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Beskrivelse
The President's Malaria Initiative (PMI) is a core component of the USG Foreign Assistance Strategy. PMI was launched in June 2005 as a five-year, $1.2 billion initiative to rapidly scale up malaria prevention and treatment interventions and reduce malaria-related mortality by 50% in 15 high-burden countries in sub-Saharan Africa. With passage of the 2008 Lantos-Hyde Act, PMI was extended and a US Global Malaria Strategy was developed covering 2009-2014. The goal is now to reduce malaria-related mortality by 70% in the original 15 countries by the end of 2015. This will be achieved by reaching 85% coverage of the most vulnerable groups - children under five years of age and pregnant women - with proven preventive and therapeutic interventions, including artemisinin-based combination therapies (ACTs), insecticide-treated nets (ITNs), intermittent preventive treatment of pregnant women (IPTp), and indoor residual spraying (IRS). Development of a new six-year US Global Malaria Strategy 2015 - 2020 is underway. Senegal was selected as a PMI country in 2006. Large-scale implementation of ACTs and rapid diagnostic tests (RDTs) began in 2007 and progressed rapidly with support from PMI and other partners. ACTs and IPTp are now being used in all public health facilities nationwide, RDTs are used to confirm malaria cases at all levels of the health system (including the community level) and more than 7.3 million long-lasting insecticide-treated bed nets (LLINs) have been distributed using a universal coverage (UC) approach since 2010. Senegal's estimated population in 2016 will be approximately 14 million, with approximately 2.7 million children less than five years of age and 561,000 pregnant women. Malaria is still a major cause of morbidity and mortality and a high priority for the government, even though the number of reported cases of malaria has dropped significantly since 2007-2008. While the decline in the first year can be partially ascribed to a change in the malaria case definition that now requires parasitological confirmation of all cases, the proportion of all outpatient visits due to confirmed malaria continued to fall, from 6% in 2008 to 3% in 2009. However, there has been an uptick of cases in recent years with malaria representing 5.4% of all consultations and 7.5% of all deaths in 2013. Forty-three of 76 health districts saw their incidence decrease or remain stable from 2010-2013, while 30 districts had increases (no data available for three districts). Eight districts in the southeastern part of the country carry the highest disease burden (more than 100 cases per 1,000 population). The 2012 continuous Demographic and Health Survey (cDHS) showed that under-five mortality continued to fall, from 121 per 1,000 live births in 2005 to 65 in 2012, a 46% drop in seven years. The proportion of households owning at least one insecticide-treated net (ITN) increased from 20% in 2005 to 73% in 2012, and the proportion of children under five sleeping under an ITN the previous night increased from 7% to 46%, with similar trends for pregnant women. The proportion of pregnant women receiving two doses of intermittent preventive treatment with sulfadoxine-pyrimethamine (SP) fell from 52% in 2008 to 39% in 2010, a decline due to many factors including problems in maintaining supplies of the drug. A slight increase was noted in 2012, to 41%.
