1. Malaria Case management KPA conference

2. Presentation outline  Introduction  National malaria strategy  Case management targets  AMFm subsidy  The treatment policy  The health worker’s role

3. INTRODUCTION  Annual burden of falciparum malaria in SSA - 365 million clinical episodes (Hay et al., 2005)  Over 1 million fatal cases, mostly in children <5 yrs ( Snow et al., 2005).

4. INTRODUCTION  Malaria - leading cause of mortality and morbidity in Kenya  It accounts for 5% - 25% of deaths  34,000 under fives die annually due to malaria  30% of outpatient and 19% of inpatient attendance.  An estimated 28 million Kenyans are at risk of infection  of which 1.5 million are pregnant women.

5. Introduction  ~ 170 million working days are lost annually to the disease,  control and management of malaria – multi pronged  Sound severe management presents the ” final arsenal” of defense for the particular patients  Parasitemia in the presence of features like anaemia, convulsions, comma, hypoglycaemia

6. National malaria strategy  Interventions-  Vector control  Case management  Surveillance, monitoring and evaluation and operations research  Advocacy, communication and social mobilisation  Intermittent presumptive treatment

7. Case management objective  Objective 2: To have 80% of all self managed fever cases receive prompt and effective treatment and  100% of all fever cases who present to health facilities receive parasitological diagnosis and effective treatment by 2013

8. Strategies  Strategy 2.1 Capacity building for malaria diagnosis and treatment  Strategy 2.2 Access to affordable malaria medicines through the private sector  Strategy 2.3 Strengthening Home Management of Malaria using the community strategy  Strategy 6.7 Strengthen procurement and supply management systems for malaria drugs and commodities

9. Targets  Scale up capacity for parasite based diagnosis countrywide in all public and mission health care facilities  Implement community based case management in high burden districts where community strategy is under implementation  Private sector capacity building beginning with major private hospitals and, pharmacies

10. Challenges  Procurement delays resulting in stock outs of anti malarials  Lack of diagnostic tools for universal implementation of the RDT policy  Irrational medicines use and non adherence to guidelines  Access to prompt and effective treatment 4% KMIS 2007

11. The AMFM  Global subsidy hosted by the GFATM to increase access to antimalarials in the private sector  Two year pilot 2010-2012 with a promise of extension if successful  Main objective is to subsidise cost of ACTs in the private sector

12. SUPPORTING INTERVENTIONS  Training of private sector workers  Deployment of ACTs to community health workers  Major IEC campaign  Inspection visits  Quality assurance of medicines and pharmacovigilance  Quality of care  Monitoring and evaluation

13. The policy  Uncomplicated malaria – first line ACTs  Second line – Dihydroartemisinine Piperaquine  Severe malaria – Quinine or alternatively artemisinines  WHO recommendations to change to artemisinines and government on the move to change policy (cost?)

14. Diagnosis  Confirmatory diagnosis for all age groups  Microscopy at higher levels  Rapid diagnostic tests for lower levels and where diagnosis by microscopy isn’t accessible.  Roll out at the community level 2013

15. ACTs  A group of schzonticidal drugs of which one is an artemisinine and which have different modes of action and biochemical targets  Advantages;  Rapid parasite clearance  Gametocytocidal effects  Slow development of resistance  Options- AL, DHAP, ASAQ.

16. Conclusion- health workers role  Enforcing diagnosis  Adhering to treatment policy  Encourage patient compliance  Refer severe cases  Monitor for treatment failure