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An Epidemiological Profile of Malaria and Its Control in Malawi

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An Epidemiological Profile of Malaria and Its Control in Malawi An Epidemiological Profile of Malaria and its Control in Malawi Report prepared for National Malaria Control Programme By The INFORM Project & Malaria Alert Centre March 2014 Contacts INFORM Project Public Health Department, KEMRI-Wellcome Trust Collaborative Programme P.O.Box 43640 00100 Nairobi, Kenya [email protected] [email protected] Malaria Alert Centre University of Malawi College of Medicine, Private Bag Blantyre, Malawi [email protected] Suggested citation Emelda A Okiro, Abdisalan M Noor, Josephine Malinga, Bernard Mitto, Clara W Mundia, Don Mathanga, Themba Mzilahowa & Robert W Snow (2013). An epidemiological profile of malaria and its control in Malawi. A report prepared for the Ministry of Health, the Roll Back Malaria Partnership and the Department for International Development, UK. March, 2014 i Acknowledgments The authors are indebted to the following individuals from the INFORM Project, KEMRI- Wellcome Trust programme in Kenya: Ngiang-Bakwin Kandala, Caroline Kabaria, Viola Otieno, Damaris Kinyoki, Jonesmus Mutua, Punam Amratia, Boniface Makone and Stella Kasura; Catherine Linard for assistance on modelling human population settlement; and Muriel Bastien, Marie Sarah Villemin Partow, Reynald Erard and Christian Pethas-Magilad of the World Health Organization (WHO) archives in Geneva. We would also like to extend a special acknowledgement to Lawrence Kazembe and Adam Bennett, both of whom have provided valuable insights and sustained enthusiasm around risk mapping and its applications for health planning in Malawi. We are also grateful to Malcolm Molyneux, Monica Olewe and Peter Troell who provided comments on an earlier draft of the report. And finally the important feedback and contribributions made by the National Malaria Control Programme, notably Drs Doreen Ali, Misheck Luhanga and John Zoya and Wilfred Dodoli of the World Health Organization, Country Office. The following national scientists and their international collaborators have provided access to unpublished data, helped geo-locate survey locations or provided comments on the final report: Cameron Bowie, Bernard Brabin, Simon Brooker, Marian Bruce, Mota Bwanali, Job Calis, Des Chevasse, Tiyese Chimuna, John Chiphwanya, James Chirombo, Maureen Coetzee, Michael Coleman, Thomas Eisele, Oliver Gadabu, Paul Prinsen Geerligs, Sarah Gibson, Timothy Holtz, Gertrude Kalanda, Lawrence Kazembe, Peter Kazembe, Immo Kleinschmidt, David Lalloo, Misheck Luhanga, Alan Macheso, Kingsley Manda, Ganizani Malata, Don Mathanga, Malcolm Molyneux, Kelias Msyamboza, Piyali Mustaphi, Themba Mzilahowa, Monica Olewe, Kamija Phiri, Arantxa Roca-Feltrer, John Sande, Andrea Sharma, Bertha Simwaka, Jacek Skarbinski, Kevin Sullivan, Miriam Laufer, Terrie Taylor, Anja Terlouw, Lindsay Townes, Peter Troell, Charles Yuma and Mark Wilson. The authors also acknowledge the support and encouragement provided by the RBM Partnership, Susan Claplan and Alistair Robb of the UK government's Department for International Development (DFID) and Thomas Teuscher of RBM, Geneva. This work was supported by grants from The Wellcome Trust, UK to Professor Bob Snow (# 079080) and Dr Abdisalan Mohamed Noor (# 095127) and a contract between the University of Oxford and RBM with funds provided by DFID-UK. iii Table of Contents Executive Summary ................................................................................................................................. 1 Chapter 1: Introduction .......................................................................................................................... 2 1.1 References ................................................................................................................................. 4 Chapter 2: Country context, administration, population & health services .......................................... 6 2.1 Location ..................................................................................................................................... 7 2.2 Social and political evolution .................................................................................................... 8 2.3 Economy .................................................................................................................................... 9 2.4 Poverty .................................................................................................................................... 11 2.5 Decentralization and administrative boundaries .................................................................... 12 2.6 Child Survival ............................................................................................................................ 14 2.7 Causes of death ....................................................................................................................... 16 2.8 Population growth and distribution ........................................................................................ 17 2.9 Urbanization ............................................................................................................................ 18 2.10 Health system ........................................................................................................................ 20 2.10.1 History of the health system ........................................................................................ 20 2.10.2 Current Health Care System ......................................................................................... 22 2.10.3 Development of health facility database and mapping ................................................ 23 2.11 References ............................................................................................................................. 25 Chapter 3: The first 100 years of malaria control ................................................................................ 30 3.1 Background ............................................................................................................................. 31 3.2 1900-1949: The first fifty years ................................................................................................ 31 3.3 1950-1960s: Post second world war: the first attempts at indoor residual spraying ............. 36 3.4 Malaria control during the 1970s and 1980s ........................................................................... 37 3.5 Malaria control 1980-1999: defining the challenge and building the programme ................. 38 3.5.1 Building the programme and national strategies .......................................................... 38 3.5.2 Grappling with anti-malarial drug resistance and fever case-management ................. 40 3.5.3 Malaria in pregnancy ...................................................................................................... 41 3.5.4 Bed net use ..................................................................................................................... 42 3.5.5 Grappling again with drug resistance and effective case-management ........................ 44 3.6 Malaria control 2001-2005: The early days of Roll Back Malaria (RBM) ................................. 46 3.6.1 National Malaria Strategy 2001-2005 ............................................................................. 46 3.6.2 Poor funding landscape for malaria ............................................................................... 47 3.6.3 Insecticide treated net strategies ................................................................................... 47 3.6.4 Malaria in Pregnancy ...................................................................................................... 49 3.6.5 Increasing access to malaria treatment and initiating the second drug policy change . 49 3.7 Malaria Control 2005-2010: RBM going to scale ...................................................................... 50 3.7.1 National Malaria Strategy 2005-2010 ............................................................................. 50 3.7.2 Funding and staff changes 2005-2010 ........................................................................... 50 3.7.3 Vector control ................................................................................................................ 52 3.7.3.1 ITN .................................................................................................................. 52 3.7.3.2 Modelling and mapping ITN Coverage 2000-2012 ......................................... 54 3.7.3.3 IRS .................................................................................................................. 55 3.7.4 IPTp from 2007................................................................................................................ 58 3.7.5 Monitoring and evaluation (M&E) framework in sentinel sites ..................................... 58 3.7.6 Malaria case management challenges during the AL era .............................................. 59 3.7.6.1 The second antimalarial treatment policy change ........................................ 59 iv 3.7.6.2 Implementation of AL policy and coverage .................................................... 60 3.7.6.3 Improving access, treatment and adherence to AL ....................................... 61 3.7.6.4 Improving diagnosis ....................................................................................... 63 3.8 Consolidation of progress and the future: the third NMSP 2011-2015 ..................................
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