1. COUNTRY PLANNING EXERCISE MALAYSIA (SABAH) BIREGIONAL WHO MALARIA ELIMINATION TRAINING COURSE 18 FEBRUARY 2014

2. FEASIBILITY ASSESSMENT Technical – Challenges : vectorial capacity, physical environment, human ecology Operational – Mostly favorable Target: no local human malaria case by 2017 Conclusion: FEASIBLE Be cautious on P. knowlesi

3. SURVEILLANCE SYSTEM 1)Case definition a.SUSPECTED CASE: febrile case from endemic country, red or yellow locality b.CONFIRMED CASE: case confirmed by microscopy test (gold standard) or PCR (if indicated) c.INCUBATION PERIOD: P. falciparum 8 - 14 days, P. vivax 10 - 18 days, P. malariae and P. ovale 30 - 45 days d.OUTBREAK – Malarious area: more than monthly median case for the past 3 years – Malaria prone or malaria free area: more than one locally transmitted case within 2 incubation period

4. 2)Methods for confirmation and their QA – Gold standard Microscopy test (BFMP) – Quality assurance 100% positive slides and 10% negatives slides will be sent to state vector laboratory for re-checking

5. 3)Personnel responsible for case detection, involvement of other entities than public health services – State level: Vector Borne Disease Department, – District level (ie Lahad Datu): health office covering 7 subdistricts – Subdistrict level: specific malaria team consisting of 3-4 staff – Active case detection (ACD) by district health inspector Notification within 24 hours Completion of report within 3 days Completion of vector control activities within 7 days

6. – Private sector Medical practitioners to send microscopy tests for suspected case and to refer to hospital if indicated – Quality assurance of private laboratory Routine sample checking by state vector laboratory – Volunteers (SPKA) are trained to assist in fever screening, slide examination and referral at community level – Informal public and private partnership onsite clinics in private plantations / logging camps – All confirmed malaria cases will admitted for treatment

7. 4)Laboratory methods – Microscopy examination – PCR, if indicated With clinical symptoms of malaria but no malaria parasite seen in BFMP Mortality cases Cases having microscopic appearance of P. malariae – RDTs Only during outbreak

8. 5)Methods of reporting – Mandatory notification for malaria under Prevention & Control of Infectious Disease Act 1988 – Standardized form case registry, investigation and follow up, malaria death investigation, foci registry, vector control (localities, vector control activities), laboratory (number of slides and results) – Existing database of e-notis and e-Vekpro (web- based) socio-demographic data, laboratory results, treatments and vector control activities analysis and synthesis of epidemiological information and the trend

9. 6)Reports and feedback produced by central level

10. 7)Coverage – ABER = (Total number of slides taken – duplicated slides) / total population x 100 Year200820092010201120122013 Slide Positivity Rate (SPR) 1.50%1.40%0.90% 0.52% 0.50%0.34% Annual Blood Examination Rate (ABER) 13.20%12.30%12.50% 11.80% 11.74%10.80%

11. IDENTIFY THE CHANGES REQUIRED GAPS IDENTIFIED: 1.Indigenous infection still high 2.Pf still high 3.Outbreak occur in green locality 4.Outbreak occur in locality with vector control activities

12. STRATEGIES 1.To strengthen case detection (PCD, ACD), case investigation and follow-up and usage of PCR tests for P.malariae 2.Triaging in PCD center 3.Insecticide resistance surveillance 4.ACD: slide examination for all foreign workers who seek treatment in any health facility, regardless of fever status

13. 5.Redefine outbreak to be less technical: Malarious area: more than 2 locally transmitted case within 1 incubation period Malaria prone or malaria free area: one locally transmitted case 6.ABER calculation Numerator -> slides by PCD Denominator -> population at risk

14. Identify relevant strata, where the surveillance system may be differentiated 1.Individualized target for each district CASE NUMBER 2013TARGET FOR YEAR 2014WEEKLY TARGET KOTA KINABALU750.1 PAPAR14110.2 PENAMPANG860.1 PUTATAN110.0 TUARAN24180.3 RANAU1941462.8 KOTA BELUD53400.8 KUDAT87651.3 KOTA MARUDU82621.2 PITAS48360.7 BELURAN98741.4 SANDAKAN1290.2 KINABATANGAN48360.7 TONGOD67501.0 LAHAD DATU1781342.6 TAWAU1581192.3 SEMPORNA56420.8 KUNAK21160.3 KENINGAU1861402.7 NABAWAN51380.7 TENOM99741.4 TAMBUNAN52390.8 BEAUFORT1290.2 SIPITANG49370.7 KUALA PENYU110.0 1606120523

15. 2.Risk factors analysis by districts (ie LAHAD DATU) District s Demography No. of reported Malaria cases Risk Factors No. of villages affecte d by malaria Populatio n 201020112012 Description of major occupation Times of day when people are active in their work No. of men & women infected with malaria (men: women) Malaria vectors: LAHAD DATU 2010 Locality =49 2011 Locality =64 2012 Locality =76 2013( W1- W18) Locality =35 22416 36716 42169 12602 185166213-Hunting/ fishing -Land settler/ plantation/ agriculture/ logging/ forestry -military deployment 6.00pm- 11.00pm 24 hours 2010=185 M : 113, F : 72 2 : 1 2011=166 M : 126, F : 40 4 : 1 2012=213 M : 162, F : 51 4 : 1 2013(W1- W18)=54 M : 39, F : 15 4 : 1 An. balabacensis

16. 3.GIS implementation – Need to provide equipment 4.Strengthening of PCD screening at health facility – All fever case are suspected malaria until proven otherwise, and microscopy tests will be done – Intermittent audit and reminder (letter/email) 5.Foreign workers screening at entry point – Integrated with IHR programme

17. Thank you…