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Addressing malaria vector control challenges in South Sudan: proposed recommendations.

ABSTRACT: Upon the signing of the Comprehensive Peace Agreement in 2005, the Republic of South Sudan (RSS) has faced a lot of challenges, such as a lack of infrastructure, human resources and an enormous burden of vector borne diseases including malaria. While a national malaria strategic plan 2006-2011 was developed, the vector control component has remained relatively weak. The strategy endorses the distribution of long-lasting insecticidal nets (LLINs) as the frontline intervention with other interventions recommended only when technical and institutional capacity is available. In 2006, a draft integrated vector management (IVM) strategic plan 2007-2012 was developed but never implemented, resulting in minimal coordination, implementation and coverage of malaria vector control tools including their inherent impact. To address this challenge, the vector control team of the National Malaria Control Programme (NMCP) is being strengthened. With the objective of building national capacity and technical collaboration for effective implementation of the IVM strategy, a national malaria vector control conference was held from 15-17th October 2012 in Juba. A range of NMCP partners, state ministries, acadaemia, private sector, national and international non-governmental organizations, including regional and global policymakers attended the meeting. The conference represented a major milestone and made recommendations revolving around the five key elements of the IVM approach. The meeting endorsed that vector control efforts in RSS be augmented with other interventions within the confines of the IVM strategy as a national approach, with strong adherence to its key elements.

SUBMITTER: Chanda E

PROVIDER: S-EPMC3570318 | biostudies-literature | 2013 Feb

REPOSITORIES: biostudies-literature

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Project description:BackgroundMalaria vector control activities in Sudan rely largely on Long-Lasting Insecticidal Nets (LLINs), Indoor Residual Spray (IRS) and Larval Source Management (LSM). The present study attempted to determine cost effectiveness of inputs and operations of vector control interventions applied in different environmental settings in central and eastern Sudan, as well as their impact.MethodsThe inputs utilized and cost of each vector control activity, operational achievements and impact of the applied malaria vector control activities; IRS, LLINs and LSM were determined for eight sites in Al Gazira state (central Sudan) and Al Gadarif state (eastern Sudan). Operational costs were obtained from data of the National Malaria Control Program in 2017. Impact was measured using entomological indicators for Anopheles mosquitoes.ResultsThe total cost per person per year was $1.6, $0.85, and $0.32 for IRS, LLINs and LSM, respectively. Coverage of vector control operations was 97%, 95.2% and 25-50% in IRS, LLINs and LSM, respectively. Vectorial capacity of malaria vectors showed statistically significant variations (P < 0.034) and ranged 0.294-0.65 in areas implemented LSM in comparison to 0.097-0.248 in areas applied IRS and LLINs, respectively. Both indoor and outdoor biting Anopheles mosquitoes showed noticeable increase that reached 3-12 folds in areas implemented LSM in comparison to areas implemented IRS and LLINs. Annual malaria prevalence was 13.1-21.1% in areas implemented LSM in comparison to 3.20%, 4.77% in areas implemented IRS and LLINs, respectively.ConclusionIRS and LLINs are cost effective control measures due to adequate inputs and organized process. However, the unit cost of LSM intervention per outcome and subsequently the impact is hugely affected by the low coverage. The very weak support for implementation of LSM which includes inputs resulted in weakness of its process and consequently its impact. Implementation of LSM by local government in urban settings is challenged by many factors the most important are maintenance of adequate stable level of funding, un-adequate number of well trained health workers, unstable political and administrative conditions and weak infrastructure. These challenges are critical for proper implementation of LSM and control of malaria in urban settings in Sudan.

Project description:BackgroundVector control is an important approach to preventing and controlling malaria. From the malaria epidemic to malaria elimination in China, vector control has played an essential and irreplaceable role in the historical process. This review systematically summarizes the evolution, adjustment, and optimization of vector control strategy towards elimination and discusses the challenges ahead.Main textThis review first summarizes the evolution of vector control strategies during different stages of malaria epidemic, control, elimination, and post-elimination in China. We then distill the vector control experience and lessons in different stages. We discuss the current and future challenges and propose future research directions and developments for novel malaria vector control strategies.ResultsVector control has played an invaluable role in achieving malaria elimination. China adopted different prevention and control measures in response to the different malaria-endemic situations and vector distributions. Firstly, baseline surveys were initiated to establish the entomological data and helped clarify the prevention priorities and targets. Secondly, targeted and adjusted vector control strategies were conducted in various regions according to the local epidemic characteristics and different vector species. Thirdly, scientific research facilitated efficient vector-control strategies. In addition, the overall economic and social development have promoted environmental improvement, personal protection, and health care. Prediction of the vector distribution was integrated into risk assessment strategies, allowing for sustaining achievements in risk areas.ConclusionsThe tailored and adapted vector control strategies have played a critical role in China's malaria prevention, control, and elimination. Achievements and lessons learned on vector control from this progress would provide a practical reference in coping with the challenges and potential barriers other countries face in the global effort to eliminate malaria.

Project description:IntroductionCancer is a significant public health challenge globally, with nearly 2000 lives lost daily in Africa alone. Without adequate measures, mortality rates are likely to increase. The major challenge for cancer care in Africa is equity and prioritization, as cancer is not receiving adequate attention from policy-makers and strategic stakeholders in the healthcare space. This neglect is affecting the three primary tiers of cancer care: prevention, diagnosis, and treatment/management. To promote cancer care equity, addressing issues of equity and prioritization is crucial to ensure that everyone has an equal chance at cancer prevention, early detection, and appropriate care and follow-up treatment.MethodologyUsing available literature, we provide an overview of the current state of cancer care in Africa and recommendations to close the gap.ResultsWe highlight several factors that contribute to cancer care inequity in Africa, including inadequate funding for cancer research, poor cancer education or awareness, inadequate screening or diagnostic facilities, lack of a well-organized and effective cancer registry system and access to care, shortage of specialized medical staff, high costs for screening, vaccination, and treatment, lack of technical capacity, poor vaccination response, and/or late presentation of patients for cancer screening. We also provide recommendations to address some of these obstacles to achieving cancer care equity. Our recommendations are divided into national-level initiatives and capacity-based initiatives, including cancer health promotion and awareness by healthcare professionals during every hospital visit, encouraging screening and vaccine uptake, ensuring operational regional and national cancer registries, improving healthcare budgeting for staff, equipment, and facilities, building expertise through specialty training, funding for cancer research, providing insurance coverage for cancer care, and implementing mobile health technology for telemedicine diagnosis.ConclusionAddressing challenges to cancer equity holistically would improve the likelihood of longer survival for cancer patients, lower the risk factors for groups that are already at risk, and ensure equitable access to cancer care on the continent. This study identifies the existing stance that African nations have on equity in cancer care, outlines the current constraints, and provides suggestions that could make the biggest difference in attaining equity in cancer care.

Project description:BackgroundThe present study aimed to evaluate the management of severe malaria at Gezira State hospitals in Sudan by assessing hospital readiness, health care provider knowledge and the care received by severe malaria patients.MethodsA cross-sectional descriptive study was performed to assess the severe malaria management practices at hospitals level in Gezira State. The study population included hospitals, health care providers and patients. Data was collected using checklists and structured questionnaires.ResultsA total of 20 hospitals, 158 health care providers and 370 patients were included in the study. Out of the total hospitals, 95% (19/20) were providing 24 h outpatient services, 65% (13/20) had ICU units, while triage system was found in only 35% (7/20) of hospitals. From all hospitals evaluated, 90% (18/20) were suffering from shortage of staff, especially doctors. About half of the health care providers (46.7%) did not receive severe malaria management training. The average knowledge score among health care providers was 55.4%. Microscopy was available in all hospitals (100%), while rapid diagnostic test, complete blood count and renal function test were available in 15 hospitals (75%). Fever was the most presenting symptom (97.8%) followed by repeated vomiting (51.4%), convulsion in children (24.3%) and prostration in adult (57.9%). Correctly diagnosed patients were 68.9%. Essential tests were done for only 11.1% of patients. Majority of patients (91.7%) were treated with quinine, 5.9% received artemether, while 2.4% were treated with artemether-lumefantrine. Those who received both the correct dose and dosing regimen were 53.8%. The overall compliance to guidelines was 2.2%.ConclusionThis study highlights the fact that management of severe malaria at hospital level was suboptimal with serious shortcomings in the different aspects of care particularly in specialized hospitals. Technical staff was inadequate, hospitals were anguish from defective emergency services, and most patients were not treated according to the national guidelines.

Project description:BackgroundMalaria is an important public health problem in northern Sudan, but little is known about the dynamics of its transmission. Given the characteristic low densities of Anopheles arabiensis and the difficult terrain in this area, future vector control strategies are likely to be based on area-wide integrated pest management (AW-IPM) that may include the sterile insect technique (SIT). To support the planning and implementation of future AW-IPM activities, larval surveys were carried out to provide key data on spatial and seasonal dynamics of local vector populations.MethodsMonthly cross-sectional larval surveys were carried out between March 2005 and May 2007 in two localities (Dongola and Merowe) adjacent to the river Nile. A stratified random sampling strategy based on the use of Remote Sensing (RS), Geographical Information Systems (GIS) and the Global Positioning System (GPS) was used to select survey locations. Breeding sites were mapped using GPS and data on larval density and breeding site characteristics were recorded using handheld computers. Bivariate and multivariate logistic regression models were used to identify breeding site characteristics associated with increased risk of presence of larvae. Seasonal patterns in the proportion of breeding sites positive for larvae were compared visually to contemporaneous data on climate and river height.ResultsOf a total of 3,349 aquatic habitats sampled, 321 (9.6%) contained An. arabiensis larvae. The frequency with which larvae were found varied markedly by habitat type. Although most positive sites were associated with temporary standing water around the margins of the main Nile channel, larvae were also found at brickworks and in areas of leaking pipes and canals - often far from the river. Close to the Nile channel, a distinct seasonal pattern in larval populations was evident and appeared to be linked to the rise and fall of the river level. These patterns were not evident in vector populations breeding in artificial water sources away from the river.ConclusionThe GIS-based survey strategy developed in this study provides key data on the population dynamics of An. arabiensis in Northern State. Quantitative estimates of the contributions of various habitat types and their proximity to settlements provide a basis for planning a strategy for reducing malaria risk by elimination of the vector population.

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Addressing malaria vector control challenges in South Sudan: proposed recommendations.

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