World Health Organization 19 April, 2017 Malaria Case Management Dr Peter Olumese Global Malaria Programme WHO/HQ, Geneva RBM Case Management Working Group Meeting 8-9 July 2009

The WHO Guidelines for the treatment of malaria... World Health Organization The WHO Guidelines for the treatment of malaria... 19 April, 2017 ...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

Parasitological diagnosis of Malaria World Health Organization Parasitological diagnosis of Malaria 19 April, 2017 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

ACTs for uncomplicated falciparum malaria World Health Organization ACTs for uncomplicated falciparum malaria 19 April, 2017 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

What is in the Package for HMM?... World Health Organization What is in the Package for HMM?... 19 April, 2017 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

World Health Organization 19 April, 2017

Goal of Malaria Case Management World Health Organization 19 April, 2017 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

Components of Malaria Case Management World Health Organization 19 April, 2017 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 8

What do we need now for Case Management Implementation World Health Organization 19 April, 2017 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 9

Purpose and Aim of the CMOM World Health Organization Purpose and Aim of the CMOM 19 April, 2017 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. 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

World Health Organization Content of CMOM 19 April, 2017 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)

World Health Organization Content of CMOM …. 19 April, 2017 Logistics and Supply chain management 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

World Health Organization Content of CMOM …. 19 April, 2017 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

World Health Organization Content of CMOM …. 19 April, 2017 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 Drug regulatory issues Training and supervision of formal private providers Availability and marketing of drugs Challenges for private providers

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

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 District monthly report summary form.

World Health Organization 19 April, 2017 Malaria Patient Card

Malaria Patient Card - OPD General Patient Information Clinical Assessment Duration of fever Recognition of signs of severe malaria 3. Malaria Diagnosis Clinical Confirmed Uncomplicated Re-treatment Severe Malaria 2. Lab Confirmation Examination No/Yes Microscopy +/- Species RDT +/- Dispensed 4. Treatment Prescribed 5. Outcome Sent home, Referred, Admitted Admitted Referred Sent Home 5. Outcome: 6. Notes: * F = P. falciparum; V = P. vivax; M = mixed infection; O = others (P. malariae or P. ovale) ; U = not identified.

Malaria Register Laboratory Test OPD Number Address Name RDT sex Age Outpatient Malaria Treatment and action Outpatient Malaria Diagnosis Not Tested Laboratory Test Address sex Age Name OPD Number Referred Severe Malaria Uncomplicated Malaria OPD Action Taken Dispensed Medicine Prescribed Confirmed Clinical ACT Re-treatment New Cases Parasite Species Microscopy RDT A R H NO YES U O M V F N P

Information Flow Patient Card District Summary Malaria Register Monthly Report Summary District Summary

Monthly Stock Management Form

Monthly Supply Report Form Stock Management (treatment course) Stock-out (tick as appropriate) Item Quantity Re-ordered Lead Time Expected variation Consumption Closing Stock Opening Stock Safety Stock >1 week <1 week None ACT Pack 1 ACT Pack 2 ACT Pack 3 RDT

Centralized Country Database Electronic or Paper District Database National Malaria Database