Transcript Tenth Regional Lymphatic Filariasis Elimination Program

Bi-national Commission on Health
Guyana Suriname
Neglected Tropical Diseases
Dr. Shamdeo Persaud
Chief Medical Officer
GUYANA
NTD Control
• Guyana on 1 of four in the Americas where LF still
endemic and 3 other NTD
• Development of National Plan
• Identification of Priorities
– LF – Targeted for elimination by 2016
– STH – Targeted for control by 2015
– Chagas – Elimination of vertical and Blood Transfusion
transmission; control of Oral and vector transmission
– Leprosy – Elimination
– ONCO and SCH not transmitted
– Dengue, Leptospirosis and Malaria remain endemic in
selected Regions
Region
Neglected Diseases
Region 1 – Barima Wine
Chagas, Malaria, STH
Region 2 – Pomoroon/Supername
Chagas, STH, LF, Leprosy, Rabies
Region 3 – West Demerara/Essequibo
LF, STH, Leprosy, Dengue, Leptospirosis
Region 4 – East Bank Demerara
LF, STH, Leprosy, Dengue, Leptospirosis
Region 4 – East Coast Demerara
LF, STH, Leprosy, Dengue, leptospirosis
Region 4 – Georgetown
LF, STH, Leprosy, Dengue, Leptospirosis
Region 5 – West Berbice/Mahaica
LF, STH, Leprosy
Region 6 – East Berbice Corentyne
LF, STH, Leprosy, Rabies
Region 7 – Cuyune/Mazurini
Malaria, STH, Malaria, LF
Region 8 – Pataro/Sepurini
Malaria, STH
Region 9 – Upper Essequibo/Upper
Takatu
Region 10 – Upper Demerara/Upper
Berbice
Malaria, STH, LF, Dengue
STH, LF, Malaria, Leprosy, Dengue
SEROLOGY PREVALENCE
OF LF ANTIGEN
Key: Prevalence
Red=20%-50%
Yellow=4-20%
Green< 4%
Ministry of Health, Guyana
Plan for Transmission Interruption
• Phase one (2003 – 2007)
– Social Mobilization
– Develop, distribute, promote and use DEC salt
– Monitoring and evaluation progress at sentinel sites
• Phase two (2008 – 2015)
–
–
–
–
–
Synergies with other neglected diseases
Evaluation of Phase one
Identify “Hot Spots” using surveillance information
Implement MDA with DEC and Albendazole
Monitor and evaluation progress at sentinel and spot
check sites
Ministry of Health, Guyana
Endemic LF IUs in Guyana
Region
/province
Total
population
Region II
49,254
Source of
population
data
Cencus 2002
Region III
103,061
“
Region IV
310,320
Region V
Year of first
round of MDA
Current Status
2003-DEC Salt
DEC/Alb 2009
2003-DEC Salt
Eliminated
“
2003-DEC Salt
2012–
DEC/ALB
Endemic
52,428
“
2003-DEC Salt
2008–DEC/Alb
Endemic
Region VI
123,694
“
2003-DEC Salt
DEC/Alb 2009
Eliminate
Region X
41,112
“
2003-DEC Salt
Endemic
Other Ares
11,000
Estimated
Total
690,869
Ministry of Health, Guyana
2003
Salt
–
Endemic
DEC Eliminate
Phase one
Salt Fortification
• Adding beneficial chemical to salt
• Does not alter taste or other qualities of salt
• To combat public health problems (IDD, Dental Caries, Malaria, LF)
Iodine Deficiency Disorder (IDD)
• Inadequate iodine in the body
• Disease observed as enlarged thyroid, Mental retardation and
Cretinism, but several stages of physical sluggishness, learning
disability, growth retardation and childhood morbidity
Iodized Salt- successful in eliminating these problems
Ministry of Health, Guyana
DEC-Salt for Mass Treatment
• Program Launched in July 2003
– 2003 to early 2004 - 480 tons imported
• Hurricane in Jamaica disrupted production, New
plant commissioned in March 2005
• Salt became blue in 2006
• Production recommenced in August 2005
– 2005 – 49 tons
– 2006 – 80 tons
– 2007 – 290 tons
• Production stop in August 2007
Ministry of Health, Guyana
Phase II
Mass Drug Administration
 Region 5 – Annually form 2009 - 2015
◦ Population - 52,428
◦ Eligible Pop – 47,000
◦ Population Treated - (2008 =81.7) (2010 =84%)
 Region 2 – one round 2009
 Region 6 – one round 2010
 Region 4 – 2010 -2015
 Georgetown/East Bank/East Coast
 360,000*
 Eligible 300,000*
Ministry of Health, Guyana
Phase II
Mass Drug Administration
• Region 3 – Annual 2012 – 2016
◦ Population - 103,061
◦ Eligible Pop – 91,000
◦ Region 10 – Annual 2012 – 2016
◦ Population – 41,112
◦ Eligible Pop – 37,200
Integrated NTD Program
Background
• The Georgetown Sanitation Improvement
Project (GSOP) was developed by the
Government of Guyana to improve the
sanitation in the Capital City
• Project was supported by Inter-American
Development Bank (IDB)
• Guyana Water Incorporated is the executing
Agency a
Sentinel Monitoring
Sentinel
Site
YEAR
Microfilaria
%
2003
11.2
Lodge
Region 4
2.6
Tucbur
Region 6
Spot Check Sites
Antigen
(ICT) %
2006 2008 2012
2003
2006
2008
2012
7.2
NA
2.9
38
17.7
18.2
8.6
2.9
1.7
NA
17.5
10.9
12
NA
Melanie
Region 4
NA
NA
1.7
27
NA
NA
7.9
Bush Lot
Region 5
NA
3,7
NA
NA
NA
14.6
NA
Ministry of Health, Guyana
GSIP
The aims of the program are:
i. Improve the operational performance of the
Georgetown sewerage system through the
reconstruction of its most critical components;
ii. Strengthen GWI operational and financial
performance by improving asset management
and decreasing energy consumption;
iii. Limit the transmission of the water-related
diseases lymphatic filariasis and intestinal
helminthiasis.
Results of Baseline Study
Sentinel
Site
Sample
ICT
Microfilara
Prevalence
STH
(KATOKAT)
Lodge
462
8.6
2.9
1.7
Melanie
Damishana
448
7.9
1.7
2.1
Totals
910
8.25
2.3
1q.9
Training
• Develop MDA guidelines
in accordance with the
Program Managers
Guidelines
• Procure all essential
medicines (DEC,
albendazole) and supplies
• Training and orientation
of health workers
• Requirement and training
of community volunteers
and supervisors
Mass Drug Administration
• Packaging of medication
• Implement MDA (door to
door, Booths at Health
Centers and Outreach
teams)
• Collect and analysis
program data on
Coverage
• Conduct Coverage survey
(post treatment survey)
Mass Drug Administration
Implementation Unit –
Demerara/Mahaica
(Region IV)
– Population – 310, 320
(41.3% Guyana's
Population)
– Eligible population –
301,000
– Divided into 3 areas
• The City of Georgetown –
Prevalence 28% (ICT)
• East Coast Demerara –
Prevalence 16.5 % (ICT)
• East Bank Demerara –
Prevalence -10.8% (ICT)
By age group
Guyana Mass Treatment Chart
NTD (LF/STH)
Age/height
ALB
DEC
2-5 years
400mg
(1 tablet)
100mg
(2 tablets)
6-15 years
400mg
(1 tablet)
200mg
(4 tablets)
> 15 years
400mg
(1 tablet)
300mg
(6 tablets)
Coverage – Region IV
Year 1
Treatment
Area
Target
population
Household
Targets
Adults
Children
Total
East Coast
A-57,000
C-8,000
T-65,000
15,476
39,482
6,109
45,591
(70.1%)
East Bank
A-41,000
C-6,000
T-47,000
11,190
27,921
4,977
32,898
(70%)
Georgetown
A-152,000
C-15,600
T-167,000
39,761
87,134
11,924
99,058
59.4
Total
A-250,000
C-19,000
T-269,000
66,427
154,537
23,010
177, 547
66%
Monitoring and evaluation
– Program coverage – Data
management
– Survey coverage – Post
treatment cluster surveys
– Morbidity
– Reporting
• IDB and GWI
• National and Regional
Programs
– Impact evaluation
• Surveillance
• National feedback
Challenges
• Capacity – Technical and administrative (PAHO/WHO and
MOH assisted), Training (University Interns)
• Supervision and Data management – PAHO supported
training and coordination
• Administrative and Logistic Support – Transport, Office
space, Medicine storage and packaging (MOH provided all
support)
• Procurement and supplies chain – DEC Procurements from
Brazil, ALB donation from GSK
• Social Mobilization – Mass Media program was late and did
not reach target population, MOH and GWI used their
individual to enhance SM and HW conducted community
Mobilization
Innovations
• Training of Volunteers from Community and Faith
Based Organization
• Target large employers – Ministries, work places
and Institutions
• Establishment of Distribution Points mainly at
Health facilities
• Special Outreaches and “Mop-up” Exercises
• Public Education – opportunities to “talk health”
• Integrated Vector management.
Leprosy situation at national level,2011
Prevalence
0.9 per 10,000 pop
Number of new cases
% of multibacillary cases
amongst new cases
24
% of cases with grade 2
disability amongst new cases
4.2%
% of cases in children under
15 amongst new cases
12.5%
Detection rate
(x 100.000 population)
3.2 x 100,000
70.8%
Prevalence at first sub-national
administrative level, 2011
Prevalence at first
subnational level-2011,
GUYANA
2
1.5
1
0.5
0
1
2
3
4
5
6
7
8
9
10
Thank You