BY SHAARI NGADIMAN,
MD, MPH, EIP, AM
HIV/AIDS kill > 20 millions 90% Malaria death in Africa TB death about 1.8 millions TB/HIV death about 0.5 million
6c
Incidence and death rates Insecticide-treated bed nets Appropriate anti-malarial drugs (fever) TB incidence, prevalence and death rates Detection and cure rates (DOTS)
80% MARPs reached prevention programmes 60% of MARPs use condoms consistently. 60% of IDUs use clean injecting equipment. Able to eliminate vertical HIV transmission 80% ARV coverage for eligible PLHIV,
No. screening
Detection Rate
1.5
No. screening
1,000,000
1
500,000
0.5
0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
2008
TARGET ACHIEVED 16.0 13.3
2009
15.3 10.8
2010
14.6 12.8
2011
13.9 12.2
2012
13.2 11.7
2013
12.5
2014
11.7
2015
11.0
Target : To reduce new HIV from 21.7 per 100.000 pop (year 2000) to 11 per 100,000 pop by year 2015
70 60
50
40 30
20
10 0 1990 1992 1994 1996 1998 2000 IDU 2002 Sexual 2004 2006 2008 2010 2012
COVERED (2012):
PROGRAMME: (REGISTERED CLIENTS) NSEP (55,255) MMT (27,756) Retention Rate 70.1 (2012) PRIVATE GPs DST (22,000) Estimated PWID : 170,000 Coverage about : 62%
50000000 40000000 30000000 20000000 10000000 0 2008 2009 2010 2011 2012
ARV : 2011 USD 16.10 mil 2012 USD 20.41 mil
USD 16.76 Line ARV USD 3.65 2nd Line ARV 1st
38%
6c: HAVE HALTED AND BEGUN TO REVERSE THE INCIDENCE OF MALARIA AND OTHER MAJOR DISEASES BY 2015
MALARIA
Have achieved target of halting and reversing the incidence of malaria
This is a tremendous achievement. But we are still far from achieving universal access to life-saving malaria interventions.
Until countries are able to test, treat, and report every malaria case, we will never defeat this disease, "We need strong and sustained political commitment from all countries where malaria is endemic, and from the global health community, to see this fight through to the end. Dr Margaret Chan, WHO Director-General.
GLOBAL MALARIA
Malaria is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected mosquitoes. In 2010, there were about 219 million cases of malaria and an estimated 660 000 deaths globally. Approximately half of the world's population is at risk of malaria. Most malaria cases and deaths occur in subSaharan Africa. In 2011, 99 countries and territories had ongoing malaria transmission.
MALARIA IN MALAYSIA
300,000 243,870
250,000
In 1961, there were 243,870 malaria cases reported in Malaysia while in 1990, the cases have declined to 50,500.
181,495
151,822
200,000
A decade later, in the year 2000, the number of reported cases have further decreased to 12,705 cases.
In 2012, there were 4,725 cases which is a 63% reduction compared to 2000.
69,127 55,068 50,500 58,958 59,208 49,526 44,226 48,007 41,708 39,189 51,921
150,000 87,432
100,000
36,853
39,890
13,491
11,106
12,705
12,780
11,019
50,000
26,649
7,390
7,010
6,338
6,154
5,569
5,456
6,650
5,306
5,294
Malaria Eradication Programme (Sabah & Sarawak) Malaria Eradication Programme (Peninsular Malaysia) Malaria Control Programme National Strategic Plan for Elimination of Malaria (2011-2020)
4,725
6c: HAVE HALTED AND BEGUN TO REVERSE THE INCIDENCE OF MALARIA AND OTHER MAJOR DISEASES BY 2015
MALARIA
Have achieved target of halting and reversing the incidence of malaria
Malaysia has achieved the MDG goal for malaria well ahead of the 2015 deadline and has built on these achievements to strengthen current efforts and secure further commitments towards elimination by 2020 which is the target for Malaysias MDG-Plus. The incidence of malaria has declined from 289.5 per 100,000 populations in 1990 to 54.6 per 100,000 populations by year 2000 and to 16.4 per 100,000 populations in 2012. (Target to reduce to 27.3 per 100,000 by 2015 but achieved much earlier) There has also been a reduction in the number of malaria deaths from 43 in 1990 to 35 in 2000 and to 16 deaths in 2012. The mortality rate due to malaria has been around 0.1 per 100,000 population since 2006.
To ensure Malaysia is free from local malaria transmission by 2020 Peninsular Malaysia malaria free by 2015 Sabah & Sarawak malaria free by 2017
2011 - 2015 2011 - 2017
SPECIFIC OBJECTIVES
o o
STRATEGY 1. Early case detection & prompt treatment 2. Close monitoring of imported cases 3. Residual spraying 4. Usage of bednets 5. Environmental management & anti larva. 6. Monitoring of drug resistance 7.Collaboration with the neighbouring countries
CHALLENGES
Malaria transmission in Sabah and Sarawak.
The National Tuberculosis Control Programme (NTBCP) in Malaysia was launched in 1961 as a vertical programme with the main aim to control and reduce the prevalence of tuberculosis as a public health concern. BCG Vaccination program was introduced as one of the strategies of NTBCP in the same year. In 1995, the programme was integrated into the general medical and health system following WHOs recommendation and implementation of primary care concept in Malaysia. Ministry of Health is the leading agency in NTBCP and collaborates with other ministries and relevant non governmental agency for this course. Malaysia is classified as a country with an intermediate TB burden, that is, with an incidence of between 20-100 reported cases per 100,000 population annually. Since the implementation of national TB Control Program in 1961, the number of reported TB cases had successfully reduced to from 350 cases per 100,00 to less than 100 per 100,000 in 1980s. However, since then reported TB cases has remained unchanged between 60 to 68 per 100,000 population. It was noted that the reported TB cases had show slight increment since 2004.
Myanmar
Sabah
Pinang
KL
Johor
Sarawak
Indonesia
Indonesia
Incidence: 9.5 million new cases/year Prevalence: 14 million cases 95% of cases in resource poor settings 1.1 millions co-infection TB/ HIV
Incidence Rate and Mortality Rate Of Communicable Disease 2012 (per 100,000 population)
Communicable Disease Food and Water Borne Disease Cholera Dysentry Food Poisoning Typhoid Hepatitis A Vector Borne Disease Dengue Dengue Haemorrhagic Fever Malaria Typhus Plague Yellow Fever Vaccine Preventable Disease Acute Poliomyelitis Diphtheria Measles Other Tetanus Neonatal Tetanus Hepatitis B Whooping Cough Sexually Transmitted Disease Chancroid Gonorrhoea Syphilis Other Infectious Disease HIV AIDS Ebola Hepatitis C Hand, Foot & Mouth Diseases Leprosy Other Specified Viral Hepatitis Rabies Relapsing Fever Tuberculosis Viral Encephalitis H1N1 Leptospirosis Influenza Source: Disease Control division, MOH Incidence Rate 0.96 0.29 44.93 0.75 1.58 72.20 2.45 16.11 0.03 0.00 0.00 0.00 0.00 6.39 0.08 0.02 8.99 0.76 0.00 5.09 5.70 11.72 4.64 0.00 5.91 117.67 1.10 0.26 0.00 0.00 77.41 0.08 0.93 12.49 2.90 Mortality Rate 0.003 0.000 0.003 0.003 0.000 0.000 0.119 0.050 0.000 0.000 0.000 0.000 0.000 0.000 0.010 0.004 0.070 0.010 0.000 0.000 0.003 0.570 1.820 0.000 0.109 0.003 0.000 0.000 0.000 0.000 4.900 0.006 0.010 0.164 0.024
18 304 new TB cases (mean ~ 50 cases /day) 1414 TB death (mean ~ 4 death/day)
120
100 80 60 61 40 20 0 Year 68 95 82 81 77 78
72
65
WHO Estimated Incidence R per 100,000 1990-2020 Malaysia Reported Incidence Rate (Notification Rate) per 100,000, 1990-2012
1. Not achieving WHO estimated incidence case 2. WHO Estimation Notification Rate (NR) downwards trend 3. Actual NR increasing (CDR 2011: 85%, 2012 :95%)
Year
7.1
5.8
4.9
0.0
2000
2013
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2014
2015
2016
2017
2018
2019
WHO Estimated Mortality Rate (Excluding TBHIV Mortality) per 100,000, 1990-2020 Malaysia Reported TB Mortality per 100,000, 1990-2012
1. 2. 3. 4. WHO estimated mortality rate (MR) is excluding TBHIV mortality Actual MR : 1990-2011 including TBHIV mortality; 2012 excluding TBHIV mortality. WHO estimated MR downward trend Actual MR : plateau since 1990
2020
Year
Mortality
30
227
Deaths per 100,000 population
26
25
200
20
150
107
100
15
8.5 Target = 13
Target = 113
10
50
80
60
40
20
2005 12 0
2006 42 0
2007 15 0
2008 9 0
2009 8 0
2010 7 0
2011 8 0
Not evaluated
Failed
Defaulted Died Complete Cure
10
8 1 69
3
6 3 46
5
8 5 67
4
8 1 78
4
9 1 78
4
9 1 79
4
9 1 78
Cure Rate shows improvement . Management of TB patient need to strengthen especially on detection of default cases and on decreasing deaths during TB treatment (TBHIV).
80
60
40
20
2005 12 0 10 8 1 69
2006 42 0 3 6 3 46
2007 15 0 5 8 5 67
2008 9 0 4 8 1 78
2009 8 0 4 9 1 78
2010 7 0 4 9 1 79
2011 8 0 4 9 1 78
Cure Rate shows improvement . Management of TB patient need to strengthen especially on detection of default cases and on decreasing deaths during TB treatment (TBHIV).
Target 85%
MALAYSIA Sarawak
Sabah
WP(Labuan) Kelantan Terengganu Pahang Johor Melaka N.Sembilan WP(KL) Selangor Perak P.Pinang Kedah Perlis 0 15 30 45 60 75
Intermediate targets 70% Case Detection 85% Treatment success 100% DOTS Coverage
MDG
Impact targets Reverse
1995
2000
2005
2010
2015
3. Delivering, enhancing and expanding highquality TB treatment 4. Empower people with TB and the community
Vision
To reduce the burden of TB
NSP To Control TB 2011-2015 Strategies
1.Strengthening components of health system 5. Limiting people from contracting TB
Goal
HCW
98
Migrant 127 Elderly 132
*DM 351
Close Contact 708 Prisoner 752 Drug Rehabilitation Inmates 937 HIV positive 1782
6c: HAVE HALTED AND BEGUN TO REVERSE THE INCIDENCE OF MALARIA AND OTHER MAJOR DISEASES BY 2015
TUBERCULOSIS
Have achieved target of halting and reversing the incidence of tuberculosis
Have not achieved target of halting and reversing the incidence of tuberculosis. Unlikely to achieve by 2015
Rate/100,000
140 127
120
100 80 60 40 20 0 61
Estimation by WHO
95 82 81 77 78
Actual Incidence
65
68 72
Year
NOT YET!, NEED INNOVATIVE AND VIGOROUS APPROACH TO WIN THE GAME!
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