CMWG Meeting 8-9 July 2009 1 |1 | Dr Peter Olumese Global Malaria Programme WHO/HQ, Geneva Malaria...

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


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


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


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


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


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


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


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


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


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)


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



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



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


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


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


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


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


Information FlowInformation Flow

Monthly Report SummaryDistrict Summary

Patient Card Malaria Register


Monthly Stock Management FormMonthly Stock Management Form


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


Centralized Country DatabaseCentralized Country Database

Electronic or Paper District Database

National Malaria Database

CMWG Meeting 8-9 July 2009 1 |1 | Dr Peter Olumese Global Malaria Programme WHO/HQ, Geneva Malaria...

Documents

Transcript of CMWG Meeting 8-9 July 2009 1 |1 | Dr Peter Olumese Global Malaria Programme WHO/HQ, Geneva Malaria...