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Training Module on Malaria Elimination. Guide for Participants PARTICIPANTS GUIDE FOR Malaria elimination elimination Malaria MALARIA ELIMINATION ELIMINATION MALARIA TRAINING MODULE ON ON MODULE TRAINING TRAINING MODULE ON MALARIA ELIMINATION GUIDE FOR PARTICIPANTS Malaria elimination GUIDE FOR PARTICIPANTS MALARIA ELIMINATION MALARIA TRAINING MODULE ON MODULE TRAINING WHO Library Cataloguing-in-Publication Data Malaria elimination. 2 v. Contents: Guide for tutors – Guide for participants 1.Malaria - prevention and control. 2.Disease Eradication. 3.Case Management. 4.Endemic Diseases – prevention and control. 5.Population Surveillance. 6.Teaching Materials. I.World Health Organization. ISBN 978 92 4 154943 1 (Guide for tutors) (NLM classification: WC 765) ISBN 978 92 4 154942 4 (Guide for participants) Preparation of this document was made possible through a grant from the Russian Federation for strengthening human resource capacity for the control and elimination of malaria. © World Health Organization 2016 All rights reserved. Publications of the World Health Organization are available on the WHO website (www. who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications –whether for sale or for non-commercial distribution– should be addressed to WHO Press through the WHO website (www.who.int/about/licensing/ copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Hématies : ©Ingram Publishing Cover Design par Paprika-Annecy.com iii Contents Foreword ������������������������������������������������������������������������������������������������������������������������������������������������������������v Abbreviations ����������������������������������������������������������������������������������������������������������������������������������������������������vi Acknowledgements ������������������������������������������������������������������������������������������������������������������������������������������vii Development of the module ���������������������������������������������������������������������������������������������������������������������������� viii Introduction ������������������������������������������������������������������������������������������������������������������������������������������������������ix Learning unit 1: Introduction to malaria elimination ����������������������������������������������������������������������������������������1 Learning unit 2: Basic malaria epidemiology, including transmission dynamics ��������������������������������������������11 Learning unit 3: Road map to elimination: from advanced control to the prevention of reintroduction��������37 Learning unit 4: Approaches and interventions in pre-elimination, elimination and prevention of reintroduction ������������������������������������������������������������������������������������������������������������������������45 Learning unit 5: Surveillance, including laboratory methods ��������������������������������������������������������������������������61 Learning unit 6: Prevention of reintroduction �������������������������������������������������������������������������������������������������83 Learning unit 7: Health systems and inter-sectoral and cross-border collaboration �������������������������������������91 Learning unit 8: Assessment of the feasibility of malaria elimination ���������������������������������������������������������103 Learning unit 9: WHO certification of malaria elimination ���������������������������������������������������������������������������141 Annex 1� Key issues in quality assurance for malaria microscopy in the elimination phase �����������������������147 Annex 2� Moshkovsky’s method for determining transmissibility of malaria as a function of temperature in temperate and subtropical areas ������������������������������������������������������������������������150 v Foreword Malaria is a major global public health problem and a leading cause of morbidity and mortality in many countries. It caused an estimated 198 million cases (range, 124–283 million) and 584 000 deaths (range, 367 000–755 000 deaths) in 2013. Approximately 80% of the cases and 90% of the deaths occurred in Africa and the remaining cases and deaths mainly in the South- East Asia and Eastern Mediterranean Regions.1 For the most recent figures on burden of malaria, see the World malaria report, available on the WHO Global Malaria Programme website (http:// www.who.int/malaria/en/). The new WHOGlobal technical strategy for malaria 2016–2030 provides a comprehensive framework to guide countries in accelerating progress towards malaria elimination. The strategy sets the targets of reducing global malaria incidence and mortality rates by 2030 by at least 90% from the rates in 2015 and eliminating malaria from 10 countries in 2020, 20 countries in 2025 and 30 countries in 2030. Elimination of malaria is defined as the reduction to 0 of the incidence of locally acquired infection from human malaria parasites in a defined geographical area as a result of deliberate efforts. Elimination programmes require more technical expertise than standard malaria control programmes, including national expertise in malaria epidemiology and entomology. Since 2007, three countries (Armenia, Morocco and Turkmenistan) have been certified malaria-free. As of December 2014, 12 countries (Argentina, Armenia, Azerbaijan, Georgia, Iraq, Kyrgyzstan, Morocco, Oman, Paraguay, Sri Lanka, Turkmenistan and Uzbekistan) reported 0 indigenous cases. In addition, 19 countries were in pre-elimination or elimination stages.1 The progression to malaria elimination builds on successful, sustained malaria control, which requires appropriately planned, targeted diagnostic testing of all suspected malaria cases and prompt treatment with effective artemisinin-based combination therapy (ACT), intermittent preventive treatment of pregnant women and infants where appropriate and seasonal malaria chemoprevention in children, appropriate vector control interventions, particularly long-lasting insecticide-treated nets (LLINs) and indoor residual spraying (IRS), and effective surveillance. This training module has been prepared to support health professionals in planning, managing, monitoring and evaluating malaria elimination programmes. The aims are to improve capacity in critical synthesis and analysis of determinants of malaria transmission in low-endemic settings; increase understanding of health system components in order to assess the feasibility of national or sub-national malaria elimination; and plan strategies and approaches for sustained malaria elimination. 1 World malaria report 2014. Geneva, World Health Organization; 2014 (http://www.who.int/malaria/publications/world_ malaria_report_2014/en/, accessed 14 September 2015). vi MALARIA ELIMINATION: GUIDE FOR PARTICIPANTS Abbreviations ACT artemisinin-based combination therapy bw bodyweight ESP elimination scenario planning G6PD glucose-6-phosphate dehydrogenase GIS geographical information system GMP Gobal Malaria Programme IRS indoor residual spraying ITN insecticide-treated net LLIN long-lasting insecticide-treated net PCR polymerase chain reaction pLDH parasite lactic dehydrogenase RDT rapid diagnostic test WHOPES WHO Pesticide Evaluation Sceme vii Acknowledgements This module was produced by the WHO Global Malaria Programme (GMP), with the participation of current and former staff from WHO headquarters and regional offices. WHO gratefully acknowledges the following experts who contributed to preparation of this document. Dr A.E. Beljaev prepared the first draft of the content, and Dr A.A.A. Adeel transformed the training material into guides for learners and tutors. The technical experts who reviewed and updated this module are: A.A.A. Adeel (King Saud University, Saudi Arabia), M.S. Al-Zedjali (Malaria Epidemiology, Ministry of Health, Oman), A. Kondrashin (former WHO staff, Russian Federation), B. Ayivi (National University Hospital, Benin), C. Hugo (ACT Malaria Foundation Inc., Philippines), A. Baranova (Martzinovsky Institute of Medical Parasitology and Tropical Medicine, Russian Federation), P.F. Beales (former WHO staff, United Kingdom), A.E. Beljaev (Russian Medical Academy for Moscow,
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