Mohamed Faisal 2014 RPRG Meeting WHO Region

 Geography and Population ◦ Total population: 371,507 (Census 2006) ◦ Ecological zones – next slide  Political & Health Administrative Divisions: -First level :Central Level - HPA -Second level : Regional (political but not for health sector) - Atoll Level -Third level : Island Level

REPUBLIC OF MALDIVES Maldives comprises of 1190 Islands Administrative natural atolls 20 Total inhabited Islands197 Country population (2013 projected)371,507 Av. flow of expatriate workers per year 44,845 Av. flow of visitors (tourist) per year 395,320 Climate (monsoon) (NW &SW) Av. temperature deg C

 Filaria was considered as a public health problem in the Maldives, 50 years ago.  First survey was carried in 1951, in southern most 5 atolls.  Seenu  Ghaviyani  Gaaf Alif  Gaaf Dhaal  Laamu  Disease incidence rate was 24% (1951).  National control programme was launched on 1968 in Male’.  Filaria control programme in atolls was started on 1974 and continued till 1997.

 10 known endemic islands by  National filaria elimination plan was developed. ( )  A re-assessment survey of the 10 islands were conducted in  Only Laam Fonadhoo(island) was found to be endemic.  MDA 5 rounds completed ◦ First round of MDA in Laam Fonadhoo started in ◦ Fifth round of MDA in Laam Fonadhoo completed on 23 rd June 2008.

Disease under elimination since 2008 No local cases since 2008 Imported cases: ( ) nil Vector – Culex Quinquefasciatus still exists Surveillance rounds ongoing since 2008 Treatment provided free for any new cases

IndicatorTargetedAchieved M&E Total # sentinel and spot check sites surveyed (LF) 5 (2012) Total # IUs where stopping-MDA TAS implemented (LF) 0 Total # IUs which passed TAS and stopped MDA (LF) 0 Total # IUs where surveillance TAS implemented (LF) 0 MMDP# IUs where hydrocele surgeries performed No recent data

 Describe how coverage is monitored  Surveys conducted every year ~4 atolls  SAE protocol

Definitions Started MDA ≥5 MDA rounds SurveillanceMMDP access

 Conducting awareness programmes about LF and vector control methods  Reporting through health facilities to HPA on vector control programmes conducted by atoll level.

LF National policy exist?yes Organizational placement within the government (who is responsible?) Health protection Agency/ Ministry of health How integrated with the health service?Ministry of education/school health programme Training of service providers conducted (by who? How frequent?) Health protection Agency/ Ministry of health Patient mobilization and registration (by who? How?) Health protection Agency/Ministry of health

 Describe interventions and/or M&E activities that worked well i.Integrated activities i.Elimination activities ii.Disease-specific activities: ICT surveys every year for 4 atolls iii.At present, activities (surveys) are low.

 For each disease, list the specific challenges/issues that need advice from RPRG  For LF, ◦ Now low priority as it is under elimination, so less resources for continuing activities ◦ Need programs for preventing re-entry of the disease as vector is still present. e.g. Testing migrants, vector surveillance and IVM

MNS (Micro nutrient survey) 2007:4% of children 6 months to 5 years of age were found having any kind of worm infestation.(stool examination) Prevalence in all age groups: 6.1%

 Government provides deworming syrups to all children under the age of 2-5 years  Government provides deworming tablets (albendazole) to all children under the age of thirteen years.(6-13 years)  Public health awareness programs are conducted in all the schools  Public awareness programs are conducted through media  IEC materials are developed and distributed in all health centers and schools  Conduct awareness programs on personal hygiene

IndicatorLFSTH Year of inception of the national programme 1968 Elimination plan: Target date for elimination2010 Name of administrative unit for implementation of PC Central Total # administrative units requiring PC at the start of the programme 1056 Total population requiring PC in the country Eliminated since 2008 Mainly migrants

IndicatorTargetedAchieved M&ETotal # sentinel sites surveyed (STH) 0 Activities TargetedAchieved # administrati ve units for PC # people # administrati ve units for PC # people PC MDA2 (DEC + ALB) 0 T3 (ALB/MBD) for STH 1 st round T3 (ALB/MBD) for STH 2 nd round

*65% for LF and 75% for STH **reported coverage was verified by coverage survey or similar independent activity PC type # administrativ e units receiving PC # administrative units with reported coverage above target* # administrative units where coverage was verified** MDA2 (DEC + ALB) 000 T3 (ALB/MBD) for STH 1 st round 5617 T3 (ALB/MBD) for STH 2 nd round 5620

 Patients detected through health facilities ◦ Management  Treatment provided free of charge from Nutrition programme ◦ Reporting –  through health facilities to HPA (Central Level)

 For each disease, list the specific challenges/issues that need advice from RPRG  STH: ◦ Since the programme started in 2000, there is an need to review and strengthen the deworming programme.

Activities 2014 target2015 target # administrative units for PC # people # administrative units for PC # people PC MDA2 (DEC + ALB) Not required T3 (ALB/MBD) for STH 1 st round T3 (ALB/MBD) for STH 2 nd round

ALB (LF)ALB (STH)MBDDEC required61064 in stock65200 in pipeline-