1. 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

2. 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

3. 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

4. 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

5. 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

6. World Health Organization
19 April, 2017

7. 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

8. 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

9. 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

10. 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

11. 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)

12. 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

13. 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

14. 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

15. 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

16. 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.

17. World Health Organization
19 April, 2017
Malaria Patient Card

18. 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.

19. 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

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

21. Monthly Stock Management Form

22. 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

23. Centralized Country Database
Electronic or Paper District Database
National Malaria Database