OVERVIEW OF RBM IN

NIGERIA IN NIGERIA:
CURRENT TREATMENT
POLICY
DR. T. O. SOFOLA
NATIONAL COORDINATOR
 PREAMBLE
 Generally, malaria causes 300-500 million
illnesses and 1-2 million deaths every year.

 In Nigeria Malaria is responsible for

 60% of Out Patients visits
 30% of childhood mortality
 25% of infant mortality
 11% of maternal deaths

 N132 billion is lost to Malaria annually in form of

treatment costs, prevention, loss of man-hours,
etc.
 CONTROL OF MALARIA IN
NIGERIA

 Several initiatives and programmes

 RBM now on ground since 1999

 Historic Summit in Abuja, April 25,

2000 (Abuja Declaration and Targets)
 ROLL BACK MALARIA
 A partnership involving governments, private
sector, research organizations, civil society,
media.

 Aim to reduce malaria by half in 2010

 Abuja Targets (By 2005);

• 60% prompt access to appropriate treatment in
24hrs
• 60% of (children Under 5yrs and pregnant
women) use insecticide treated nets (ITNs)
• 60% pregnant women to use Intermittent
Preventive Treatment (IPT) with Sulfadoxine-
Pyrimethamine
 RBM STRATEGIC PLAN

 PRIORITY ISSUES:

 Case management including Home Treatment

 Promotion of ITN Use

 Intermittent Preventive Treatment (IPT) for

Malaria in Pregnancy

 Partnership
 RBM PROCESS IN NIGERIA
 Inception Phase
 Consensus Building Meetings
 Deskwork analysis
 Situation Analysis
 Collection of baseline data for monitoring and
evaluation
 Fostering of effective Partnership through
formation of Partners forum and National
Malaria Control Committee
 Development of National and States Plans of
Action, Strategic Plan.
 Development of time-bound implementation
plans with specific Interventions and products.
 RBM PROCESS IN NIGERIA

 Implementation Stage: Focusing on these

1. Disease Management – improve access to

quality affordable anti-malaria drugs,
encouraging home care and training of health
care providers.
2. Disease Prevention – Promote use of ITNs,
environmental management, and intermittent
preventive treatment of malaria in
pregnancy.
 RBM PROCESS IN NIGERIA
CONTD.
1. IEC/Social Mobilization – for community
action

3. Operational Research to discover new

tools and better interventions

5. Health systems development – Improve

quality of care and make facilities able to
handle / refer cases
 ITNs COVERAGE

ITN Coverage, 2001-2005

60
50
40
coverage (%) 30
20
10
0
2001 2002 2003 2004 2005 Abuja
year
ACCESS TO TREATMENT
Access to Treatment, 2001-2005

60
50
40
Cov (%) 30
20
10
0
2001 2002 2003 2004 2005 Abuja
year
INTERMITTENT PREVENTIVE
TREATMENT – (IPT )

Coverage IPT, 2001-2005

60
50
40
Cov (%) 30
20
10
0
2001 2002 2003 2004 2005 Abuja
year
 CASE MANAGEMENT
 Improving Case Management involves:
• Instituting evidence based treatment Policy
through monitoring resistance trends.
• Capacity building to improve prescription
practices among health professionals
• Encouraging Home Management of Malaria
• Making effective and affordable quality age-
specific anti-malaria drugs at community and
home levels
• Building capacity of community based health
support personnel e.g. PMVs
 ACCESS TO TREATMENT

 ACHIEVEMENTS TO DATE
 Policy on PPD accepted by Govt.
 PPDs produced by private sector (Public / Private Partnership
ensured)
 PPDs in the market
 Capacity building of health professionals through cascade
training
 Work on orientation of health workers and community agents
has started
 Monitoring of drug efficacy through studies at sentinel sites
were instituted
 DTET carried out in 2002, previous one was done in 1987
 Social marketing of PPD has been piloted in three States.
 Guidelines on use of PPD produced
 Rapid assessment on the use of anti-malarial drugs conducted
 Consensus Meeting on Drug Policy Review
 National Treatment
Policy
 First line drug – Chloroquine
 Second line drug – Sulphadoxine
Pyrimethamine

 Criteria for second line drug:

 Ineffectiveness of the first line drugs

 Adverse Reaction to first line

 Resistance problems
 National Treatment
Policy Contd
MALARIA MGT WITH PRE-PACKAGED DRUG (PPD)
REASONS FOR PPD All patients grouped in 4 age-groups Chloroquine
•Reduce adulteration/fake drug Colour
Agegroup Day 1 Day2 Day3
•Improve patients´compliance
*Simplify dosage regimen no Yellow Below 1yr 75mg(1tab) 75mg(1tab) 75mg(1tab)
breaking of tablets etc.)
Blue 1 – 6yrs 150mg(1tab) 150mg(1tab) 150mg(1tab)
•Although drugs are best White >6–12yrs 150mg x2tabs 150mg x2tabs 150mg x2tabs
given according to body-
weight, in practice majority Pink >12 years 300mg x 2tabs 300mg x2 tab 300mg x1tab
of the population do not
have weighing-scales. Age Patients in 4 age-groups Sulphadoxine-pyrimethamine
is therefore used for PPD Colour Agegroup Single dose Paracetamol*
•It is colour coded, age Yellow 2–24months 250+12.5mg x1tab 125mg x1tab
specific to aid recognition
by less educated Blue 2-6yrs 500+25mg x1tab 500mg x1tab
•It is labelled for White >6-12yrs 500+25mg x2tabs 500mg x1tab
manufacturers to protect
and maintain quality & Pink >12yrs 500+25mg x3tabs 500mg x2tab
standards of their product * Paracetamol is co-packed with SP and may be given thrice daily for 3 days
7
 LESSONS LEARNED

 Local production of PPDs feasible

 PPDs available in the market

 PPDs acceptable
 CHALLENGES
 There is need to:
 Work out a framework to update policy
in line with results of the DTET
 Sustain and indeed improve on the
public private collaboration through
the process
 Use available evidence and lessons
from other countries to go through the
process efficiently
 Move through this process fast in
collaboration with all relevant
stakeholders
When we join hands, pictures like this will be a thing of the past
THANK YOU!!!
THANK YOU