Lessons Learned from Rotarians Against Malaria Program in Papua New Guinea

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Community-based malaria control program undertaken by Rotarians Against Malaria in Papua New Guinea focused on chasing malaria hotspots through various strategies like using Long Lasting Insecticidal Nets (LLINs) and mapping malaria cases. The program aims to replicate its success in other partner countries by identifying areas with high malaria prevalence to effectively combat the disease.

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ROTARIANS AGAINST MALARIA PAPUA NEW GUINEA Community Based Malaria Control Program Lessons From PNG RAM Meeting Melbourne 24 August 2019 Tim Freeman

PNG MALARIA PROGRAMME PRESENTATION PURPOSE Can the Papua New Guinea Chasing Malaria Project be replicated in other RAM Partner Countries.

PNG MALARIA PROGRAMME CHASING MALARIA Ingredients For Community Malaria Control Program You need to have levels of malaria to which the community feels that there is a problem. No or little malaria or mosquitoes little likelihood of community by in. Best to identify hot spots of malaria. This can be done in three ways: National Health Information System School prevalence surveys Active surveillance using nets.

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA Using Long Lasting Insecticidal Nets (LLINs) To Locate Malaria Hotspots. LLINs Given Out For Positive Cases Of Malaria In Health Centres In Central, NCD and Gulf Provinces Locations of all cases recorded and put into data base. This data is mapped. Table below shows nets given out in PNG for this purpose in the last few years. Province Central NCD Gulf Total 2014 325 167 2015 3,276 925 214 4,415 2016 1,888 592 972 3,452 2017 1,559 624 1,148 3,331 2018 1,912 419 113 2,444 Total 8,960 2,727 2,447 14,134 0 492

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA MAPPING IN NCD This map shows malaria cases in children in NCD. This suggests that malaria is still being transmitted in Kaugere.

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA MAPPING IN CENTRAL PROVINCE Based on this map, Chasing Malaria has concentrated its activities in the Waima and Bereina areas of Kairuku

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA MAPPING IN CENTRAL PROVINCE Based on this map, Chasing Malaria has concentrated its activities in the Waima and Bereina and then Kuriva areas of Kairuku

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA MAPPING IN ENGA FROM ENHIS

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA MAPPING IN BOUGAINVILLE FROM ENHIS

PNG MALARIA PROGRAMME RAM PROGRAMME Ingredients For Community Malaria Control Program Checking Local Data

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA SCHOOL PREVALENCE SURVEYS School Prevalence Survey In Brown River

PNG - MALARIA PROGRAMME CHASING MALARIA Nets were given to RDT Positive Cases through the Chasing Malaria Programme

PNG - MALARIA LLIN PROGRAMME WORLD MALARIA DAY PREVALENCE SURVEYS School Prevalence Surveys Initiated On World Malaria Day in Kuriva in 2018 Central Province showed very high prevalence rates Row Labels Berere Brown River Doromoku Kerea Vanapa Grand Total Neg 14 77 33 83 74 281 Pf 9 17 4 20 16 66 Non Pf Mixed Tested Positivity 39 144 46 123 132 484 8 8 64.1 46.5 28.3 32.5 43.9 41.9 26 6 10 20 70 24 3 10 22 67

PNG - MALARIA LLIN PROGRAMME ELEMENTARY SCHOOL PREVALENCE SURVEYS School Prevalence Surveys Now carried out throughout PNG in Elementary Schools. Results have shown very high prevalence rates in many parts of the country. The area big differences between provinces but also within the same province. Results from Central Province at least show reductions of malaria from 2018. Total RDTs Tested Total Positive % Primary School Date Negative Pf Non Pf Mixed Pf % Positive DISTRICT Kuriva Vanapa Kerea Brown River TOTAL RDTs HIRI DISTRICT Apr 19 Apr 19 Apr 19 Apr 19 139 95 74 144 452 12 5 1 12 30 24 14 19 6 63 12 2 2 25 41 187 116 96 187 586 48 21 22 43 134 25.7 18.1 22.9 23.0 22.9 6.4 4.3 1.0 6.4 5.1

PNG MALARIA PROGRAMME CHASING MALARIA Once areas of high incidence or prevalence are identified, it is then important to hold consultations with local leadership at provincial, district, health centre, school and village level. This is to ascertain the following: Is malaria in the areas identified considered to be a malaria problem at all levels Is there a political willingness to be involved at all levels Is there any social cohesion at community level i.e. clear community leadership or strong community based organisations?

PNG MALARIA PROGRAMME RAM PROGRAMME Ingredients For Community Malaria Control Program You need to have levels of malaria to which the community feels that there is a problem. No or little malaria or mosquitoes little likelihood of community by in. Greatest danger is that communities will not fully participate when project is not there.

PNG MALARIA PROGRAMME RAM PROGRAMME Ingredients For Community Malaria Control Program Challenge is buy in? Issues that can help research on mosquitoes, biting times, usage of nets can all help focus community on issues. Do they have strong leaders and or local Community Groups such as Church or women's group.

PNG MALARIA PROGRAMME RAM PROGRAMME Ingredients For Community Malaria Control Program Possible Activities Health education at all levels School and community surveys School clubs or village clubs where leadership is found to destroy breeding sites. Ensuring that the local health centre reports all cases of malaria and that all cases are treated correctly.

PNG MALARIA PROGRAMME RAM PROGRAMME Ingredients For Community Malaria Control Program EDUCATION MESSAGES Sleep under bednets every night can local leaders assist in this. Use nets all night don t leave them in cupboards hang them up on the walls when not used, cover windows and doors, make old nets into sarongs, hand around your shoulders when sitting outside. Destroy mosquito breeding sites If sick, seek early treatment!!

PNG MALARIA PROGRAMME RAM PROGRAMME Ingredients For Community Malaria Control Program Checking Local Data Spending a lot of time with the community at first and then weaning them off for longer and longer period. Activities include school clubs looking for breeding sites weekly. In remote areas train volunteers and teachers in testing and treatment of malaria Be involved with National Program and World Malaria Day

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA TRAINING ELEMENTARY TEACHERS IN KURIVA CENTRAL PROVINCE IN APRIL 2019 April 2019 - 13 teachers trained in testing and treating malaria. Teachers came from six schools plus one village volunteer trained at Kuriva Primary School. Teachers now all testing and treating malaria

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA TRAINING ELEMENTARY TEACHERS IN KURIVA CENTRAL PROVINCE IN APRIL 2019

PNG - MALARIA PROGRAMME WORLD MALRIA DAY Working now in collaboration with WHO, NDoH Malaria Programme, CPHL and Central Province PHA World Malaria Day 2019 NCD Ron Seddon (Chairman of RAM together with Minister of Health giving prizes) World Malaria Day 2018 Kuriva Central Province

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA RESEARCH BY INSTITUTE OF MEDICAL RESEARCH (IMR) To try and understand malaria in the area, the IMR was invited to come to Kuriva in Central Province in November 2018

PNG - MALARIA LLIN PROGRAMME IMR RESEARCH Findings Many species of anophelines biting both inside and outside

PNG - MALARIA LLIN PROGRAMME IMR RESEARCH Findings Much biting at early hours of the evening and only at night

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA LARVAE HOUSES Four compartments built to represent North, East South And West for children to put collected larvae

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA School And Community Involvement

PNG - MALARIA LLIN PROGRAMME CHASING MALARIA Community Involvement

PNG - MALARIA LLIN PROGRAMME OTHER ACTIVITIES Intervention Failure Net barrier had no measurable impact on malaria and was continually destroyed by pigs