RAM in PNG Activities Past and future May 2015

SUMMARY ACHIEVEMENTS From 2010 to 2014 Rotarians Against Malaria in PNG together with National and Provincial Health Services has distributed over 6.5 million Long Lasting Insecticide Treated Mosquito Nets (LLINs) (5.8 million to household level and about 0.8 million to vulnerable groups such as pregnant women). The programme has reached almost all of the 22,000 villages in PNG at least once, with villagers receiving new nets every three years.

THE SUCCESS STORY Malaria Incidence has fallen from 277 cases per one thousand people in 2005 to only 125 cases per 1000 people in In some provinces malaria incidence has fallen over 70%. Suspected malaria deaths down from 731 in 2005 to 296 in Malaria prevalence reduced by more that 80% from 2009 to It is generally believed that the use of treated mosquito nets have definitely contributed to these reductions. THE RESULT OF LLIN DISTRIBUTION HAS SEEN A HUGE REDUCTION IN MALARIA IN PNG

SUMMARY RESULTS Malaria Prevalence Reduced From 2009 To 2014 By More Than 90% In Highlands And Southern Region and 80% In Momase And Niugini Islands AS A RESULT OF TREATED MOSQUITO NETS DISTRIBUTED MALARIA HAS BEEN GREATLY REDUCED IN PNG

CHALLENGES TO REDUCE MALARIA FURTHER There are still areas in PNG, especially in the New Guinea Islands region, where, despite education on the causes and prevention of the disease, the incidence of malaria is still relatively high. This high incidence would indicate that RAM needs to locate experts who can provide Technical Assistance in ascertaining the reason for the low reduction in malaria prevalence. Malaria prevalence is not normally associated with altitudes above 2000 metres. However, villagers living on mountains and having gardens in valleys are susceptible to malaria. With the general reduction of malaria, there is no system in place to detect where these anomalies occur.

ADDITIONAL CHALLENGES Other challenges include: Making sure that people use their nets. Making sure they can buy nets when new ones are needed. Outdoor and early mosquito biting. Use of “Mosbar” (a mosquito repellent in a bar) Getting clinics to test all suspected malaria patients with rapid diagnostic tests (RDTs) for malaria. Making sure that drugs and RDTS are always available at health centres. Making malaria treatment is available in remote places.

THE FUTURE FOR RAM – “Funding” RAM will continue to work with the National Department of Health and Provincial Health Authorities to deliver nets throughout PNG with Global Fund funding as well as funds from the international Rotary family. The very successful “Adopt a Village Programme” (AAV) which many Rotary Clubs supported. (Every village adopted under AAV, received mosquito nets and shows substantial reductions in malaria). AAV will now be elevated to a new programme, aptly named “Chasing Malaria”, which is fully explained later. This programme will fill the gaps where Global Fund money cannot be used. (i.e. Chasing Malaria Programme, nets for HIV positive persons and TB sufferers).

THE FUTURE Delivering Nets Due to reduced Global Fund funding: No nets will be distributed in high altitude locations such as Kandep in Enga. Only under fives will receive nets in low endemic areas of malaria such as the highlands provinces between 1500 to 2000 metres and urban areas such as Port Moresby and Lae where health care is accessible. All other areas will receive nets on a needs basis

THE FUTURE – DELIVERING NETS (4) Global Fund will employ four regional Malaria Officers who will predominantly coordinate the distribution of antenatal nets. In addition They will carry out HSS in the following activities: Ensure that Provinces keep good stock records of nets received and are able to account for all the nets received. Assist the provinces to deliver Antenatal Nets to all health centres. Assist the provinces in delivering antimalarial drugs and RDTs to health centres. Assist provinces in monitoring the use of RDTs at health centres

THE FUTURE Private Sector Programme Mosquito nets can last many years but many don’t due to wear and tear and accidents. RAM only distributes Global Fund nets once every three years, therefore, if a net is damaged, it is very difficult to replace it. Only the very largest of retailers (Brian Bell, City Pharmacy) in Port Moresby are selling LLINs. All other shops are selling expensive Chinese nets of poor quality and generally untreated. In a bid to rectify this, RAM has employed a salesman to visit stores in NCD and the adjacent provinces. This initiative is now seeing WHO approved LLINs being sold in smaller tradestores. Advertising has started to now target other provinces in PNG to stock and sell approved LLINs

THE FUTURE Chasing Malaria Malaria transmission is very focalised. Malaria is greatly reduced throughout PNG but no one knows where the hot spots are which are left. Often clinics do not test suspected malaria cases, and even when they do, there is no system to record where the positive patients come from. RAM is changing this situation with a pilot project in Port Moresby and Central Province to find out where the malaria is coming from.

THE FUTURE Chasing Malaria (2) To encourage patients to come to clinics and for staff to test them with RDTs (Rapid Diagnostic Test) when malaria is suspected. RAM is giving out a free LLIN to every person who tests positive for malaria. To make sure that it is a genuine malaria case, the project asks health staff to register all positive malaria cases in a register book and keep all the RDT cassettes used. From the register books, the project can map all the malaria cases in an area. Positive RDT –Left Negative RDT - Right

THE FUTURE – Chasing Malaria (3) The Chasing Malaria Project to date has achieved the following. RAM has employed a full time employee to carry out the collection of data from the Health Centres. This person has already developed a very good working relationship with both NCD Health and Central Provincial Health Authorities. Latest results appear to suggest that malaria is not a problem within the NCD but has already identified four areas in Central Province which need further investigateion, namely, Kuriva, Brown River, Kubuna and Vanapa.

THE FUTURE – Other Projects In response to outside and early biting of mosquitoes (malaria carrying female mosquitoes usually bite late at night in PNG) To counter this, RAM has introduced Mosbar which is a solid formulation repellent which has a proven record of repelling mosquito bites in other countries. It is being sold through RAM’s Private Sector Programme and RAM will also ensure increased sales in highly malarial villages. RAM will also work with Institute of Medical Research (IMR) to find other appropriate ways of preventing mosquito bites from early or out door biting mosquitoes.

THE FUTURE What we want to do As malaria hot spots are identified, initiate community based programmes against malaria in these areas. (Healthy Islands) Deliver mosquito nets to HIV and TB patients as these are not covered through the Global Fund. Support other vulnerable groups when necessary in emergencies and support other Rotary Groups.

SOME HIGLIGHTS OF THE LAST FIVE YEARS

Logistic Problems

PNG Roads Menyamya District

Other Pictures

Happy Customers

Thank You Very Much

Yes We want to Help Eliminate Malaria in PNG If your club or organisation wishes to help eliminateMalaria in Papua NewGuinea then please send your Donation to PDG Richmond Manyweathers at PO Box ******, Carrinbah, New South Wales 2000 Australia. Or Send to Rotarians Against Malaria, PO Box 3626, Boroko National Capital District, Papua New Guinea For the attention of PP Ron Seddon – Chair, Rotarians Against Malaria For further information please contact: or