12. National Malaria Indicators Survey, 2008
Dr. Randa Youssef, Dr. Najibullah Safi, Dr. Hamida Hemeed, Dr. Walid Sediqi, Dr. Jamal Abdul Naser, Dr. Waqar Butt
Conclusion and Recommendation:
The survey was accomplished successfully in 10 provinces with different levels of malaria endemicity during the peak transmission season of P. falciparum. The sample selected provided a representation of all population 47 subgroups that adequately mirrored the population of the 10 provinces.
Bed net coverage is low (26.7%) with a much lower coverage with ITNs (10.7%) and LLINs (9.9%). Coverage with bed nets is low in rural areas (23.2%) and high risk provinces including Hirat (6.2%) and Faryab (7.1%) and Nimroz (0.0%) where population are at a much higher risk of malaria.
The least wealthy has lower access to bed net. Majority of bed net (89.0%) available at community level were purchased and the cost of bed net was the barrier that prevented 74.5% of the head of households to acquire it. Less than a quarter (22.1%) of the surveyed population reported the habit of sleeping under bed nets. This proportion is especially low in rural areas (17.5%) than urban ones (31.3%). The night of the survey less than 5% of the surveyed population in urban (4.7%) and rural areas (4.0%) slept under bed net. Only 16.6% of the bed nets available to the population were used the night of the survey.
The prevalence of self reported fever the day of the survey was very low in both rural areas (8.0%; 95%CI= 7.35, 8.59) and urban areas urban areas (3.8%; 95%CI= 3.18, 4.42). Also the point prevalence of fever at the time of the survey was low (2.8%; 95%CI= 2.57, 3.27) among rural (3.8%) and urban (2.0%) population. Two week period prevalence of fever was low in urban (2.5%) and rural (3.9%) areas. These fevers were mostly due to respiratory and gastrointestinal infections as reflected by the described associated symptoms and the fact that most of them received antipyretics (56.8%) and/or antibiotics (34.1%) that resulted in a cure or improvement of the condition in 86.4% of the instances. Only 40 out of the 169 who visited a health care facility for the treatment of fever reported in the two weeks prior to the survey had their blood tested for malaria and 22 out of them reported a positive test. Only 18 patients reported receiving antimalarial drugs in Badagshan (n=11), Nangarhar (n=5), Bamyan (n=1) and Kunar (n=1); 16 of them were rural dwellers and 15 reported receiving chloroquine. Just more than half of those who reported fever in the two weeks prior to the survey (59.8%) took action to treat the fever and nearly half of them (53.3%) visited a health care facility. Governmental health facility was visited by nearly half (51.5%) of those who sought a health care facility for the treatment of fever. Patients had to travel for an average duration of 41.07 minutes and to wait for an average duration of 41.64 minutes to be seen. Only 33.7% incurred the cost of consultation which was on average 69.21 AFG. For those who did not take any action to treat the fever as well as those who did not visit a health care facility, the most frequently stated barriers were the unavailability of facility in the area of residence (24.5%), the long travel distance to 48 the facility (22.7%) as well as the unaffordable cost of consultation (46.0%).
General public should be encourage to use the available health care facilities in the event if sickness. All stated barriers for visiting health care facility should be considered by the MoPH in the respective provinces to ensure appropriate diagnosis and adequate treatment including the long travel and waiting time at the facility as well as the cost of consultation.
At the time of the survey, only 45 subjects were positive for the parasite yielding a point prevalence of 0.4%. In view of the low point prevalence and the predominance of P. vivax, information that will soon be available from analysis of the blood drops collected on filter paper will provide a better insight into situation of malaria in the surveyed provinces by describing historical infection among the population. Research is needed into disease vector to identify potential risks of transmission.
Less than half (43.1%) of the surveyed population reported receiving health education messages addressing areas related to malaria transmission and disease prevention. Intensification of information, education and communication efforts is highly recommended to improve people knowledge and enable then to adopt a behavior that obviate risks of malaria infection. Very low proportions of the population living in high risk provinces were aware of the actual risks of malaria transmission and infection. This lack of essential knowledge has an adverse effect on people behavior regarding taking appropriate protective measures and seeking medical care once malaria is suspected. Health education messages should emphasize on risk of malaria in different geographical localities. Messages should address clearly how the disease is acquired and what are its manifestations to enable people to protect themselves and seek medical care once symptoms are suspected.
Nearly a quarter (23.8%) of the surveyed population did not know the best preventive measure for malaria and less than half (46.0%) perceived bed net as the best measure to prevent malaria. Health education messages should address measures of prevention against malaria with special emphasis on effectiveness of insecticide treated bed nets. Health education messages should as well take into consideration the misconception of the population related to the health hazards of using insecticide impregnated. Health care facilities should consider health education activities of relevance to malaria as part of the routine services provided to the population. Health education messages using mass media will ensure the wide spread of accurate and up to date information. Radio and television are the most suitable mass media in view of the high rates of illiteracy among the population.
The information, reports and lessons learned from this survey should be made available to all partners. A national seminar including all partners and the health staff involved in the survey will create a sense of ownership and facilitate usage of information and implementation of the survey recommendations. The data base of the survey should be linked to the available geographical information systems for further spatial analysis of the information. Using the experiences and lessons learned from this survey, a population based survey should be planned for other malarious areas which were not part of the survey at this stage. Survey results and experiences should be shared with the international community. MoPH of Afghanistan is encouraged to prepare a scientific paper for publication in international journals.
Afghanistan Annual Malaria Journal (2009) P 37-49
Full Report Available at: