Malaria Epidemic Forecasting and Preparedness Manual

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IntroductionThis manual is written for zoba malaria coordinators (and futuresub-zoba malaria coordinators) to help predict, prevent, detectand control malaria epidemics in Eritrea.Epidemic preparedness and prevention is mostly a matter ofbeing on alert. From year to year, the probability of an epidemicvaries depending on biological factors, social factors, andparticularly the weather. The level of alert varies from year toyear depending on these factors. In this manual, we will usethree levels of alert in a colour-coded system:REDYELLOWGREENWe can think of these levels as a series of steps, raising alertfrom the baseline (Green) to higher levels (Yellow and Red). Inthe manual, we define which factors should cause the alert levelto rise up a step. These are noted in “boxes” in the text, andsummarised on Page 22.Eritrea Epidemic Manual, June 2003iii
There are also criteria for deciding when to move down a step inthe alert level. This is an important part of the system becauseotherwise you would be permanently on high alert.The alert level should ideally be decided by the sub-zoba. Thisis because the likelihood of epidemics varies too much over azoba or over the country as a whole. Since the alert leveldepends greatly on the amount of recent local rainfall, it cannotbe decided unless there is a source of rainfall data for the subzoba.The manual is organized as follows:In Sections 1 and 2, we provide a general definition of anepidemic and describe key characteristics of malaria epidemicsin Eritrea.In Eritrea there is large variation in malaria incidence across thecountry due to altitude, terrain, amount of rainfall and proximityto water. In Section 3, we describe this variation in terms of“geographical stratification.” This does not vary much from yearto year. We can then add information on factors which dochange from year to year as discussed under “AssessingVulnerability” in Section 4. We use such information to decideon the likelihood of an epidemic in any particular year. Thislikelihood is characterized by the alert level.Action to prevent or control an epidemic should not wait untilafter an epidemic is in progress. Certain actions can be takenafter forecasting and warning indicate that the level of alert ishigh. The appropriate actions to be taken are discussed underSection 5: “Epidemic Forecasting and Warning.”Once an epidemic has been detected, we should move from“ALERT” to “RESPONSE.” How to detect an epidemic isdiscussed in Section 6 “Epidemic Detection.” How to preparefor epidemics is discussed in Section 7 “EpidemicivEritrea Epidemic Manual, June 2003
Page 2: Malaria Epidemic Forecastingand Pre
Page 6: ContentsIntroduction...............
Page 12: 1. General Definitionof an Epidemic
Page 15 and 16: Fig 1: GASH BARKA - GULUJ 1996 - 20
Page 18: 3. GeographicStratificationStratifi
Page 21 and 22: If there has been unusually large m
Page 23 and 24: Long-term forecasting (severalmonth
Page 25 and 26: You can see from Fig. 4 that there
Page 27 and 28: 6. Inform Epidemic Preparedness and
Page 29 and 30: The threshold can be calculated by
Page 31 and 32: To calculate and draw monthly thres
Page 33 and 34: Table 2:MonthRe-ordered OPD malaria
Page 35 and 36: To calculate and draw weekly thresh
Page 37 and 38: Definition of an epidemicAt the beg
Page 39 and 40: 2. Drugs3. Insecticides for IRS and
Page 41 and 42: factor (for example increase in num
Page 43 and 44: ResponseWhen to change from “ALER
Page 45 and 46: Table 2:MonthJanFebMarAprMayJunJuly
Page 47 and 48: Graphs are shown in the sheets call
Page 49 and 50: Month GraphEXAMPLE Health Centre400
Page 51 and 52: Week Data continuedweek median 3rd

Malaria Epidemic Forecasting and Preparedness Manual

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