapeutic efficacy
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CMWG Meeting 8-9 July 2009
What do we need now for Case
Management Implementation
 Greater support from adoption to implementation of safe and
effective ACTs: from "What" to "How"
 Strategic approach to increase parasite based diagnosis and ACT
coverage through facilities, HMM and private sector
 Effective drug supply & management systems at country level
 Improved quality of care and service delivery
 Monitor performance and progress through strong routine HMIS and
sentinel surveillance
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CMWG Meeting 8-9 July 2009
Purpose and Aim of the CMOM
● To support NMCP to efficiently and effectively organize malaria case
management service delivery at all levels of care.
● It aims to provide basic information for best practices for successful
programme management.
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Assessment of capacity
Programme planning for service delivery
Logistical management for regular supplies
Quality control and assurance of services
Programme supervision, monitoring and information systems
CMWG Meeting 8-9 July 2009
Content of CMOM
 Introduction
– Purpose and aim of the manual
– Target audience
 Defining the epidemiology and clinical profile of malaria
 Structure and planning for malaria case management implementation
– Assessment of the health system and infrastructure
– Programme management organization
– Planning for resources – human, financial and material
 Technical aspects to malaria case management (diagnosis and
treatment, and deployment)
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CMWG Meeting 8-9 July 2009
Content of CMOM ….
 Logistics and Supply chain management
–
–
–
–
–
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Quantification of drug requirements
Management of routine ordering
Managing distribution
Medicine management information system in health facilities (including tools)
Quantification of rapid diagnostic test requirements
CMWG Meeting 8-9 July 2009
Content of CMOM ….
 Quality assurance systems
– Microscopy
– Rapid diagnostic tests
– Pharmaceuticals
 Training
– Training (health providers in public and private sector)
 Communication for behaviour change
– Communication (health providers and general population)
– Advocacy
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CMWG Meeting 8-9 July 2009
Content of CMOM ….
 Supervision, monitoring and evaluation
–
–
–
–
–
Sources of information
Monitoring
Programme evaluation
Surveillance of resistance to antimalarial drugs
Supervision
 Integration of malaria case management into other health programmes
 Working with the private sector
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Drug regulatory issues
Training and supervision of formal private providers
Availability and marketing of drugs
Challenges for private providers
CMWG Meeting 8-9 July 2009
Why Focus on Strengthening Data
Collection and Reporting?
To support improvement in:
 decision making and programme management
 planning and logistics management at all levels
 monitoring case management performance
 monitoring progress, outcomes and impact
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CMWG Meeting 8-9 July 2009
Improved Sample Data collection Forms
•
•
•
•
Malaria Patient Card - OPD
Health Unit Malaria Case Recording Register
Health Unit Monthly Summary Report Form
Health Unit Monthly Supply Report Form for Antimalarial Medicines
and Laboratory Supplies
•
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District monthly report summary form.
CMWG Meeting 8-9 July 2009
Malaria Patient Card - OPD
General Patient Information
1. Clinical Assessment
–
–
Duration of fever
Recognition of signs of severe malaria
2. Lab Confirmation
– Examination No/Yes
– Microscopy +/- Species
– RDT
+/-
3. Malaria Diagnosis
– Clinical
– Confirmed
• Uncomplicated
• Re-treatment
• Severe Malaria
4. Treatment
–
Prescribed
5. Outcome
–
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Sent home, Referred, Admitted
CMWG Meeting 8-9 July 2009
– Dispensed
Malaria Register
Outpatient Malaria Diagnosis
Laboratory Test
OPD
Action
Taken
Dispense
d
NO
YES
Medicine
Prescribed
Confirmed
F V M O U
Referred
Severe
Malaria
Clinical
CMWG Meeting 8-9 July 2009
N
ACT Re-treatment
P
Confirmed
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N
New
Cases
Clinical
P
Parasite
Species
Not Tested
Address
sex
Age
Name
OPD Number
RDT
Microscop
y
Uncomplicated
Malaria
Outpatient Malaria
Treatment and action
H
R
A
Information Flow
Patient Card
District Summary
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CMWG Meeting 8-9 July 2009
Malaria Register
Monthly Report Summary
Monthly Stock Management Form
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CMWG Meeting 8-9 July 2009
Monthly Supply Report Form
Stock-out
Stock Management
(treatment course)
(tick as appropriate)
Quantity Re-ordered
Lead Time
CMWG Meeting 8-9 July 2009
Expected variation
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Consumption
RDT
Closing Stock
ACT Pack 3
Opening Stock
ACT Pack 2
Safety Stock
ACT Pack 1
>1 week
<1 week
None
Item
Centralized Country Database
Electronic or Paper
District Database
National Malaria
Database
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CMWG Meeting 8-9 July 2009