Post on 22-Dec-2015
CMWG Meeting 8-9 July 20091 |
Dr Peter OlumeseGlobal Malaria Programme
WHO/HQ, Geneva
Malaria Case Management
RBM Case Management Working Group Meeting
8-9 July 2009
CMWG Meeting 8-9 July 20092 |
The WHO Guidelines for the treatment of malaria...
The WHO Guidelines for the treatment of malaria...
...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
www.who.int/malaria/docs/TreatmentGuidelines2006.pdf
CMWG Meeting 8-9 July 20093 |
Parasitological diagnosis of MalariaParasitological diagnosis of Malaria
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
CMWG Meeting 8-9 July 20094 |
ACTs for uncomplicated falciparum malariaACTs for uncomplicated falciparum malaria
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*Update in 2009 Revised Guidelines
CMWG Meeting 8-9 July 20095 |
What is in the Package for HMM?...What is in the Package for HMM?...
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*Update in 2009 Revised Guidelines
CMWG Meeting 8-9 July 20096 |
CMWG Meeting 8-9 July 20097 |
Goal of Malaria Case ManagementGoal 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
CMWG Meeting 8-9 July 20098 |
Components of Malaria Case ManagementComponents of Malaria Case Management
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
CMWG Meeting 8-9 July 20099 |
What do we need now for Case Management Implementation
What do we need now for Case Management Implementation
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
CMWG Meeting 8-9 July 200910 |
Purpose and Aim of the CMOMPurpose and Aim of the CMOM
● 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
CMWG Meeting 8-9 July 200911 |
Content of CMOMContent of CMOM
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)
CMWG Meeting 8-9 July 200912 |
Content of CMOM ….Content of CMOM ….
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
CMWG Meeting 8-9 July 200913 |
Content of CMOM ….Content of CMOM ….
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
CMWG Meeting 8-9 July 200914 |
Content of CMOM ….Content of CMOM ….
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
CMWG Meeting 8-9 July 200915 |
Why Focus on Strengthening Data Collection and Reporting?
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
CMWG Meeting 8-9 July 200916 |
Improved Sample Data collection FormsImproved 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.
Malaria Patient Card
Malaria Patient Card
CMWG Meeting 8-9 July 200918 |
Malaria Patient Card - OPDMalaria Patient Card - OPD
General Patient Information
1. Clinical Assessment– Duration of fever– Recognition of signs of severe malaria
2. Lab Confirmation– Examination No/Yes – Microscopy +/- Species– RDT +/-
3. Malaria Diagnosis– Clinical– Confirmed
• Uncomplicated• Re-treatment• Severe Malaria
4. Treatment– Prescribed– Dispensed
5. Outcome– Sent home, Referred, Admitted
CMWG Meeting 8-9 July 200919 |
Malaria RegisterMalaria RegisterO
PD
Nu
mb
erN
ame
Ag
e
sex
Ad
dre
ss
Laboratory Test
No
t Te
ste
d
Outpatient Malaria Diagnosis
Outpatient Malaria Treatment and action Uncomplicated
Malaria
Referred Severe Malaria
RDTMicroscop
yParasite Species
New Cases
AC
T R
e-tre
atm
en
t
Clin
ica
l
Co
nfirm
ed
Me
dic
ine
Pre
sc
ribe
d
Dispensed
OPD Action Taken
Clin
ica
l
Co
nfirm
ed
PNPNFVMOU
YE
S
NOHRA
CMWG Meeting 8-9 July 200920 |
Information FlowInformation Flow
Monthly Report SummaryDistrict Summary
Patient Card Malaria Register
CMWG Meeting 8-9 July 200921 |
Monthly Stock Management FormMonthly Stock Management Form
CMWG Meeting 8-9 July 200922 |
Monthly Supply Report Form Monthly Supply Report Form
Item
Stock-out
(tick as appropriate)Stock Management (treatment course)
No
ne
<1 w
eek
>1 w
eek
Safety S
tock
Op
enin
g S
tock
Clo
sing
Sto
ck
Co
nsu
mp
tion
Exp
ected variatio
n
Lead
Tim
e
Qu
antity R
e-ord
ered
ACT Pack 1
ACT Pack 2
ACT Pack 3
RDT
CMWG Meeting 8-9 July 200923 |
Centralized Country DatabaseCentralized Country Database
Electronic or Paper District Database
National Malaria Database