Update on malaria surveillance system and

strategy for cross border coordination

BA SOE THET

ESS VBDC Team

Tachileik 21st-22nd November, 2019

Outline of presentation

• Epidemiology update and ESS profile

• Use of surveillance data for programmatic actions

• Strategies and Challenges for cross-border collaboration on malaria

elimination

• Dengue situation and challenges

Outline of presentation

• ESS profile and Epidemiology update

• Use of surveillance data for programmatic actions

• Strategies and Challenges for cross-border collaboration on malaria

elimination

• Dengue situation and challenges

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Background information of ESS • Area - 37,093 sq km. • Location - Eastern most part of the country - North (China) - East (LPDR), - South (Thailand) - West (Southern Shan State)

• 10 townships, 8 sub-townships, 71 wards,

147 village tracts and 2,063 villages.

• Estimated population was about 0.8 million. • Population density was 16/sq km.

Malaria situation in GMS countries (2017–2018)

Data source - Mekong Malaria Elimination Epidemiology summary 2017-2018 5

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Jan-Jun 2017 Jul-Dec 2017 Jan-Jun 2018 Jul-Dec 2018

Malaria case distribution in GMS countries (2017-2018)

Viet Nam

Thailand

Myanmar

Laos PDR

Cambodia

Malaria incidence by provinces in GMS countries 2018

Malaria situation in Myanmar, 2005–2018

291 out of 330 townships are malaria endemic;

20 million population are at risk of malaria in 2019;

76,518 cases were reported in 2018;

19 persons died from malaria in 2018;

48% of all malaria cases was Plasmodium Vivax in 2018

Data source-Annual malaria database 2005-2018 6

Malaria morbidity and mortality rate of ESS (2000 – 2019 Oct)

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Rate

Morbidity rate per 1,000 population Mortality rate per 100,000 population

Seasonal distribution of malaria cases, 2014 - 2019 Oct

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2014 2015 2016 2017 2018 2019

Overview of malaria situation in ESS, 2019 (Jan – Oct)

33,959 tested

66 Malaria cases

<1 1-4 5-9 10-14 >15

26 %

74 %

0 %

73% 27%

ABER – 23 %

API – 0.09 / 1000 population

53 26 8 2 12

(Percentage %)

LLINs – 64,367

ABER (%) and API, per 1,000 Pop. of townships, (2015–2018)

Legend Incidence per 1,000 pop

Legend Annual blood examination rate (%)

Case based surveillance activities in ESS (2019)

Indicators Number

Number of confirmed malaria cases 66

Number of confirmed malaria cases fully investigated and classified 20

Number of indigenous cases among investigated cases 15

Number of foci identified, investigated and classified 5

Number of Active foci 5

Number of confirmed foci that received an appropriate response 5

Outline of presentation

• Epidemiology update and ESS profile

• Use of surveillance data for programmatic actions

• Strategies and Challenges for cross-border collaboration on malaria

elimination

• Dengue situation and challenges

Malaria Stratification, 2019

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Based on :

1. Village wised annual parasite incidence (API)

2. Epidemiological:

Ecology, vector bionomics, endemic,

epidemic potential

3. Operational

Health infrastructure, accessibility

4. Socio-economic

Major economic activities, development

projects, immigration

Source : ESS Village wised micro stratification result, 2016 and 2017

Decision based on stratification

• State/Region is responsible for planning and township is the unit for implementation

• In 2018, a total of 190 townships achieved API <1 /1000 population and are targeted for malaria

elimination (actual target was 215 townships depending on the availability of resources)

• The existing NSP (2016-2020) revised in 2018 targeting malaria elimination at township level

• LLIN distribution - Mass distribution (3a, 3b and 3c) and Continuous distribution

• Mandatory malaria notification recommended by external review team – document drafted and is in

the process of review and MoHS endorsement

• Reprogramming include resource mobilization for interventions on 12 high burden townships done

and activities started

• Target and costing of the new NSP (2021-2025) will be based on the stratification at the lower level

Malaria Surveillance system in Myanmar

Key remaining challenges to strengthen surveillance

• Reporting from hard to reach and conflict areas including mobile and migrant population

• Malaria should be a notifiable disease • Limited technical and human resource capacity for data encoding, analysis and

documentation • Delay reporting from some partner organizations • Defense service and numerous private sector still not included in routine

surveillance • Transition of paper-based reporting system to electronic based reporting due to

Poor internet connectivity in some areas and NSA areas Skill of the staff Hard to reach areas; maintenance of electronic system

Outline of presentation

• Epidemiology update and ESS profile

• Use of surveillance data for programmatic actions

• Strategies and Challenges for cross-border collaboration on malaria

elimination

• Dengue situation and challenges

Cross-border malaria elimination strategy

• Principle

• In line with Global Technical Strategy (GTS-WHO)

• In line with strategy for malaria elimination in GMS countries

• Based on developed and developing national malaria control/elimination

strategies in both countries

• Vision

• Free of malaria in border townships

• Goal • Ultimate goal is to eliminate malaria by 2030 in Thailand-Laos-Myanmar

border

Strategies for Cross-border malaria elimination

• Establish sensitive, specific and effective surveillance and warning system

• Categorized guide to carry out rapid diagnose and treatment, foci

investigation and appropriate response

• Focus on border region

1. Establish border-specific mobile population management and

surveillance system

2. Establish cross-border malaria control/elimination program and

information sharing framework

Interventions for Cross-border malaria elimination

• Multisectoral approach

• Key intervention: Case detection, appropriate diagnose and treatment, case

investigation, foci investigation and response (CIFIR)

• Strengthen vector control measures (LLINs for MMPs)

• Capacity building of health staffs especially in border townships

• Develop joint SRRT team for outbreak response and information sharing

• Maintain surveillance and response capacity in elimination and post-elimination stage

• Strengthen technical guidance and supervision on malaria elimination assessment

Challenges for Cross-border malaria elimination

• Intense population movement across national borders

• Movement may be illegal, if not, may be difficult to track

• Communication constraints by different languages

• Complex malaria transmission pattern by different ecological condition

• Remote and neglected border areas

• Different policy, strategies and activities by neighboring countries

• Poor adherence to guideline

DF/DHF Situation of ESS

DHF Cases and Deaths (2007 – 2019) of ESS

2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019Deaths 1 2 0 0 0 0 0 0 1 1 1Cases 254 119 9 1 92 8 56 106 538 906 600

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Number of dengue case by township (2015-2018)

Legend 1 Red dot : 1 Dengue case

DF/DHF – 55 cases DF/DHF – 109 cases DF/DHF – 538 cases DF/DHF – 906 cases

Number of Dengue Cases in ESS, 2018 Compared with 5-year Median

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Weekly morbidity of Dengue in ESS, 2017 – 2019

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2017 2018 2019

Weekly Dengue morbidity between State and Tachileik, 2018-2019

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Tachileik 2018 ESS 2018

82.8 % of cases contributed by

Tachileik

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Tachileik 2019 ESS 2019

70 % of cases contributed by

Tachileik

Big Challenges for Dengue Control and prevention

• Significant arising public health issue in border township (Tachileik & Mong Lar) • Cross-border issues: Timely information exchange, Joint control activities • Vector control : Mainstay for dengue prevention and control • Existing vector control tools : Several limitations in terms of cost, delivery, long-

term sustainability and participation. • Vector surveillance : Labor intensive, time consuming, not sustainable and

inadequate information. • Any vector control strategy should be selected based on evidence and

appropriateness for the entomological and epidemiological setting.

International Health Regulation 2005

• The IHR (2005) encompass dengue as a disease of concern to the international community because of its high potential for build-up of epidemics of DF and DHF.

• IHR enjoin Member States to develop capabilities for detection, reporting and responding to global health threats by establishing effective surveillance systems

• Thailand is the first country in the South-East Asia Region to have developed an IHR Action Plan for 2008–2012

Thank you for your kind attention !

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For more information: dr.basoethet@gmail.com +9595278105