Malaria control in humanitarian emergencies. An inter-agency field

250 Pages·2013·2.54 MB·English

Malaria
MTHE ENTOR
control initiative
in humanitarian
emergencies
AN INTER-AGENCY
FIELD HANDBOOK
Second Edition

Malaria control
in humanitarian emergencies
AN INTER-AGENCY
FIELD HANDBOOK
Second Edition
i
WHO Library Cataloguing-in-Publication Data
Malaria control in humanitarian emergencies: an inter-agency field
handbook – 2nd ed.
First edition published with title “Malaria control in complex
emergencies: an inter-agency field handbook”
1.Malaria – prevention and control. 2.Emergencies. 3.Malaria – drug
therapy. 4.Relief work. 5.Disease outbreaks. 6.Mosquito control.
7.Handbooks. I.World Health Organization.
ISBN 978 92 4 154865 6 (NLM classification: WC 765)
© World Health Organization 2013
All rights reserved. Publications of the World Health Organization are available on the WHO
web site (www.who.int) or can be purchased from WHO Press, World Health Organization,
20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: [phone]; fax: [phone];
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 web site (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 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.
This publication contains the collective views of an international group of experts and does not
necessarily represent the decisions or the policies of the World Health Organization.
Please consult the WHO Global Malaria Programme web site for the most up-to-date version
of all documents (www.who.int/malaria).
Cover photo: © 2008 Paul Jeffrey, Courtesy of Photoshare
Designed by minimum graphics
Printed in Italy
Contents
Preface vii
Contributors ix
Acknowledgements xi
Abbreviations xii
Glossary xiv
Chapter 1 Introduction 1
Humanitarian emergencies 1
Malaria 3
Importance of malaria in humanitarian emergencies 7
References 9
Finding out more 9
Chapter 2 Coordination 10
Coordination mechanisms 10
Advocacy and resource mobilization 11
Priorities and constraints 13
Finding out more 13
Chapter 3 Assessment and operational planning 15
Assessment and information needs 15
Data collection 17
Operational planning 23
Finding out more 27
Chapter 4 Surveillance 28
Health surveillance in humanitarian emergencies 28
Planning malaria surveillance during humanitarian emergencies 30
Monitoring and evaluation 39
References 42
Finding out more 42
iii
MALARIA CONTROL IN HUMANITARIAN EMERGENCIES
Chapter 5 Outbreaks 43
Outbreak preparedness 43
Outbreak investigation 45
Outbreak response and follow-up 47
References 52
Finding out more 52
Chapter 6 Case management 53
Initial assessment 53
Confirmatory malaria diagnosis 55
Malaria treatment 61
Managing malaria in special groups 73
References 78
Finding out more 79
Chapter 7 Prevention 81
Malaria prevention in humanitarian emergencies 81
Selecting and implementing prevention methods 101
Operational aspects of mosquito biology and behaviour 109
References 116
Finding out more 118
Chapter 8 Community participation 119
Principles for community participation 119
Involving communities 122
Health communication in malaria control 134
References 137
Finding out more 138
Chapter 9 Operational research and associated routine monitoring 139
Importance of operational research in humanitarian emergencies 139
Operational research areas 142
Operational research planning 151
References 160
Finding out more 161
Annexes 163
I Sources and methods for collecting population data 165
II Methods for collecting retrospective mortality data 170
III Overview of methods for conducting rapid assessments of
malaria transmission 171
IV Example malaria rapid prevalence data collection tool 179
iv
CONTENTS
V Checklist for effective response to malaria epidemics 180
VI Antimalarial treatment regimes 184
VII Assessment and treatment of danger signs 200
VIII Assessment of level of consciousness 202
IX Rapid qualitative assessment of social, economic, and cultural
aspects of malaria 204
X Tube and cone assays for insecticide testing of adult mosquitoes 210
XI Example malaria outbreak form 214
Figures and tables
Figures
Figure 1.1 Malaria, countries or areas at risk of transmission, 2011 4
Figure 3.1 Assessing malaria risk 18
Figure 4.1 Example: mortality surveillance reporting form 33
Figure 4.2 Example: cause-specific mortality reporting form 34
Figure 4.3 Example: cause-specific morbidity reporting form 35
Figure 5.1 Epidemic malaria in Northwest Frontier Province Pakistan 2003 46
Figure 7.1 Example approaches to hanging LLINs indoors and outdoors 90
Figure 7.2 Example compression sprayer 92
Figure 7.3 Life-cycles of anopheline and culicine mosquitoes 111
Boxes
Box 4.1 Surveillance challenges after the Haiti earthquake, 2010 29
Box 4.2 Budgeting for surveillance 31
Box 4.3 Classification of malaria treatment responses 42
Box 5.1 Pakistan malaria outbreak 46
Box 5.2 Outbreak response using mobile clinics in Burundi, 2009 49
Box 7.1 Evidence for ITPS prevention of malaria in an emergency
setting in Sierra Leone 97
Box 8.1 Importance of communicating and listening to community concerns 125
Box 8.2 Importance of understanding local context 125
Box 8.3 Involving traditional healers in case management in Cambodia 131
Box 8.4 Caregivers as peer role models 132
Box 8.5 Training community health educators in malaria prevention in
refugee camps on the Myanmar-Thailand border 132
Box 8.6 Training community health workers 133
Box 9.1 Case-control study in Afghanistan 156
v
MALARIA CONTROL IN HUMANITARIAN EMERGENCIES
Tables
Table 1.1 Phases of humanitarian emergencies 2
Table 1.2 Population displacement and risk of malaria in resettlement areas 8
Table 2.1 Constraints in humanitarian emergencies 14
Table 4.1 Useful indicators for malaria surveillance 37
Table 4.2 Standardized malaria case definitions 38
Table 6.1 Groups at high risk of severe malaria and mortality in all
transmission areas 54
Table 6.2 IMCI guidelines for the management of febrile children 56
Table 6.3 Clinical features of uncomplicated and severe malaria 57
Table 6.4 Comparison of microscopy and RDTs 58
Table 6.5 Antigen targets of rapid diagnostic tests 60
Table 6.6 Supportive treatment for patients with severe malaria 66
Table 6.7 Managing complications of severe malaria 68
Table 6.8 IPTp in areas of high malaria endemicity 75
Table 7.1 Factors that may affect prevention approaches in
humanitarian emergencies 82
Table 7.2 WHO recommended LLINs 86
Table 7.3 LLIN distribution by phase of emergency and level of transmission 88
Table 7.4 Household aspects of indoor residual spraying 93
Table 7.5 WHO-recommended insecticides for IRS against malaria vectors 94
Table 7.6 Recommended insecticides for larval control of malaria vectors
in humanitarian emergencies 101
Table 7.7 Geographical issues to consider in selecting prevention activities 103
Table 7.8 Factors for choosing malaria prevention interventions 104
Table 7.9 Information to guide planning of malaria prevention activities 108
Table 7.10 Three ways to distinguish anopheline from culicine mosquitoes 109
Table 7.11 Important malaria vectors in Africa 112
Table 7.12 Important malaria vectors in South-east Asia 113
Table 7.13 Important malaria vectors in South Asia 113
Table 7.14 Important malaria vectors in South America 114
Table 8.1 Community participation and health education in malaria control 122
Table 8.2 Potential roles of community organizations after crisis 126
Table 8.3 Involving the community 127
Table 8.4 Qualitative methods 129
Table 8.5 Reflections on ‘lessons learnt’ from fieldwork 131
Table 8.6 Communication channels, messages and methods 136
Table 9.1 Operational research considerations 141
Table 9.2 Steps in planning operational research 152
vi
Preface
This second edition represents a thorough updating and revision of the first
edition. The structure remains similar, but includes an additional chapter
on humanitarian coordination. All chapters have been revised to reflect
changes in best practices, improvements in technologies, availability of new
tools, and changes in WHO recommendations.
The interagency handbook was developed to set out effective malaria con-
trol responses in humanitarian emergencies, particularly during the acute
phase when reliance on international humanitarian assistance is greatest.
It provides policy-makers, planners, and field coordinators with practical
advice on designing and implementing measures to reduce malaria morbid-
ity and mortality in both man-made and natural disasters. Such measures
must address the needs of all affected population groups and accommo-
date changing needs as an acute emergency evolves into either recovery or
chronic emergency phase. The handbook is organized as follows:
Chapter 1: Introduction introduces complex humanitarian emergencies and
malaria control.
Chapter 2: Coordination describes essential coordination, advocacy and
resource mobilization.
Chapter 3: Assessment and operational planning describes how to assess malaria
burden in an emergency, identify those most at risk, and use the informa-
tion collected to design an effective response.
Chapter 4: Surveillance discusses establishment of disease surveillance sys-
tems to monitor the malaria situation.
Chapter 5: Outbreaks describes how to prepare for and respond to a sudden
increase in malaria cases.
Chapter 6: Case management describes methods of diagnosis, treatment, and
patient care in humanitarian emergencies.
Chapter 7: Prevention describes approaches and tools for vector control and
personal malaria protection during emergencies.
Chapter 8: Community participation discusses how to mobilize affected com-
munities to improve malaria control interventions.
vii
MALARIA CONTROL IN HUMANITARIAN EMERGENCIES
Chapter 9: Operational research and associated routine monitoring discusses con-
ducting research to improve the effectiveness of prevention and treat-
ment in humanitarian emergencies.
A glossary is provided at the beginning of the handbook. Suggestions for
further reading are included at the end of several chapters.
Ideal, or gold standard, approaches to malaria control are not always fea-
sible in humanitarian emergencies. Interventions must be adapted to the
realities of each emergency. Using this handbook should help humanitarian
workers implement effective and concerted responses to malaria problems.
As new information becomes available, updates to this handbook will be
published. Comments and suggestions are welcome and should be sent to
WHO/Global Malaria Programme ([email protected]).
viii