NATIONAL STRATEGIC PLAN FOR ELIMINATION OF MALARIA 2011-2020

National Strategic Plan

For Elimination Of
Malaria 2010 – 2020

Prepared by

Vector Borne Disease Section

Disease Control Division
Ministry of Health Malaysia
October 2010
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Contents
Contents .................................................................................................................... 2
Chart lists ................................................................................................................... 3
Table lists ................................................................................................................... 3
Abbreviation ............................................................. Error! Bookmark not defined.4
1.0 Introduction ........................................................................................................ 6
1.1 Elimination defination ...................................................................................... 6
1.2 Current situation .............................................................................................. 7
1.2.1 Epidemiology ............................................................................................ 9
1.2.2 Types of infection (Species) ..................................................................... 9
1.2.3 Case detection and slides examination .................................................... 9
1.3 Feasibility of Malaria Elimination Programme in Malaysia ............................ 10
1.4 Benchmarks and SWOT analysis .................................................................. 11
1.5 Elimination Status Assessment ..................................................................... 14
2.0 National Strategic Plan for Elimination of Malaria (NSPEM) ............................ 15
2.1 Objective 15
2.1.1 Main objective ...................................................................................... 166
2.1.2 Specific objective.................................................................................... 16
2.2 Stratification of Malarious Area ..................................................................... 16
2.3 Strategy 1: Surveillance system .................................................................... 17
2.3.1 Database ................................................................................................ 17
2.3.2 Foci registry ............................................................................................ 18
2.3.3 Laboratory surveillance .......................................................................... 19
2.3.4 Surveillance system management.......................................................... 19
2.3.5 Financial implication ............................................................................... 19
2.4 Strategy 2: Control of malaria vectors using the concept of Integrated Vector
Management (IVM) . .................................................................... 19
2.4.1 Insecticide residual spraying activity ...................................................... 20
2.4.2 Insecticide impregnated bed net............................................................. 20
2.4.3 Other control activities ............................................................................ 21
2.4.4 Malaria vector surveillance ..................................................................... 21
2.4.5 Inter-sector and international collaboration ............................................ 22
2.4.6 Activity monitoring .................................................................................. 22
2.4.7 Financial implication ............................................................................... 22
2.5 Strategy 3: Early detection and treatment for malaria case .......................... 23
2.5.1 Passive Case Detection ......................................................................... 23
2.5.2 Active Case Detection .......................... Error! Bookmark not defined.24
2.5.3 Mass Blood Survey (MBS) ................... Error! Bookmark not defined.25
2.5.4 Screening for high risk group ................................................................ 25
2.5.5 Laboratory service .................................................................................. 26
2.5.6 Case investigation and follow-up ............................................................ 27

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2.5.7 Treatment ............................................................................................... 27

2.5.8 Financial implication .............................................................................. 27
2.6 Strategy 4: Preparedness and response to malaria outbreak ....................... 28
2.7 Strategy 5: Communication and social mobilization for malaria control ....... 28
2.8 Strategy 6: Capacity buidling......................................................................... 29
2.9 Strategi 7: Malaria research .......................................................................... 30
3.0 Indicators dan targets ....................................................................................... 30
4.0 Budget ............................................................................................................ 301
5.0 Conclusion ....................................................................................................... 32
References .............................................................................................................. 33
Annex 1.................................................................................................................... 34
Annex 2.................................................................................................................... 36
Annex 3.................................................................................................................... 37
Annex 4.................................................................................................................... 38
Annex 5.................................................................................................................... 39

Chart lists
Chart 1: Malaria cases trend in Malaysia, 1961 - 2009 ................................................... 6
Chart 2: Malaria programme phase and milestone path for malaria elimination.............. 7

Table lists
Table 1: Malaria incidence and slide positivity rate (SPR), 2000 - 2009.......................... 8
Table 2: Malaria incidence (total cases) by states, 2007 – 2009 ..................................... 8
Table 3: Comparisons between control and elimination programme ............................. 10
Table 4: SWOT Analysis (Strength, Weakness, Opportunity and Threat) for Malaria
Control Programme, 2006 - 2008 .................................................................................. 12
Table 5: Criteria by area ................................................................................................ 16
Table 6: Stratification for red area based on 2006-2008 data ...................................... 17
Table 7: Comparison between data in e-VEKPRO and e-notis with the monthly reported
data in 2009 .................................................................................................................. 17
Table 8: Spraying activities criteria by loaclities ............................................................ 20
Table 9: Bed net impregnation activitiees by localities .................................................. 21
Table 10: Estimation for insecticides and mosquito nets requirements to achieve 100%
coverage for residents at risk (red locality) .................................................................... 23
Table 11: Target group for slide sampling as PCD based on locality ........................... 24
Table 12: ACD types and process ................................................................................ 24
Table 13: Turnaround time for slide examination .......................................................... 26
Table 14: Number of job vacancy and emplacement for the posts of PPKP U29, PKA
U17 and PRA R1 in all states ........................................................................................ 29
Table 15: Strategies and indicators for Malaria Elimination Programme ....................... 30
Table 16: Budget for Mlaria Elimination Programme in the 10th Malaysia plan ............. 31

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Abbreviation
ACD Active Case Detection
ACT Artemisinin Combination Therapy
API Annual Parasite Incidence
BFMP Blood Film for Malaria Parasite
COMBI Communication for Behavioural Impact
CPBV Cawangan Penyakit Bawaan Vektor
CQ Chloroquine
EQA External Quality Assessment
FELCRA Federal Land Consolidation and Rehabilitation Authority
FELDA Federal Land Development Authority
INVEST Investigation
IVM Integrated Vector Management
JHEOA Jabatan Hal Ehwal Orang Asli
JKN Jabatan Kesihatan Negeri
JTMP Juru Tenologi Makmal Perubatan
KEDA Kedah Regional Development Authority
KKM Kementerian Kesihatan Malaysia
MBS Mass Blood Survey
MDG Millineum Development Goal
PCD Passive Case Detection
PCR Polymerase Chain Reaction
PKA Pembantu Kesihatan Awam
PKD Pejabat Kesihatan Daerah
PKM Pembantu Kesihatan Masyarakat
PORIM Palm Oil Research Institute Of Malaysia
PPKP Penolong Pegawai Kesihatan Persekitaran
PRA Pekerja Rendah Awam
PSEMK Pelan Strategik Eliminasi Malaria Kebangsaan
PSS Pejabat Subsektor
RELA Pasukan Sukarelawan Malaysia
RKPBV Rancangan Kawalan Penyakit Bawaan Vektor
SALCRA Sarawak Land Consolidation and Rehabilitation Authority

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SPKA Sukarelawan Penjagaan Kesihatan Asas

SPR Slide Positivity Rate
WHO World Health Organisation

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1.0 Introduction

In Malaysia, the number of malaria cases has declined from 243,470 cases in 1961 to
7,010 in 2009. (Chart 1) Malaysia has successfully achieved its Millennium
Development Goal (MDG). In 2009, there is a case reduction of 45% and the mortality
has dropped by 26% as compared to the year 2000.

Chart 1: Malaria cases trend in Malaysia, 1961 - 2009

Based on the experience and knowledge in malaria control to minimise the impact of
the disease morbidity and mortality, Malaysia consider eliminating malaria as the option
to maximize the benefits of elimination such as the health sector operating cost
reduction, reduction in school absenteeism, increased productivity and population
education level and attraction of foreign investment . Elimination of malaria is also a
policy that guarantees equality in line with the mission of the Ministry of Health as the
activities of this program must be implemented at all levels, and includes those who are
less capable, marginalized and hard to get treatment.

1.1 Elimination Definition

Elimination of malaria as recommended by the World Health Organization (WHO) is to

reduce the incidence of local cases in any one geographical area to zero. The country
may still have malaria vectors and still report cases of imported malaria due to
international travel and migration.

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To facilitate the understanding of Malaria Elimination Programme, WHO divides the

phases and malaria status as summarized in Figure 2. Based on Figure 2, when the
slide positivity rate reaches less than 5 %, the country will enter into the pre-elimination
phase. When the malaria incidence rate is less than one (1) per 1000 population, the
country can consider initiating elimination program to reach the status of zero local
cases. When there is no local malaria transmission in a country for three consecutive
years, the country can apply for WHO’s recognition. To ensure smooth transition from
current phase to the next one, two re-orientation programs have been proposed, which
is during the initiation of program elimination and when the elimination of malaria has
been achieved.

Chart 2: Malaria programme phase and milestone path for malaria elimination
0 indigenous WHO cert
SPR < 5% from IR < 1 case/1000 at
fever cases risk case
population

3 years

Control Pre- Elimination Re-introd

Phase elimination Phase of Preve
Phase Phas

Reorientasion Reorientasion
Program 1 Program 2
Source: Informal consultation on malaria elimination: setting up the WHO
agenda, WHO 2006.

1.2 Current situation

Elimination program is a continuation of a successful control program. Malaysia has
reported a slide positivity rate (SPR) of less than 5% and an incidence rate of less than
1 per 1000 population for over a decade. Thus,Malaysia may consider entering the
elimination phase from current pre-elimination phase with the reported malaria
incidence of less than 1 per 1000 residents in 1998 (data not included).

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Table 1: Malaria incidence and slide positivity rate (SPR), 2000 - 2009
Incidence Incidence Slide
Total rate rate positivity
malaria Indigenous (Total cases) (Indigenous) rate
Year Population cases malaria per 1,000 per 1,000 (SPR)
2000 23,274,690 12,705 9,273 0.5 0.4 0.69
2001 23,795,300 12,780 8,808 0.5 0.4 0.70
2002 24,526,500 11,016 7,652 0.4 0.3 0.62
2003 25,048,300 6,338 4,264 0.3 0.2 0.38
2004 25,580,900 6,154 3,989 0.2 0.2 0.39
2005 26,127,500 5,569 3,329 0.2 0.1 0.39
2006 26,640,100 5,294 3,917 0.2 0.1 0.38
2007 27,173,700 5,456 4,048 0.2 0.1 0.35
2008 27,728,800 7,390 6,071 0.3 0.2 0.47
2009 28,306,600 7,010 5,955 0.2 0.2 0.45
Source: CPBV Annual Report, 2000 to 2009

However, analysis of malaria incidence rates by state shows that Sabah still has the
incidence of more than 1 per 1000 population for the period of year 2007 to 2009.
(Table 2)

Table 2: Malaria incidence (total cases) by states, 2007 – 2009

Year 2007 2008 2009

Perlis 0.02 0.02 0.01
Kedah 0.05 0.07 0.04
Pulau Pinang 0.04 0.13 0.06
Perak 0.10 0.04 0.03
Selangor 0.07 0.04 0.04
WPKL 0.01 0.02 0.03
Negeri Sembilan 0.03 0.12 0.09
Melaka 0.02 0.02 0.01
Johor 0.03 0.03 0.03
Pahang 0.08 0.1 0.11
Terengganu 0.03 0.02 0.03
Kelantan 0.05 0.17 0.17
Sarawak 0.48 0.78 0.73

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Sabah 1.04 1.32 1.25

WP Labuan 0.02 0.05 0.03
Malaysia 0.20 0.27 0.25
Source: Annual Report Year 2007, 2008, 2009 CPBV MOH

Specifically, the malaria situation in Malaysia based on the results for the period 2006 to
2008 are as follows.

1.2.1 Epidemiology
For year 2006 to 2008, malaria cases increased from 5,254 (2006) to 5,456 (2007) and
then, increased again by 45 % to 7,930 in 2008. The increments of cases in 2009 were
reported in the state of Sabah (30%), Sarawak (65%), Pulau Pinang (259%), Negeri
Sembilan (350%) and Kelantan (249%). From 2006 to 2008, more than half of the
cases reported from Sabah and about 25% reported from Sarawak.

For the age group, the age group 20 to 29 years contributing to around 27 % of the total
cases. Risk groups of children < 5 years, only about 5 % of the total cases. For 2006 to
2008, there was a decrease in the percentage of cases among children < 5 years in
Peninsular Malaysia and Sabah. However, there is an increase in cases of the same
age group in Sarawak, from 3.0% of total cases in 2006 to 6.8% in 2008.

Almost 80% of malaria cases in Malaysia are among men. In Peninsular Malaysia,
more than half of the cases were foreigners, while for Sabah, about 40% and for
Sarawak, the percentage is much lower at around 10%. Occupational groups of high
risk of malaria infection are agriculture and farming sector workers (18%), followed by
work related to forestry such as logging (15%).

1.2.2 Types of infection (Species)

Half of the cases of malaria in Malaysia are due to Plasmodium vivax, one third due to
Plasmodium falciparum and the rest, Plasmodium malariae (around 9%) and mixed
infection (4%).

1.2.3 Case detection and slides examination

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Around 90% of cases are detected by PCD in Sarawak whereas the percentage is
lower in Peninsular Malaysia (average 58%) and Sabah (average 75%). Percentage of
error in overall slide examination is not satisfactory, namely 3% in 2007 and 7% in
2008.

1.3 Feasibility of Malaria Elimination Programme in Malaysia

To assess whether a country is ready to enter into the elimination phase, Malaria
Elimination Group (MEG) recommenda a feasibility assessment based on the technical,
operational and financial aspects before starting an elimination program.

The technical feasibility assessment helps to determine whether elimination can be

achieved. Elimination phase can be achieved if the incidence is less than 1 case per
1000 population. Specifically for Malaysia , malaria elimination was achieved in 815
(71%) sub-districts across the country where there is no local infection reported for the
period 2006-2008 , while 218 (19%) sub-districts have the incidence rate of less than 1
per 1000 population (pre-elimination). Meanwhile, 115 (10%) sub-districts in seven (7)
states have the incidence rate > 1 per 1000 population and of this number , there are
87 (76%) sub-districts in Sabah and 21 ( 18 % ) in Sarawak .

Operational feasibility of a country is measured by the ability to implement all activities

towards the attainment of elimination. Malaysia has several important components such
as the health system that is capable of diagnosing early and start treatment for all cases
of malaria, the ability to ensure high coverage of vector control activities, political
stability and government support as well as close multi-sector collaboration.

Long-term financial planning for the elimination and retention programs perlaksaanan
malaria-free status is important because without financial support, the incidence of
malaria cases will increase and the investment and effort that has been initiated will be
wasted. .

Table 3 gives an explicit picture of the differences between the control and elimination
programs. In short, the management of elimination program management needs to be
more efficient and complete than the control program.

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Table 3: Comparisons between control and elimination programme

Matter Control Programme Elimination Programme
Objective Reduction of malaria burden Cessation and absence of local case
Operating area Depends on endemicity, relationship All malaria foci
and interest of social, politics or
economy.
Minimum standard of Good: reduction of transmission to Perfect/best: Transmission chain has
activity the level where disease is no longer
been terminated in one area. If new case
regarded as public health problem occur, source of infection need to be
identified and isolated
Activity duration No limit One country is regarded as malria free if
no transmission for three years
Economy aspect Continuous Continue after elimination but focus will
be on efficient health service delivery
Integration with other Better to be integrated with other Not advisable as elimination is specific
health programme programme and has its time period
Case detection Mostly by PCD Case detection very important including
ACD
Imported case Less attention given Very important to give attention
especially after elimination is achieved
Case investigation Less attention given except for Become more important and wil be the
P.falciparum case in area of low priority once elimination achieved
incidence
Epidemiology Reduction of parasite index and Absence of local case (with proof)
assessment malaria incidence
Monitoring of Assessment of achievement Assessment of what is not achived yet
achievement
Intervetion level Residents, patients Focus/locality
Programme Not perfect but sufficient Must be very quick and efficient. If not,
management there is a possibility if failure
Adapted from WHO Expert Committee on Malaria. Sixth report

1.4 Benchmarks and SWOT analysis

The countries that have succeeded in eliminating malaria share the following factors:
i. political stability
ii. commitment from the government to eliminate malaria through the
continuous fund channelinh
iii. good technical infrastructure and program management
iv. quality training and competent workforce
v. health service that is well developed and functioning
vi. no internal and external conflict

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vii. no large movement of population from neighboring countries that are

malaria endemic
viii. unstable malaria situation

Based on the above factors as well as the SWOT analysis (Table 4), Malaysia could
achieve elimination status by strengthening management of existing programs and
improve the weaknesses that have been identified. In addition, the elimination of
malaria should be seen as part of a larger development that will improve the socio-
economic of the population, comprehensive health coverage and a high standard of
living. Malaria-free status will accelerate the country development by attracting foreign
investment and tourism.

Table 4: SWOT Analysis (Strength, Weakness, Opportunity and Threat) for

Malaria Control Programme, 2006 - 2008
STRENGTH
1. Commitment The Government is committed to implement the National Malaria
Elimination Strategic Programme 2011-2020 through the
continuous financial support.
2. CDC Act1 Malaria is an infectious disease that must be notified within
1998 seven (7) days under this Act. This allows all reported malaria
cases be treated in any health facilities including private clinics.
3. Case Almost all health facilities across the country have the facility to
detection conduct the test of Blood Film for Malaria Parasite (BFMP). This
allows early detection and prompt treatment.
4. Case Around 98% of malaria cases are investigated within 7 days from
investigation the date of notification. This ensures control activities can be
started immediately.

5. Diagnosis Diagnosis and treatment for free in all government health

and treatment facilities and hospitals make healthcare more affordable to
public.
6. DDBIA Act2 This Act is to enforce the destruction of vectors.
1975
WEAKNESS
1. Case • A total of 168 health clinics in Sarawak are without

1
CDC Act - Control of Communicable Diseases Act
2
DDBIA – Destruction of Disease Bearing Insects Act

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detection microscope.
• The screening activity, especially among foreign workers
from malaria endemic areas has not been substantial resultiing
in frequent malaria outbreaks in this group.
2. Slide • Errors in positive slide examination is still high at 3-7%.
examination • Late slide examination in Sarawak because of the shortage of
microscopy service at the clinics.
3. Malaria case Incomplete investigation form results in failure in identification of
investigation the source and transmission of the infection.
4. Treatment Physicians using a variety of treatment regimes, particularly for
P. falciparum. Guidelines on the treatment regime version year
2000 needs to be updated by including the latest and better
treatment regime.
5. Follow-up Follow-up, especially among foreign workers is not complete.
Among the problems are incompetent management at the district
level and also the frequent shifting of foreign workers.
6. Drug Was stopped by the IMR in 2006.
resistence
surveillance

7. Residual Residual spray coverage of the locality that should be done

spray regularly is still unsatisfactory. For example: in 2008, residual
coverage spray coverage in Sarawak (22.3%), Kelantan (12.2%) and
Pahang (22.6%).
8. Special spray High-risk areas (especially where the foreign workers work) that
require special spray were not identified. For example: Selangor
and Penang.
9. Insectide • Low (<80%) insectide treated nets coverage in some states
Treated Nets due to lack of staff and logistical problems.
• The Penan that refuse the use of nets supplied by MOH.
• Study on the effectiveness of impregnated bed nets is not
conducted in the field.
10. Preparedness • There is no malaria outbreak management guidelines.
and response • Lack of skilled health personnel to control malaria outbreak.
• The district and the state are less sensitive to potential
outbreaks area such as the workplace of foreign workers.
11. Surveillance • Vekpro data is not updated and not fully analyzed.
system • There is a discrepency between data and reten Vekpro
monthly.
OPPORTUNITY
1. Slide Medical assistants and staff of private clinics, workers in estate
preparation or logging camp can be trained to collect and examine BFMP
and sample including making follow up for malaria cases.

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examination

2. Health Corp Malaysian Army Medical Corps can carry out ACD activities
and ACD among their members who recently returned from the operation.
slide
3. COMBI COMBI program can be established in the high-risk
program communities.

4. Volunteer Volunteers in high-risk localities can monitor treatment and take

BFMP slide from fever patient or those involved in high-risk
activities besides helping in vector control activities.
6. Collaboration Inter-agency collaboration is encouraged.
with other
agencies
7. International Cooperation with neighboring countries such as Thailand and
cooperation Indonesia via Goodwill Meeting between Malaysia - Thailand and
SOSEK MALINDO.
THREAT
1. Foreign • Influx of illegal migrants from malaria endemic countries allow
worker the reintroduction of malaria receptive areas.
• Migrant workers who are changing workplace frequently
made it difficult for follow-up action.
2. Incooperative Employers did not provide insecticide treated nets to their
employer workers.
3. Attitude Delay seeking treatment due to logistical problems, social, self-
treatment practice and traditional treatment.
4. Logistical Difficulty to perform case detection and control activities in rural
problem areas.
5. Resistance • The presence of parasites resistant to anti-malarial drugs.
• The presence of vector insects resistant to pesticides.

1.5 Elimination Status Assessment

When a country has recorded local transmission zero for three (3) consecutive years,
the country can apply for recognition of malaria-free status of the WHO. This
recognition requires proof beyond reasonable doubt which includes:
a) An effective surveillance mechanism and covers all areas.
b) The national registry of malaria cases, notification of all facilities including

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the private sector.

c) Health services are able to detect cases early, provide treatment and
conduct follow up on the imported cases.
d) Laboratory capable of diagnosing cases by microscopy.
e) Epidemiological investigation done for all cases.
f) National Action Plan that shows continuous commitment.
g) System to raise the awareness of tourists on infection prevention.
h) Database for cases and foci.
i) Surveillance entomology and monitoring of insectide resistance of vector.
j) Coordination system in the borders.
k) The ability to detect and control outbreaks.
l) Sero-Epidemiological Study to understand the status of immunity against
malaria.
All the elements mentioned above are included in this malaria elimination strategy
plan to ensure early planning and preparation of a comprehensive documentation
for the program assessment. Monitoring framework for pre-elimination and
elimination programmes recommended by WHO are as in Appendix 1.

2.0 National Strategic Plan for Elimination of Malaria (NSPEM)

There are seven (7) strategies in NSPEM :
 Surveillance of malaria,
 Control of malaria vectors using the concept of IVM (Integrated Vector
Management),
 Early detection and prompt treatment of malaria cases,
 Preparedness and response to outbreaks of malaria,
 Communication and social mobilization,
 Capacity building and
 Malaria Research

To ensure the success of this program, Malaria Elimination Programme Monitoring

Committee will be formed at ministry level to monitor the progress of the implementation
of activities by the outlined Key Performance Indicators (KPI).

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2.1 Objective
The formulated NSPEM aims to achieve the following objectives:

2.1.1 Main objective

To make Malaysia free from locally acquired malaria infection (Indigenous) by 2020.

2.1.2 Specific objectives

i. To make Peninsular Malaysia is free from local malaria infection
(Indigenous) by 2015.
ii. To make the states of Sabah and Sarawak free from local malaria
infection (Indigenous) by 2020.
To achieve this status, local case reduction will be targeted at 20% reduction per year
for all states based on the number of cases in 2009.

2.2 Stratification of Malarious Area

For the purpose of implementation of the National Strategic Plan for Malaria Elimination
(PSEMK), localities are divided into three (3) types as shown in Table 5.

Table 5: Criteria by area

LOCALITY CRYTERIA
RED LOCALITY Incidence > 1 / 1000 population
YELLOW LOCALITY Incidence < 1 / 1000 population
GREEN LOCALITY No locally acquired infection

Out of a total of 656 sub-districts (mukim) in Sabah, Sarawak, Pahang, Perak,

Kelantan, Selangor and Penang, 115 sub-districts are red zones which cover 5,216
localities, 180,599 houses and 1,266,729 population at risk (Table 6). Out of 115 red
sub-distrcits, 87 (76%) in Sabah and 21 (18%) in Sarawak. There are 218 (19%) sud-
distrcits in eleven (11) states that has already in the pre-elimination phase. Meanwhile,
815 (71%) sub-districts across the country, including the entire state of Perlis, Melaka,
Labuan aand Kuala Lumpur do no have local infection in the period of the year 2006-
2008.

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Table 6: Strafication for red area based on 2006 – 2008 data

Red

Population
No of sub-
No of

localities
districts/
sectors

houses
No of

No of
sub-
No of districts/
No States districts sectors
1 Sabah 23 214 87 3,204 125,775 784,985
2 Sarawak 31 85 21 2210 44489 492947
3 Pahang 11 71 6 135 3,970 18,017
4 Perak 9 80 3 107 6,681 32,788
5 Kelantan 10 66 1 91 9,169 39,084
6 Selangor 9 56 1 2
7 PPinang 5 84 1 1 20 100
Total 98 656 115 5,216 180,599 1,266,729

Apart from the stratification as shown in Table 5, receptive and vulnerable localities
have also been identified to ensure the necessary interventions to be implemented for
the area. When the parasite reservoir decreases, surveillance needs to be improved to
obtain evidence whether new transmission continues to occur and to detect imported
cases so that the follow-up action can be initiated immediately.

2.3 Strategy 1: Surveillance system

2.3.1 Database
Efficient and comprehensive surveillance system is very important to ensure the
success of any program related to the disease. Existing database of e-notis and e-
Vekpro provides important information of malaria patient such as socio-demographic
data, laboratory results, treatments and vector control activities. This data been used for
analysis and synthesis of epidemiological information and the trend. However, the
performance of database management is still not satisfactory (Table 7) in which there
are data dicrepencies between the two database data and delay in data entry. Efforts to

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ensure timely data entry and proper data verification will be implemented to ensure an
effective surveillance system.

2.3.2 Foci registry

In addition to this database, Ministry of Health will update the foci registry which
provides data on foci case prevalence, entomological surveillance and intervention
activities including mapping of breeding areas, foci investigation and control activities
for each foci (locality). Existing foci registry has been used for the malaria area
stratification. However, it requires additional information, it should be regularly updated
and accessible at all levels. This is consistent with the approach of elimination
programs that focus base on foci and not only to the population within malarious area
as in malaria control program. Informations in foci registry also useful for the outbreak
warning system.

Table 7: Comparison between data in e-VEKPRO and e-notis with the monthly
reported data in 2009
No of cases No of cases
States Reported data
e-VEKPRO e- Notis
Perlis 2 2 2
Kedah 69 69 48
P Pinang 86 86 107
Perak 70 70 72
Selangor 231 209 200
WPKL 49 49 28
N Sembilan 89 90 91
Melaka 10 10 10
Johor 108 108 74
Pahang 176 176 175
Terengganu 30 30 24
Kelantan 276 276 276
Sarawak 1,795 1,823 1,231
Sabah 4,009 4,009 2,704
WP Labuan 3 3 0
TOTAL 7,003 7,010 5,042

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2.3.3 Laboratory surveillance

Parasite isolates bank and genotyping facilities will also be established. This service will
be used to differentiate between local and imported cases for P. vivax infection, and
also between the relapse cases and new infection.

2.3.4 Surveillance system management

Database management will be improved including the monitoring of data entry into e-
notis and e-Vekpro, standardization of existing forms and periodic data (epidemiology
and vector control) analysis.

2.3.5 Financial implication

Existing management of e-Notis and e-Vekpro must be improved and it involve financial
requirements for the replacement of equipment of procurement of new equipment such
as computers, GPS devices and digital cameras are as follows:
i. Computer : 124 units ~ RM630, 000.00 [New: 102, Replacement: 22]
ii. GPS : 230 units ~ RM460, 000.00 [New: 197, Replacement: 33]
iii. Digital camera : 38 units ~ RM 76, 000.00 [New: 38]

Meanwhile for the parasite isolate bank, RM40, 000.00 is needed for the purchase of
Liquid Nitrogen storage and accessories. Distribution of items (i) to (iii) is in Appendix 4.

2.4 Strategy 2: Control of malaria vectors using the concept of IVM (Integrated
Vector Management)

Vector control activities will be continued in the elimination program as in the control
program but differ in term of coverage target to be achieved. In the control program,
coverage of 85% and 80% for bed-nets and spraying activities respectively are
sufficient but for elimination program, 100% coverage needs to be achieved. In addition,
the program will also introduce the concept of Intergrated Vector Management (IVM), a
rational decision-making process for the use of resources to improve the effectiveness
of vector-borne disease control.

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2.4.1 Insecticide residual spraying activity

Regular residual spray coverage is still unsatisfactory. Problems identified include lack
of human resource that effects the district’s control activities plan, lack of activity
monitoring and inaccurate dosage of insecticide sprays which not follow the guidelines.
There is also the some districts that does not identify high-risk areas, particularly in the
presence of foreign workers who require special residual spraying activities.
In Elimination Programme, residual spraying activities is based on the locality
stratification as in Table 8 with TOCOSURE coverage which is total, complete, sufficient
and regular.
For the receptive and vulnerable localities, a special spray will be implemented with
100% coverage and is performed every six (6) months for a residential building with
complete wall, while for the residential building without complete wall will be sprayed
every three (3) months. Special sprays should be continued until the localities is no
longer at risk of malaria.

Table 8: Spraying activities criteria by localities

LOCALITY SPRAYING ACTIVITIES
 Regular residual spray coverage : 100%
 Every Six (6) months
RED  Eight (8) cycles
 Insecticide dosage ≥ 0.02g/m2 for deltamethrin and 0.03g/m2 for lambda
cyhalothrin
YELLOW  Focal residual spray coverage : 100%
 Every six (6) months
GREEN  Minimum of two (2) cycles until no more malaria cases reported for 1 year period
(receptive from the last reported cases
and vulnerable)  Insecticide dosage ≥ 0.02g/m2 for deltamethrin and 0.03g/m2 for lambda
cyhalothrin.

Monitoring of residual spray coverage will also be conducted regularly include the
insecticide susceptibility testing and bioassay testing.

2.4.2 Insecticide impregnated bed net

In year 2008, the coverage for second round of bed-nets impregnation was 89% with
the average of one net covers for two (2) people. Issues related to the impregnated

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bednets includes no efficacy studies, low quality of non-durable nets, poor compliance
issue among Penan tribe in Sarawak and ineffective practice issue as the impregnated
bed nets are not used during peak hours Anopheles mosquito bites.

Table 9: Bed net impregnation activities by localities

LOCALITY BED NET IMPREGNATION ACTIVITIES
 Impregnated bed net coverage : 100%
 Bed net impregnation every six (6) months
RED
 Eight (8) cycles
 Bed net and population ratio : not less than 1 for every 2 people
YELLOW  Impregnated bed net coverage : 100% for locality with malaria case
 Every six (6) months
GREEN  Minimum two (2) cycles until no more malaria case reported for 1 year period from
(receptive and the last case reported
vulnerable)  Bed net and population ratio : less than 1 for every 2 people

Use of pesticides for bed net impregnation will be diversified to reduce the risk of vector
resistance. Bioassay tests will be conducted to assess the effectiveness of the
insectiside used. Ethnic of Penan in Sarawak will be provided with special nets to
increase their compliant and the use of Long Lasting Insecticidal Net (LLIN) will be
considered for the community in rural area with poor accessibility.

2.4.3 Other control activities

Anti-larval activities includes drain control maintenance and larvasid spraying activity
are only practiced in several towns in Perak, Pahang and Penang. Besides, these anti-
larval activities are only performed during the outbreak.
In elimination programs, maintenance of existing manipulation projects such as the
automatic manipulation siphon, subsoil drainage and drainage control will continue.
State should identify new area for the environmental manipulation and modification
projects, particularly in receptive urban area, the vulnerable settlements on the outskirts
of the forest and hillside and the areas with frequent outbreaks. Other activities include
larvaciding using chemical control, biological control and use of repellent.

2.4.4 Malaria vector surveillance

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Malaria vector surveillance is not carried out routinely and entomological studies is
conducted only in epidemic areas due to lack of equipment and trained staffs. Malaria
vector surveillance will be enhanced through the establishment of three (3) of the
sentinel stations in Peninsular Malaysia, Sabah and Sarawak. Activities to be
undertaken include the bioassay test. Malaria vector surveillance in residential areas of
high risk groups such as migrant workers and indigenous peoples will also be carried
out periodically.

2.4.5 Inter-sector and international collaboration

Vector control with the concept of IVM approach requires cooperation from various
sectors, especially in border areas, plantations and logging camps. Cooperation with
other agencies involved in farming and logging sector will be developed and nurtured.
Information about the mass opening of new land will be obtained from the State Action
Committee in order to plan surveillance activity and control activities can be initiated.

Collaboration with neighboring countries such as Thailand, Indonesia and the

Philippines will also be enhanced to discuss the issue of malaria control in the border
areas. Existing meetings such as Goodwill Meeting of the Malaysia-Thailand-MALINDO
and BIMPS SOSEK-EAGA will be optimized for discussions on the formation of the
Joint Action Plan, information sharing and coordination of border control activities.

2.4.6 Activity monitoring

District Health Office and the State Department of Health shall hold meetings at district
and state level every three (3) months to review and discuss the performance of control
activities and monitor all outbreak locality and high risk locality.

2.4.7 Financial implication

To achieve coverage of bed-nets to all people at risk and residual spray coverage in the
red area, the estimated requirements are shown in Table 10. In addition, there is also a
need for the replacement and purchase of new equipment related to vector control
activities as listed:
i. Spray cans : 406 units ~ RM609, 000.00 [Replacement: 192, New: 214]
ii. Mist blower : 82 units ~ RM656, 000.00 [Replacement: 31, New: 51]
iii. Stereo Microscope : 20 units ~ RM140, 000.00 [Replacement: 20]

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Table 10: Insecticide and nets estimation to achieve 100% coverage of the
population at risk (red localities)
For insecticide treated net coverage
Population at risk (red locality): 1,266,729 people
Population covered with ITN: 528,837 people
Population not covered with ITN: 737,892 people

Number of ITN needed (one net is estimated for two people) 368,946 units
for population at risk that not covered with ITN:
Estimated costs for net: RM9.00 X 368,946 units RM3,320,514.00
Insecticide requirement: 30 ml X 2 cycles X 368,946 22,137 L

Estimated costs for insecticide: RM 140.00/liter X 22,137 L RM3,099,180

For indoor residual spraying (IRS)
Number of house in red area: 180,599 houses
Number of house covered with IRS: 81,029 houses
Number of house not covered with IRS: 99,570 houses
Insecticide requirement: 75 g X 2 cycles X 99,570 14,936 kg
Estimated costs for insecticide: RM 260.00 /kg X 14,936 kg RM3,883,600.00

2.5 Strategy 3: Early detection and treatment for malaria case

One of the strength of Malaria Contorl Programme is the easy availability of diagnostic
tools and treatment for the public via the health services provided in all government
health centers.

2.5.1 Passive case detection (PCD)

Currently, case detection for malaria is conducted through PCD, ACD, MBS, contact
tracing and special screening. In control programme, not all outpatient fever cases will
have BFMP done. For malarious and malaria prone area, at least 10% of all outpatient
fever cases are required for screening whereas for malaria free area, only 5% are
required. In view of the main objective of elimination programme is to eliminate the

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source of infection, BFMP is required for all suspected outpatient cases. In order to
achieve this objective, criterion for outpatient screening in all health clinics has been
modified as below. (Table 11)

Table 11: Target group for slide sampling as PCD based on locality

Clinic Target group

 outpatient fever case, including foreigner
RED  foreigner from malaria endemic countries#
- All illegal immigrants
 all pregnant mother during first visit (100%), and if fever develops
during follow-up or during home visit
YELLOW
 outpatient fever case with signs and symptoms of malaria (including
GREEN foreigner and all illegal immigrant from malaria endemic countries)
 outpatient fever case with high risk*
 pregnant mother with signs and symptoms of malaria and high risk*
# foreigners from malaria endemic countries such as Thailand, Phillipines, Cambodia, Vietnam,
Myanmar, Pakistan dan Bangladesh.
* high risk group refer to people with recent travel to malaria endemic area, loggers, natives and
people that carry out activity in the forrest for 1 month duration such as rangers and hunters

In order to identify the target group for BFMP screening, each government health facility
nationwide has been given color coding based on the locality color code in the
operating area. The clinic staff needs to ensure that BFMP is taken for all outpatient
cases that fulfill the criterion

2.5.2 Active Case Detection

In malaria control programme, ACD is routinely carried out in malaria prone dan
malarious areas such as malaria foci, logging camps, plantation establishment schemes
and villages with high malaria incidents. The frequency of visit depends on the
epidemiological situation of each locality whereby the visit can be done 2-weekly in the
active locality. ACD canvasser should inspect more that 90% of the houses and
interviews more than 60% of the residents in the locality during each visit.

In malaria elimination programme, as the malaria cases continouosly decline in few

states in Peninsular Malaysia, ACD will become very important especially in
problematic areas such as land development area and construction sites where the

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workers mainly are foreigner from malaria endemic countries. In view of the high
operational cost, criterion for ACD exercise is stipulated as below. (Table 12)

Table 12: ACD types and process

ACD types When to initiate Process

Weekly ACD • one malaria case is reported in one • to be conducted twice, and if there is any new
locality AND case detected afterwards, second MBS needs
• at least one case is detected after to be conducted
contact tracing AND • if no new case detected during ACD, activitiy
• at least once case is detected after will be conducted weekly for one month
first MBS done duration, and discontinue if still no case
• positive case with slide • If no new case detected during second MBS,
confirming the presence of activity will be discontinued
gametocyte
Monthly ACD • imported case among the mobile • monthly ACD will be initiated and continued
foreigners or placements with for 12 months, and will be discontinued after no
frequent shifting of high risk group new case detected for 12 months
Note: ACD coverage must be more than 90% of the houses and more than 60% of the
residents

2.5.3 Mass Blood Survey (MBS)

MBS is carried out during outbreak before the activity to dye the mosquito nets with
insecticides in red locality dan if investigation for suspected local transmission case has
been done. MBS also will be conducted for students during the first week after the
semester break in all boarding schools located in both red and yellow localities. In order
to ascertain the effectiveness of MBS activity, at least 80% of residents will be
examined and slide sample reading must be done within 24 hours.

2.5.4 Screening for high risk group

High risk group includes foreigners from malaria endemic countries, Malaysian who
visits or works in malaria endemic countries and those involved in forestry and
plantation activities including rangers. Screening examination (100%) towards all
foreign workers from malaria endemic country can either be done at entry point or at
workplace. Surveillance activity will also be scheduled every three (3) months among
the high risk group such as foreign workers and natives. Health volunteers from rural
areas, native settlements, among the plantation workers and foreign workers will be

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trained in taking BFMP slides. The district office needs to establish smart partnership
with the employers of plantation union, construction company dan logging camp to
facilitate the screening activity.

2.5.5 Laboratory service

Diagnostic service will be available in all health facility and also in subsector office
(Sabah) dan PCD post (Sarawak) to ensure treatment will be given promptly once
malaria case is detected. BFMP slides examination in hospital and health clinic will
follow the time as stipulated in table below. (Table 13)

Table 13: Turnaround time for slide examination

Detection method Turnaround time

PCD (hospital and health clinic) 8 hours
ACD 24 hours
MBS 24 hours
**Target: MLT (Vector laboratory): 50-60 slides/day. MLT (hospital/ health clinic): 10-20 slides/day

Quality checking of BFMP slides will also be reinforced to minimize examination error. 3
Rejection rate for BFMP slides must be less than 0.5% for sample taken by health
personnel, and less than 5% for sample taken by volunteers. All positive slides and
10% of negative slides need to be sent to the state vector laboratory / National Public
Health Laboratory for re-examination. Slide examination error by medical laboratory
technician (MLT) should be less than 1%. National Public Health Laboratory will also
conduct External Quality Assurance (EQA) for all state vector laboratories.

Besides, slides for all mortality cases or slides reported as P.malariae need to be sent
to National Public Health Laboratory for PCR test confirmation. Use of Rapid Diagnostic
Tests (RDTs) is only restricted to its usage during outbreak in remote area and still
needs to be confirmed with BFMP slide examination.

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3
False positive : slide reported as positive but confirmed as negative after re-examination.
False negative : slide reported as negative but confirmed as positive after re-examination.
Missed species : slides reported as positive for one species but confirmed as mixed species
(mixed infection) after re-examination
Wrong species : slide reported as positive but with incorrect species indetified

2.5.6 Case investigation and follow-up

Case investigation will be conducted for all malaria cases and all contacts will be
examined. Besides, all case follow-up will be done at regular basis, which is weekly visit
for one month for all parasite types, followed by monthly visit for six months for
P.knowlesi and P.malariae, or monthly visit for one year for P.vivax. Nevertheless,
cases with suspected drug resistance will have follow up for longer period of time.

2.5.7 Treatment
Service offered in government health facility for malaria diagnosis and treatment is free
of charge. Generally, achievement for malaria treatment is satisfactory whereby more
than 90% of the cases are given complete treatment except for the group of illegal
immigrants.

2.5.8 Financial implication

Currently, there are only 589 (73%) health clinics and 41 (40%) mother & children
health clinics (KKIA) are equipped with laboratory service. In order to ensure all health
facility to be able to provide BFMP examination, the fund required to acquire a total of
292 units of microscopes for all health clinics and district health office laboratories is
approximately RM 2.044 million. [121 units will be used as replacements and 171 new
units]

Besides, a total of 32 subsector offices (PSS) or PCD posts, consisting of 23 in

Sarawak, 7 in Sabah and 2 in Kelantan will be constructed. All PSS in Sabah and 6
PCD posts in Sarawak have been built under the Economy Stimulation Project in year
2010. Estimated costs for construction of the 19 units are RM 5.7 million.

Badget is required for purchase and replacement of vehicles for Vector Control Unit to
ensure activities for case detection, investigation, follow-up and vector control are
conducted smoothly. The financial requirements are as below:

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i. Vehicles : 150 units ~ RM 14.25 million [new- 126 units,

replacements – 24 units, 75% for Sabah & Sarawak]
ii. Motorcycles : 131 units ~ RM 917,000.00 [new – 129 units,
52% for Sabah and Sarawak]
iii. Fiberglass boats with engine : 7 units ~ RM 210,000.00 [new – 4 units,
replacements – 3 units, 58% for Sabah and Sarawak)
iv. Wooden boats with engine : 39 units ~ RM 390,000.00 [new – 30 units,
replacements – 9 units, 93% for Sabah and Sarawak]

The adoption of ACT therapy requires additional costs for purcharse as the ACT
therapy is more expensive that existing treatment regime. The estimated cost for
chloroquine+primaquine is RM 8 per patient whereas for ACT is RM 80 per patient. 4
Thus, the annual increment in budget after taking into consideration of the price
difference for 3,000 patients would be RM 216,000.
4
Artemether–lumefantrine (Riamet): RM60/patient, ASMQ: RM77.60/patient. Source: Hospital Sg. Buloh]

2.6 Strategy 4: Preparedness and response to malaria outbreak

Management of outbreak needs to be strengthened in terms of immediate execution of

investigation and control activity to minimize the impact as well as to control the
outbreak within 6 weeks from the declaration date, and also prompt reporting to the
state office and ministry within 24 hours. There is no direct financial implication on the
fulfillment of vacant posts and asset for activities for surveillance, investigation and
control as it is included in strategy one to three.

2.7 Strategy 5: Communication and social mobilization for malaria control

Health education activity regarding the importance of using insectice treated nets (ITN)
and other vector control activities will be enhanced for the high risk groups, employers
and employees of plantations, logging camps and construction sites. The contents for
health promotion material will be suited to different risk groups such as brochure in
various language (based on native language of the foreign workers) and prevention
methods for each high risk activity.

The community will also be actively involved in activity for malaria infection prevention
via COMBI activity. Research on the usage of insectide treated nets among the children

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is an annual activity with the target of at least one red locality coverage in each state
every year.

2.8 Strategy 6: Capacity building

Capacity building is an agenda that will be given a continouos attention. The

emplacement of existing vacancy such as PPKP U29, PKA U17 and PRA needs to be
accelerated, especially for Sarawak where 74% (34/46) of PPKP and only 50%
(101/203) of PKA U17 are filled. Although the post for PRA is 100% filled up, there are
only 16 placements. Status for the posts emplacement for PPKP, PKA and PRA is
summarized as below. (Table 13)
In order to cater the needs for the posts especially in Sarawak, some of the job
vacancies for PPKP U29, PKA U17 and PRA R1 will be transferred accordingly as
below:
 PPKP U 29 : 10 posts [Kedah (4), WPKL (2), Terengganu (2), Johor (2)]
 PKA U17 : 50 posts [Kedah]
 PRA R1 : 35 posts [Kedah (15), Penang (10), Negeri Sembilan (10)]

While awating emplacement for PRA R1, job contracts for existing 203 temporary
workers from Sabah (110), Sarawak (70) and Kelantan (23) would need to be extended.

Table 14: Number of job vacancy and emplacement for the posts of PPKP U29,
PKA U17 and PRA R1 in all states
No. of PPKP U29 PKA U17 PRA R1
STATE district Posts Filled Vacant Posts Filled Vacant Posts Filled Vacant
Perlis 1 5 3 2 16 10 6 13 13 0
Kedah 11 24 20 4 155 74 81 100 72 28
P Pinang 5 12 11 1 86 48 38 139 126 13
Perak 9 28 17 11 163 117 46 169 166 3
Selangor 9 29 26 3 109 88 21 96 87 9
WPKL 1 11 7 4 5 3 2 2 0 2
N Sembilan 7 20 15 5 83 57 26 87 72 15
Melaka 3 8 8 0 32 21 11 23 22 1
Johor 8 26 17 9 94 75 19 91 91 0
Pahang 11 45 44 1 195 151 44 134 134 0
Terengganu 7 29 23 6 109 72 37 25 22 3
Kelantan 10 28 15 13 181 155 26 57 43 14
Sarawak 31 46 34 12 203 101 102 16 11 5
Sabah 23 50 38 12 202 155 47 146 131 15

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WP Labuan 1 2 0 2 5 4 1 5 5 0
M’SIA 137 363 278 85 1638 1131 507 1103 995 108

Requirements for vehicles, microscopes, spraycan and others will also be given
attention at the same time. Besides, training is an important component to enhace
knowledge, skill and competency among staff in malaria detection and treatment.
Training relavent to vector control activities such spraying, making insecticide
impregnated nets, and larvaciding will also be offered to volunteer and estate workers.

As mentioned earlier in issue 1.1, orientation programme is required to place more

focus on the new approach of malaria elimination programme, such as transition from
control programme to elimination. For the states without any local case, the focus will
be on the activity to prevent re-introduction.

Financial needs to conduct course periodically in Sabah and Sarawak are

approximately RM 376,000:
 Medical laboratory technician (MLT) intensive course: 3 weeks duration, 3
times/year, RM 65,000.00
 Revision course for MLT: 1 week duration, 2 times/year, RM 56,000.00
 Vector control course (spraying, insecticide impregnated nets): 1 week duration,
2 times/year, RM 67,000.00

2.9 Strategy 7: Malaria research

Operational research will be identified so that issues arise during implementation phase
can be sorted out.

3.0 Indicators and targets

A total of 47 indicators will be monitored (Annex 5) and out of which 10 indicators have
been chosen as the key performance indicators (KPI). (Table 15)

Table 15: Strategies and Indicators for Malaria Elimination Programme

No. Indicators Target
1 Reduction of local case each year 20%

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2 Case fatality rate 0

3 Coverage of insecticide treated nets (ITN) among residents in 100%
malarious area
4 Coverage of indoor residual spraying (IRS) in malarious area 100%
5 Percentage of malaria case investigation 100%
6 Percentage of case with radical treatment completed 100%
7 Error rate for slide examination < 1%
8 BFMP slide examination in health facility on the same day as >95%
sample collection
9 Control of malaria outbreak within 6 weeks from the 85%
declaration date
10 Increment of activities that involve local community in 10%
malarious area

4.0 Budget
A total of RM 46.73 million was spent in year 2009 for malaria control activity. The
budget requirements for elimination programme for the 10th Malaysia Plan are as below.
(Table 16)

Table 16: Budget for Malaria Elimination Programme in the 10th Malaysia plan

Budget requirement (RM)/ year

Budget (SUPPLEMENT ONLY)##
ACTIVITY
2009
1 2 3 4 5
1.Development (PSS) 2.7 3.0 - - -
million million
2.Training during 376,000 376,000 376,000 376,000 376,000
sevice

3.Asset (vehicles, 6.72 6.00 4.65 2.46 1.75

tools)* million million million million million

4.Allocation for
management of:
(a) insecticide treated 38.03 3.3 3.3 3.3 3.3 3.3
nets million** million million million million million
(b) insectides (for nets 3.5 million# 6.9 6.9 6.9 6.9 6.9
and spray) million million million million million
(c) fuel + maintenance 5.2 million# 1.02 1.91 2.59 3.02 3.05
million million million million million

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TOTAL 46.73 21.02 21.49 17.82 16.06 15.38

million million million million million million

* Refers to Annex 2, 3 and 4

** Budget for all states for malaria control activity only (OA 10000 & 20000)
#
Purchase by MOH (tender)
##
Refers to annual supplement sum compared to thr previous year

5.0 Conclusion

Malaria Elimination Programme will be the continuation of Malaria Control Programme

that has been implemented all this while. This programme requires all parties involved
to play their repective roles effectively to ensure the supervision of malaria elimination is
well-rounded and even better than the existing control programme. This document
contents will be modified accordingly base on the current development such as the
marketing of long lasting insectides for vector control and incidents of vector or parasite
resistance. Member of PSEMK 2011-2013 Technical Committee.

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References

1. A Global Advocacy Framework to Roll Back Malaria 2006-2015

2. Draf Garispanduan Malaria 2008 (unpublished).
3. World Malaria Report 2008
4. Informal consultation on malaria elimination: setting up the WHO agenda, WHO
2006.
5. Malaria Elimination – A field manual for low and moderate endemic countries,
WHO 2007.
6. Shrinking the Malaria Map. A Guide on Malaria Elimination for Policy Makers.
Richard G.A. Feachem and The Malaria Elimination Group. The Global Health
Group April 2009. UCSF Global Health Sciences San Francisco
7. Chapter 5: Elimination of malaria World Malaria Report 2009
8. Global malaria control and elimination. 17–18 January, 2008. Geneva,
Switzerland

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Annex 1
Monitoring framework for pre-elimination and elimination programmes

COMPONENT ACTIVITY INDICATOR COMMENTS (as of 2010)

Enabling Political commitment a. Official endorsement  PSEMK not endorsed yet.
environment b. Legal/regulatory network  Malaria is notifiable under the CDC Act 1988.
c. Specific domestic funding earmarked  Application for funds in RMK10 submitted.
Regional/subregional a. Regional/subregional elimination strategy in place  All states has prepared action plan based on PSEMK.
cooperation b. Cross-border agreement in place  Yes, Malaysia-Thai border meeting and SOSEK
MALINDO
c.Evidence of collaboration (cross-border/regional/subregional)  Regular meetings and exchange of information.
Adoption of enabling a. Updated treatment policies  Existing guideline due for review.
health policies b. Malaria diagnosis and treatment available at no charge to  Yes, at government facilities only.
patient
c. Regulation of anti-malaria medicines  Yes.
Epidemiology Stratification  Yes.
(geographical Foci investigation a. Number of active foci reported per year  Data available at district level.
information) b. Proportion of reported foci fully investigated
c. Proportion of reported foci correctly classified
d. Number of cases within focus
e. Total population at risk within focus
Surveillance National malaria a. Timeliness: time between diagnosis, reporting and  Data available. To be strengthen.
surveillance system investigation
b. Completeness: proportion of cases reported to surveillance
system
Inclusion of private a. Protocol for private clinics  Existing treatment guideline available to all
sector practitioners.
b. Proportion of private facilities reporting to surveillance  Malaria is a notifiable disease.
system

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COMPONENT ACTIVITY INDICATOR COMMENTS (as of 2010)

Tracking of malaria a. Total number of cases reported per year  Data available.
burden b. Proportion of reported cases that are fully investigated
c. Number of cases by classification
Evaluation of Total population at risk within country  Data available.
population at risk
Case management Diagnosis a. Proportion of cases confirmed by microscopy  All.
b. Microscopy QA/QC in place  Yes. Re-examination of slides; all positives and 10% of
negatives.
Treatment Proportion of cases treated according to guidelines  Data available.

Vector control IRS a. Number and proportion of at-risk households that have been  Data available.
sprayed
b. Number and proportion of reported active foci that were
sprayed
Larval control Proportion of known/potential breeding sites treated with  Data available.
chemicals/fish
Entomological Larvaciding Proportion of breeding sites positive for mosquito larvae Data available.
surveillance
Source: Malaria Elimination – A field manual for low and moderate endemic countries, WHO 2007.

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Annex 2
SENARAI KEPERLUAN MIKROSKOP, GENERATOR, SPRAY-CAN DAN PENYEMBUR WAP MENGIKUT NEGERI & TAHUN
Mikroskop Compound T1 T2 T3 T4 T5 T1 T1 T2 T3 T4 T5 T1 T2 T3 T4 T5 T1 T2 T3 T4 T5

Penyembur wap (mist

Generator Mudah alih
Bil Klinik Kesihatan

Mikroskop Stereo

Spray-can
Bil daerah

blower)
NEGERI

Perlis 1 9 4 2 2 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Kedah 11 53 15 5 5 5 0 0 2 2 1 1 0 0 0 0 2 2 0 0 0 0 1 1 0 0 0 0

P Pinang 5 26 10 3 3 2 2 0 0 0 1 1 0 0 0 0 2 2 0 0 0 0 1 1 0 0 0 0
13 5
Perak 9 72 6 3 3 0 0 0 0 0 4 4 5 0 0 45 10 10 10 15 0 2 3 0 0 0

Selangor 9 56 18 6 6 6 0 0 9 9 6 3 3 0 0 0 30 15 15 0 0 0 9 3 3 3 0 0

WPKL 1 14 10 3 3 2 2 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0 1 1 0 0 0 0

N Sembilan 7 38 15 4 4 4 3 0 1 1 5 2 3 0 0 0 5 5 0 0 0 0 7 3 2 2 0 0

Melaka 3 26 10 3 3 4 0 0 0 0 0 0 0 0 0 0 3 3 0 0 0 0 3 2 1 0 0 0

Johor 8 87 20 8 8 4 0 0 0 0 1 1 0 0 0 0 4 4 0 0 0 0 8 3 3 2 0 0

Pahang 11 61 20 6 6 6 2 0 0 0 6 3 3 0 0 0 40 10 10 10 10 0 11 3 3 3 2 0

Terengganu 7 39 8 4 4 0 0 0 0 0 0 0 0 0 0 0 10 10 0 0 0 0 0 0 0 0 0 0

Kelantan 10 53 20 6 6 6 2 0 1 1 0 0 0 0 0 0 11 11 0 0 0 0 6 3 3 0 0 0

Sarawak 31 194 - 30 30 30 0 0 2 2 31 6 6 8 8 3 150 30 30 30 30 30 20 5 5 5 5 0

Sabah 23 77 45 20 20 5 0 0 4 4 25 5 5 5 5 5 100 30 30 40 0 0 10 5 5 0 0 0

WP Labuan 1 1 1 0 1 0 0 0 1 1 0 0 0 0 0 0 2 2 0 0 0 0 0 0 0 0 0 0

MSIA 137 806 292 103 104 74 11 0 20 20 89 26 24 18 13 8 406 136 95 90 55 30 82 32 28 15 7 0

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Annex 3
SENARAI KEPERLUAN KENDERAAN DAN BOT MENGIKUT NEGERI DAN TAHUN
T1 T2 T3 T4 T5 T1 T2 T3 T4 T5 T1 T2 T3 T1 T2 T3

Bot Fiberglass

Bot Kayu* &

Kenderaan

Motorsikal

& Enjin
Bil

enjin
NEGERI daerah
Perlis 1 1 0 0 1 0 0 2 2 0 0 0 0 1 1 0 0 0 0 0 0
Kedah 11 3 0 1 1 1 0 2 2 0 0 0 0 0 0 0 0 0 0 0 0
P Pinang 5 2 0 1 1 0 0 5 2 3 0 0 0 0 0 0 0 0 0 0 0
Perak 9 5 2 2 1 0 0 10 3 3 2 2 0 1 1 0 0 0 0 0 0
Selangor 9 5 2 2 1 0 0 4 2 2 0 0 0 0 0 0 0 0 0 0 0
WPKL 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
N Sembilan 7 4 1 2 1 0 0 8 3 3 2 0 0 0 0 0 0 0 0 0 0
Melaka 3 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Johor 8 4 1 1 2 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0
Pahang 11 5 1 2 2 0 0 3 3 0 0 0 0 0 0 0 0 3 3 0 0
Terengganu 7 3 2 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Kelantan 10 5 2 2 1 0 0 30 8 8 8 6 0 0 0 0 0 0 0 0 0
Sarawak 31 62 15 15 12 10 10 18 4 4 5 5 0 1 1 0 0 28 10 10 8
Sabah 23 49 15 12 8 8 6 49 10 10 10 10 9 3 1 1 1 8 4 4 0
WP Labuan 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
MSIA 137 150 41 41 33 19 16 131 39 33 27 23 9 7 5 1 1 39 17 14 8

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Annex 4
SENARAI KEPERLUAN KOMPUTER, KAMERA DIGITAL, GPS DAN LCD PROJECTOR MENGIKUT NEGERI DAN TAHUN
Thn Thn Thn Thn Thn Thn Thn Thn Thn Thn Thn Thn Thn Thn Thn Thn Thn Thn Thn Thn

kamera digital

LCD Projector
1 2 3 4 5 1 2 3 4 5 1 2 3 4 5 1 2 3 4 5

Bil Komputer

GPS
NEGERI daerah
Perlis 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 1 1 0 0 0 0
Kedah 11 4 4 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0 0 0 0 0 0 0
P Pinang 5 5 5 0 0 0 0 0 0 0 0 0 0 10 6 4 0 0 0 5 2 2 1 0 0
9 18 9
Perak 9 4 5 0 0 0 0 0 0 0 0 0 6 6 6 0 0 3 3 3 0 0
Selangor 9 9 4 5 0 0 0 0 0 0 0 0 0 14 6 4 4 0 0 3 2 1 0 0 0
WPKL 1 1 1 0 0 0 0 0 0 0 0 0 0 2 2 0 0 0 0 0 0 0 0 0 0
N Sembilan 7 7 4 3 0 0 0 0 0 0 0 0 0 14 6 4 4 0 0 7 2 3 3 0 0
Melaka 3 3 3 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0 0 0 0 0 0 0
Johor 8 8 4 4 0 0 0 0 0 0 0 0 0 16 6 6 4 0 0 8 3 3 2 0 0
Pahang 11 11 5 6 0 0 0 0 0 0 0 0 0 22 6 6 6 4 0 6 3 3 0 0 0
Terengganu 7 4 4 0 0 0 0 0 0 0 0 0 0 4 4 0 0 0 0 0 0 0 0 0 0
Kelantan 10 5 5 0 0 0 0 4 4 0 0 0 0 0 0 0 0 0 0 5 3 2 0 0 0
Sarawak 31 10 10 0 0 0 0 10 5 5 0 0 0 60 16 16 16 12 0 10 3 3 2 2 0
Sabah 23 48 10 10 10 10 8 24 6 6 6 6 0 60 16 16 16 12 0 12 3 3 3 3 0
WP Labuan 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0
MSIA 137 124 63 33 10 10 8 38 15 11 6 6 0 230 84 62 56 28 0 66 25 23 14 5 0

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Annex 5
INDIKATOR BAGI PROGRAM ELIMINASI MALARIA

Strategi Indikator Target Tanggungjawab Sumber data Cara Pengiraan

Daerah Negeri KKM
Strategi 1: Sistem  Bilangan dan kadar kematian akibat √ √ √ e-Vekpro Kadar kematian akibat malaria:
Survelan Malaria malaria  Bilangan kematian X 100
Jumlah kes
 Bilangan dan insiden malaria  √ √ √ e-Vekpro Kadar kes malaria:
Bilangan kes X 1000 penduduk
Jumlah penduduk
 Bilangan dan peratus kes mengikut jenis √ √ √ e-Vekpro Peratus kes mengikut jenis jangkitan:
jangkitan Bil kes mengikut jenis jangkitan X 100
Jumlah kes
 Bilangan dan peratus kes mengikut √ √ √ e-Vekpro Peratus kes mengikut jenis spesis:
spesis parasit Bil kes mengikut jenis spesis X 100
Jumlah kes
 Bilangan dan kadar kes dimasukkan ke √ √ √ e-Vekpro Kadar kes dimasukkan ke hospital:
hospital Bilangan kes msk hosp X 100
Jumlah kes
 Slide positivity rate √ √ √ Laporan makmal / Slide positivity rate:
laporan bulanan Bilangan slaid positif X 100
Jumlah slaid diambil
 Peratus laporan bulanan lengkap √ √ Laporan bulanan Peratus laporan bulanan lengkap diterima
diterima Bilangan lap diterima X 100
Jum lap sepatutnya diterima
 Stratifikasi kawasan dilaksanakan dan √ 2006 – 2008, 2008 – 2010, 2011 – 2013, 2014 -
dikemaskini sekurang-kurangnya 3 tahun 2016
sekali berdasarkan data survelan
 Peratus lokaliti dengan API < 1 kes per √ √ √  laporan bulanan Annual Parasite Incidence (API)
1000 penduduk berisiko  e-Vekpro Bilangan slaid positif X 1000
 Foci Registry Jumlah penduduk

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Strategi Indikator Target Tanggungjawab Sumber data Cara Pengiraan

Daerah Negeri KKM
 Bilangan foci aktif dilaporkan setiap √ √ √  Foci Registry
tahun
 Annual Blood Examination Rate (ABER) √ √ √  laporan bulanan Annual Blood Examination Rate (ABER):
 Foci Registry Bil Slaid Darah Diambil X 100
Jumlah Penduduk
 Peratus fasiliti swasta yang membuat √ √ √  e-Vekpro Bilangan fasiliti swasta melaporkan kes X 100
notifikasi malaria kepada sistem survelans Jumlah fasiliti swasta
negara
Strategi 2:  Peratus liputan kelambu berubat di √ √ √  laporan bulanan Penduduk berisiko: penduduk di lokaliti merah,
Kawalan vektor kalangan penduduk yang berisiko. kuning dan RV (Receptive & vulnerable)
malaria  Bil pend dilindungi kelambu berubat X 100
menggunakan  Jumlah penduduk berisiko
konsep IVM  Peratus liputan kelambu berubat yang √ √ √  laporan bulanan Bil kelambu berubat dicelup semula X 100
(Integrated Vector dicelup semula (re-treated)  Jumlah kelambu diedar
Management)
 Liputan kelambu berubat di kalangan 100%  laporan bulanan Bil pend dilindungi kelambu berubat X 100
penduduk lokaliti merah Jum pend berisiko lokaliti merah
 Liputan kelambu berubat di lokaliti √ √ √  laporan bulanan Bil pend dilindungi kelambu berubat X 100
kuning, hijau dan RV (receptive and 100% Jum pend berisiko lokaliti kuning, hijau & RV
vulnerable)
 Nisbah kelambu dengan penduduk √ √ √  laporan bulanan Bilangan kelambu diedar:Bilangan penerima
adalah kurang daripada 1:2 1:2

 Survei / pemantauan penggunaan 90% √ √  Format khas Bil lokaliti merah dibuat survei X100
kelambu berubat – 1 lokaliti merah bagi Bil lokaliti merah dirancang utk buat survey merah
setiap daerah
 Peratus rumah berisiko malaria dengan √ √ √  laporan bulanan Bil rumah di kaw berisiko malaria dgn sekurang-
sekurang-kurangnya satu (1) kelambu kurangnya KB/disembur X 100
100%
berubat dan/atau disembur dalam tempoh Jum rumah dlm kaw berisiko
masa 12 bulan yang lalu.

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Strategi Indikator Target Tanggungjawab Sumber data Cara Pengiraan

Daerah Negeri KKM
 Peratus liputan semburan residu di √ √ √  laporan bulanan Bil rumah di kaw berisiko disembur X 100
kalangan penduduk berisiko. 100% Jum rumah dlm kaw berisiko
 Liputan semburan residu di lokaliti 100%  laporan bulanan Bil rumah di lokaliti merah disembur X 100
merah Jum rumah dlm lokaliti merah
 Liputan semburan residu di lokaliti √ √ √  laporan bulanan Bil rumah di lokaliti kuning, hijau
kuning, hijau dan RV 100% dan RV X 100
Jum rumah lokaliti kuning, hijau dan RV
 Pemantauan resistan vektor kepada √  laporan bulanan
racun serangga
Strategi 3:  Peratus kes malaria yang disiasat 100% √ √ √  e-Vekpro Peratus kes malaria yang disiasat:
Pengesanan awal  laporan bulanan Bilangan kes disiasat X 100
dan rawatan kes Jumlah kes
malaria  Peratus kes yang diberi rawatan radikal √ √ √  e-Vekpro Peratus kes diberi rawatan radikal &lengkap
dan lengkap 100%  laporan bulanan Bil kes diberi rwtn radikal & lengkap X 100
Jumlah kes
 Peratus fasiliti kesihatan yang ada stok √ √ √ Borang
untuk ubat anti-malarial dan keperluan maklumbalas 2X
100%
diagnostik dalam tempoh masa 12 bulan setahun
yang lalu.
 Pemantauan secara sistematik efikasi √ Format khas
ubat malaria sekurang-kurang sekali
dalam 2 – 3 tahun berdasarkan protocol
WHO
 Bilangan daerah/negeri yang 100% √ √ √ Sem. Malaysia: Daerah di negeri Perlis, Kedah,
mempunyai sempadan antarabangsa Perak dan Kelantan
yang telah mempunyai Pelan Tindakan Sabah dan Sarawak
Bersama Mengawal Malaria.
Peratus kes mula disiasat dalam tempoh 90% √ √ √  e-Vekpro Bil kes mula disiasat dalam
48 jam selepas notifikasi tempoh 48 jam selepas notifikasi X 100
Jumlah kes

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Strategi Indikator Target Tanggungjawab Sumber data Cara Pengiraan

Daerah Negeri KKM
Semua kes malaria perlu dirawat dalam 100%
tempoh:-
 pesakit dalam - 1 jam √ √ √  Audit
 di lapangan - 24 jam √ √ √  Audit
 Klinik Kesihatan – hari yang sama √ √ √  Audit
Semua kes malaria perlu dilakukan tindak  e-Vekpro Bil kes dibuat tindak susul (ikut spesis & ikut
susul yang lengkap mengikut jenis parasit. tempoh) X 100
- Warganegara 100% Jumlah kes (mengikut spesis)
- Bukan Warganegara 70%
 Semua plasmodium setiap minggu √ √
selama 1 bulan
 P. malariae sebulan sekali selama 6 √ √
bulan
 P. vivax sebulan sekali selama 1 √ √
tahun
Pemeriksaan slaid di kemudahan 100% √ √ √  Audit Makmal Bil pesakit dengan BFMP dibaca
kesihatan pada hari yang sama (untuk kes: e- pada hari yang sama X 100
Vekpro) Jumlah kes
Kadar kesilapan (slaid positif dan slaid < 1% √ √ √  MKAK Bilangan slaid positif salah baca
negatif) Bilangan slaid positif diterima utk baca semula
Notifikasi kes malaria ke Pejabat 100% √ √  e-Vekpro
Kesihatan Daerah yang berdekatan [Sem
M’sia: 24 jam, Sabah dan Sarawak: 3
hari].
Strategi 4: Wabak malaria perlu dikawal dalam masa 85% √ √ √  Laporan wabak Bil lokaliti dapat kawal wabak
Kesiapsiagaan 6 minggu dlm masa 6 minggu X 100
dan respon Bil lokaliti wabak
kepada wabak
malaria

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Strategi Indikator Target Tanggungjawab Sumber data Cara Pengiraan

Daerah Negeri KKM
Strategi 5:  Peratus penduduk berisiko yang √ √  Kajian
Komunikasi dan mengetahui sebab, simptom, rawatan dan
mobilisasi sosial kawalan malaria. (Kajian isi rumah)
untuk kawalan  Peratus penduduk atau kanak-kanak di √ √  Kajian – ada
malaria bawah 5 tahun atau ibu mengandung format khas
yang tidur di dalam kelambu. (Kajian isi
rumah)
 Peratus penduduk di kawasan berisiko √ √  Kajian
yang mengalami demam dalam tempoh
masa 2 minggu sebelum kajian yang
mendapatkan rawatan di kemudahan
kesihatan dalam tempoh 48 jam selepas
onset demam. ((Kajian isi rumah)
Strategi 6: Bilangan latihan dijalankan √ √ √  Laporan berkala
Pembangunan setiap 6 bulan
Modal Insan dan
sumber
Strategi 7:  Bilangan kajian dijalankan √  Laporan berkala
Penyelidikan setiap 6 bulan
malaria

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