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de Cola MA, Chestnutt EG, Richardson S, Baudry M, Nnaji C, Ibinaiye T, Moukénet A, Rotimi K, Sawadogo B, Okafor J, Compaoré CS, Oguoma C, Rassi C, Roca-Feltrer A. From efficacy to effectiveness: a comprehensive framework for monitoring, evaluating and optimizing seasonal malaria chemoprevention programmes. Malar J 2024; 23:39. [PMID: 38308288 PMCID: PMC10837904 DOI: 10.1186/s12936-024-04860-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/23/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Seasonal Malaria Chemoprevention (SMC) is a highly effective intervention for preventing malaria, particularly in areas with highly seasonal transmission. Monitoring and evaluating (M&E) SMC programmes are complex due to the scale, time-sensitive delivery of the programme, and influence of external factors. This paper describes the process followed to develop a comprehensive M&E framework tailored specifically for the SMC context. METHODS The Framework was developed through a literature and programme review, and stakeholder dialogues across three implementing countries-Burkina Faso, Chad, and Nigeria. Expert consultation further refined the Framework through an iterative approach drawing upon data collected through the three sources. The Framework was designed using the Logical Framework Approach incorporating external factors and intentionally aligned with global malaria M&E standards. RESULTS An overall aim and seven programme objectives were developed measured by 70 indicators. The indicators also capture the causal links between the implementation and results of the programme. The Framework leverages the use of current data sources and existing mechanisms, ensuring efficient data use without requiring a significant increase in resources for overall programme optimization. It also promotes the use of data triangulation, and stratification for a more nuanced understanding of factors affecting programme performance and timely data informed decision-making. CONCLUSIONS The SMC M&E Framework presented here provides a standardized approach for programme implementers to enhance decision-making for optimal programme performance. This is an essential tool as the scope of SMC programmes expands to new geographies and target age groups.
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Affiliation(s)
- Monica Anna de Cola
- Malaria Consortium, 244-254 Cambridge Heath Rd, Cambridge Heath, London, E2 9DA, UK.
| | | | - Sol Richardson
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | | | - Chuks Nnaji
- Malaria Consortium, 244-254 Cambridge Heath Rd, Cambridge Heath, London, E2 9DA, UK
| | | | | | | | | | | | | | | | - Christian Rassi
- Malaria Consortium, 244-254 Cambridge Heath Rd, Cambridge Heath, London, E2 9DA, UK
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Kabeya TK, Kasongo JCM, Matumba NB, Tshibangu DI, Garcia-Morzon LA, Burgueño E. Impact of mass distribution of long-lasting insecticide nets on the incidence of malaria in Lomami, Democratic Republic of Congo: a study based on electronic health record data (2018 - 2019). Pan Afr Med J 2023; 45:89. [PMID: 37663637 PMCID: PMC10474805 DOI: 10.11604/pamj.2023.45.89.33099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/16/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction holoendemic, malaria remains one of the major public health problems in Lomami Province in the Democratic Republic of Congo (DRC). To fight against it, a free mass distribution of long-lasting insecticide nets (LLINs) was organized in July 2019 throughout the province. The present study aimed to assess the incidence of malaria and its impact on anaemia of children from 0 to 59 months in this region before and after this intervention. Methods we had conducted a retrospective observational study from June to December 2018 and June to December 2019. The data were collected on District Health Information System version two (DHIS2) and analyzed with T-tests to compare the incidence rates before (second semester 2018) and after the distribution of LLINs (second semester 2019). Results the evolution of malaria cases immediately dropped after the distribution campaign. The incidence rates per 1,000 inhabitants in 2018 and 2019 were 106 and 107 respectively in the general population; 302 versus 305 in children aged 0 to 59 months and 219 versus 209 in pregnant women. The differences in incidence were not statistically significant with p values 0.497, 0.4602, and 0.3097 respectively. However, it was observed that the decrease in malaria cases led to a decrease in anaemia cases in general. Conclusion the LLIN distribution campaign did not decrease the incidence of malaria. The synergy of preventive interventions to reduce the incidence of malaria remains key.
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Affiliation(s)
- Theddy Kazadi Kabeya
- School of Public Health, University of Mwene Ditu, Lomami, Democratic Republic of Congo
- Health Regional Division, Kabinda, Lomami, Democratic Republic of Congo
| | - Jean Claude Musasa Kasongo
- School of Public Health, University of Mwene Ditu, Lomami, Democratic Republic of Congo
- Mwene-Ditu Health Zone, Lomami, Democratic Republic of Congo
| | | | | | | | - Eduardo Burgueño
- Centre Médical Vésale, Ngaliema, Kinshasa, Democratic Republic of Congo
- School of Medicine, Official University of Mbujimayi, Kasai-Oriental, Democratic Republic of Congo
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3
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Nice J, Nahusenay H, Eckert E, Eisele TP, Ashton RA. Estimating malaria chemoprevention and vector control coverage using program and campaign data: A scoping review of current practices and opportunities. J Glob Health 2021; 10:020413. [PMID: 33110575 PMCID: PMC7568932 DOI: 10.7189/jogh.10.020413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Accurate estimation of intervention coverage is a vital component of malaria program monitoring and evaluation, both for process evaluation (how well program targets are achieved), and impact evaluation (whether intervention coverage had an impact on malaria burden). There is growing interest in maximizing the utility of program data to generate interim estimates of intervention coverage in the periods between large-scale cross-sectional surveys (the gold standard). As such, this study aimed to identify relevant concepts and themes that may guide future optimization of intervention coverage estimation using routinely collected data, or data collected during and following intervention campaigns, with a particular focus on strategies to define the denominator. Methods We conducted a scoping review of current practices to estimate malaria intervention coverage for insecticide-treated nets (ITNs); indoor residual spray (IRS); intermittent preventive treatment in pregnancy (IPTp); mass drug administration (MDA); and seasonal malaria chemoprevention (SMC) interventions; case management was excluded. Multiple databases were searched for relevant articles published from January 1, 2015 to June 1, 2018. Additionally, we identified and included other guidance relevant to estimating population denominators, with a focus on innovative techniques. Results While program data have the potential to provide intervention coverage data, there are still substantial challenges in selecting appropriate denominators. The review identified a lack of consistency in how coverage was defined and reported for each intervention type, with denominator estimation methods not clearly or consistently reported, and denominator estimates rarely triangulated with other data sources to present the feasible range of denominator values and consequently the range of likely coverage estimates. Conclusions Though household survey-based estimates of intervention coverage remain the gold standard, efforts should be made to further standardize practices for generating interim measurements of intervention coverage from program data, and for estimating and reporting population denominators. This includes fully describing any projections or adjustments made to existing census or population data, exploring opportunities to validate available data by comparing with other sources, and explaining how the denominator has been restricted (or not) to reflect exclusion criteria.
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Affiliation(s)
- Johanna Nice
- MEASURE Evaluation, Centre for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Honelgn Nahusenay
- MEASURE Evaluation, Centre for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Erin Eckert
- U.S. President's Malaria Initiative, United States Agency for International Development, Washington, D.C., USA.,RTI International, Washington, D.C., USA
| | - Thomas P Eisele
- Centre for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Ruth A Ashton
- MEASURE Evaluation, Centre for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Karemere J, Nana IG, Andrada A, Kakesa O, Mukomena Sompwe E, Likwela Losimba J, Emina J, Sadou A, Humes M, Yé Y. Associating the scale-up of insecticide-treated nets and use with the decline in all-cause child mortality in the Democratic Republic of Congo from 2005 to 2014. Malar J 2021; 20:241. [PMID: 34051817 PMCID: PMC8164747 DOI: 10.1186/s12936-021-03771-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To reduce the malaria burden and improve the socioeconomic status of its citizens, the Democratic Republic of Congo scaled up key malaria control interventions, especially insecticide-treated nets (ITNs), between 2005 and 2014. Since then, the effects of these interventions on malaria mortality and morbidity have not been assessed. This study aimed to measure the impact of the National Malaria Control Programme's efforts and to inform future control strategies. METHODS The authors used data from the Demographic and Health Surveys 2007 and 2013-2014 to assess trends in all-cause childhood mortality (ACCM) against trends in coverage of malaria interventions at national and subnational levels. The authors used the plausibility argument to assess the impact of the malaria control interventions and used Kaplan-Meier survival probability and Cox proportional hazard models to examine the effect of ITN ownership on child survival. Contextual factor trends affecting child survival were also considered. RESULTS Countrywide, household ownership of at least one ITN increased, from 9% in 2007 to 70% in 2013-2014. All provinces experienced similar increases, with some greater than the national level. ITN use increased between 2007 and 2013-2014 among children under five (6% to 55%). Severe anaemia (haemoglobin concentration < 8 g/dl) prevalence among children aged 6-59 months significantly decreased, from 11% (95% confidence interval [CI] 9-13%) in 2007 to 6% (95% CI 5-7%) in 2013-2014. During the same period, ACCM declined, from 148 (95% CI 132-163) to 104 (95% CI 97-112) deaths per 1000 live births. The decline in ACCM was greater among children aged 6-23 months (relative reduction of 36%), compared to children aged 24-59 months (relative reduction of 12%). Cox regression indicated that household ownership of at least one ITN reduced the risk of mortality by 24% among children under five (risk ratio = 0.76, 95% CI 0.64-0.90). Contextual factor analysis revealed marginal improvements in socioeconomic indicators and other health interventions. CONCLUSIONS Given the patterns of the coverage of malaria control interventions, patterns in ACCM by province, and marginal improvements in contextual factors, the authors conclude that the malaria control interventions have plausibly contributed to the decrease in ACCM in the Democratic Republic of Congo from 2005 to 2014.
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Affiliation(s)
- Johanna Karemere
- PMI Measure Malaria, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
- ICF, Rockville, MD, USA.
| | - Ismael G Nana
- PMI Measure Malaria, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- ICF, Rockville, MD, USA
| | - Andrew Andrada
- PMI Measure Malaria, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- ICF, Rockville, MD, USA
| | - Olivier Kakesa
- PMI Measure Malaria, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- ICF, Rockville, MD, USA
| | - Eric Mukomena Sompwe
- National Malaria Control Programme, Ministry of Health, Kinshasa, Democratic Republic of Congo
- University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Joris Likwela Losimba
- National Malaria Control Programme, Ministry of Health, Kinshasa, Democratic Republic of Congo
- University of Kisangani, Kisangani, Democratic Republic of Congo
| | - Jacques Emina
- University of Kinshasa, Kinshasa, Democratic Republic of Congo
- Population and Health Research Institute, Kinshasa, Democratic Republic of Congo
| | - Aboubacar Sadou
- President's Malaria Initiative/U.S. Agency for International Development, Washington, DC, USA
| | - Michael Humes
- President's Malaria Initiative/U.S. Agency for International Development, Washington, DC, USA
| | - Yazoumé Yé
- PMI Measure Malaria, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- ICF, Rockville, MD, USA
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Macharia PM, Joseph NK, Snow RW, Sartorius B, Okiro EA. The impact of child health interventions and risk factors on child survival in Kenya, 1993-2014: a Bayesian spatio-temporal analysis with counterfactual scenarios. BMC Med 2021; 19:102. [PMID: 33941185 PMCID: PMC8094495 DOI: 10.1186/s12916-021-01974-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND During the millennium development goals period, reduction in under-five mortality (U5M) and increases in child health intervention coverage were characterised by sub-national disparities and inequities across Kenya. The contribution of changing risk factors and intervention coverage on the sub-national changes in U5M remains poorly defined. METHODS Sub-national county-level data on U5M and 43 factors known to be associated with U5M spanning 1993 and 2014 were assembled. Using a Bayesian ecological mixed-effects regression model, the relationships between U5M and significant intervention and infection risk ecological factors were quantified across 47 sub-national counties. The coefficients generated were used within a counterfactual framework to estimate U5M and under-five deaths averted (U5-DA) for every county and year (1993-2014) associated with changes in the coverage of interventions and disease infection prevalence relative to 1993. RESULTS Nationally, the stagnation and increase in U5M in the 1990s were associated with rising human immunodeficiency virus (HIV) prevalence and reduced maternal autonomy while improvements after 2006 were associated with a decline in the prevalence of HIV and malaria, increase in access to better sanitation, fever treatment-seeking rates and maternal autonomy. Reduced stunting and increased coverage of early breastfeeding and institutional deliveries were associated with a smaller number of U5-DA compared to other factors while a reduction in high parity and fully immunised children were associated with under-five lives lost. Most of the U5-DA occurred after 2006 and varied spatially across counties. The highest number of U5-DA was recorded in western and coastal Kenya while northern Kenya recorded a lower number of U5-DA than western. Central Kenya had the lowest U5-DA. The deaths averted across the different regions were associated with a unique set of factors. CONCLUSION Contributions of interventions and risk factors to changing U5M vary sub-nationally. This has important implications for targeting future interventions within decentralised health systems such as those operated in Kenya. Targeting specific factors where U5M has been high and intervention coverage poor would lead to the highest likelihood of sub-national attainment of sustainable development goal (SDG) 3.2 on U5M in Kenya.
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Affiliation(s)
- Peter M. Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Noel K. Joseph
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Robert W. Snow
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Benn Sartorius
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA USA
| | - Emelda A. Okiro
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Scott J, Kanyangarara M, Nhama A, Macete E, Moss WJ, Saute F. Factors associated with use of insecticide-treated net for malaria prevention in Manica District, Mozambique: a community-based cross-sectional survey. Malar J 2021; 20:200. [PMID: 33906642 PMCID: PMC8077836 DOI: 10.1186/s12936-021-03738-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 04/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Insecticide-treated net (ITN) use is crucial for preventing malaria infection. Despite significant improvements in ITN access and use over the past two decades, many malaria-endemic countries in sub-Saharan Africa have not yet reached global targets for universal coverage of ITNs. To reduce the gaps in ITN use, it is important to understand the factors associated with ITN use. The goal of this analysis was to determine the factors associated with ITN use in Manica District, Mozambique. METHODS A cross-sectional community-based survey was conducted from October to November 2019. Households were randomly selected, and all members of selected households were eligible to participate. Data on socio-demographic characteristics, housing construction and the ownership, use and characteristics of ITNs were collected using structured questionnaires. Factors independently associated with ITN use were identified using generalized estimating equations multivariate logistic regression. RESULTS Of the 302 households surveyed, 209 (69.2%) owned at least one ITN and 176 (58.3%) had one ITN for every two household members. The multivariate analysis indicated that the odds of ITN use was significantly lower among individuals in households with 3 or more members. However, the odds of ITN use was significantly higher among older age groups, poorer households, and as the number of ITNs in a household increased. CONCLUSIONS The findings of this analysis highlight the need for behaviour change communication strategies targeting young people and ITN distribution campaigns targeting larger households to increase ITN ownership, thereby improving ITN use in Manica District.
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Affiliation(s)
- Julia Scott
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29201, USA
| | - Mufaro Kanyangarara
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29201, USA.
| | - Abel Nhama
- Centro de Investigação Em Saúde de Manhiça (CISM), Maputo, Mozambique.,Instituto Nacional de Saúde (INS), Maputo, Mozambique
| | - Eusebio Macete
- Centro de Investigação Em Saúde de Manhiça (CISM), Maputo, Mozambique
| | - William John Moss
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Francisco Saute
- Centro de Investigação Em Saúde de Manhiça (CISM), Maputo, Mozambique
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7
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Kassam NA, Kaaya RD, Damian DJ, Schmiegelow C, Kavishe RA, Alifrangis M, Wang CW. Ten years of monitoring malaria trend and factors associated with malaria test positivity rates in Lower Moshi. Malar J 2021; 20:193. [PMID: 33879164 PMCID: PMC8056660 DOI: 10.1186/s12936-021-03730-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background High altitude settings in Eastern Africa have been reported to experience increased malaria burden due to vector habitat expansion. This study explored possible associations between malaria test positivity rates and its predictors including malaria control measures and meteorological factors at a high-altitude, low malaria transmission setting, south of Mount Kilimanjaro. Methods Malaria cases reported at the Tanganyika Plantation Company (TPC) hospital’s malaria registers, meteorological data recorded at TPC sugar factory and data on bed nets distributed in Lower Moshi from 2009 to 2018 were studied. Correlation between bed nets distributed and malaria test positivity rates were explored by using Pearson correlation analysis and the associations between malaria test positivity rates and demographic and meteorological variables were determined by logistic regression and negative binomial regression analyses, respectively. Results Malaria cases reported at TPC hospital ranged between 0.48 and 2.26% per year and increased slightly at the introduction of malaria rapid diagnostic tests. The risk of testing positive for malaria were significantly highest among individuals aged between 6 and 15 years (OR = 1.65; 1.65 CI = 1.28–2.13; p = 0.001) and 16–30 years (OR = 1.49; CI = 1.17–1.89; p = 0.001) and when adjusted for age, the risk were significantly higher among male individuals when compared to female individuals (OR = 1.54; 1.00–1.31; p = 0.044). Malaria test positivity rates were positively associated with average monthly minimum temperatures and negatively associated with average monthly maximum temperatures (incidence rate ratio (IRR) = 1.37, 95% confidence interval (CI) = 1.05–1.78, p = 0.019 and IRR = 0.72, 95% CI = 0.58–0.91, p = 0.005, respectively). When analysed with one month lag for predictor variables, malaria test positivity rates were still significantly associated with average monthly minimum and maximum temperatures (IRR = 1.67, 95% CI = 1.28–2.19, p = 0.001 and IRR = 0.68, 95% CI = 0.54–0.85, p = 0.001, respectively). Average monthly rainfall and relative humidity with or without a one month lag was not associated with malaria test positivity rates in the adjusted models. Explopring possible associations between distribution of long-lasting insecticidal nets, (LLINs) and malaria test positivity rates showed no apparent correlation between numbers of LLINs distributed in a particular year and malaria test positivity rates. Conclusion In Lower Moshi, the risk of being tested positive for malaria was highest for older children and male individuals. Higher minimum and lower maximum temperatures were the strongest climatic predictors for malaria test positivity rates. In areas with extensive irrigation activity as in Lower Moshi, vector abundance and thus malaria transmission may be less dependent on rainfall patterns and humidity. Mass distribution of LLINs did not have an effect in this area with already very low malaria transmission. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03730-1.
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Affiliation(s)
- Nancy A Kassam
- Kilimanjaro Christian Medical University College (KCMUCo), P.O. Box 2240, Moshi, Tanzania.
| | - Robert D Kaaya
- Kilimanjaro Christian Medical University College (KCMUCo), P.O. Box 2240, Moshi, Tanzania
| | - Damian J Damian
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Christentze Schmiegelow
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Reginald A Kavishe
- Kilimanjaro Christian Medical University College (KCMUCo), P.O. Box 2240, Moshi, Tanzania
| | - Michael Alifrangis
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Christian W Wang
- Centre for Medical Parasitology, Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark.,Department of Infectious Diseases, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
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Ngatu NR, Muzembo BA, Choomplang N, Kanbara S, Wumba R, Ikeda M, Mbelambela EP, Muchanga SMJ, Suzuki T, Wada K, Al Mahfuz H, Sugishita T, Miyazaki H, Ikeda S, Hirao T. Malaria rapid diagnostic test (HRP2/pLDH) positivity, incidence, care accessibility and impact of community WASH Action programme in DR Congo: mixed method study involving 625 households. Malar J 2021; 20:117. [PMID: 33639932 PMCID: PMC7913406 DOI: 10.1186/s12936-021-03647-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background Malaria is one of the most prevalent and deadliest illnesses in sub-Saharan Africa. Despite recent gains made towards its control, many African countries still have endemic malaria transmission. This study aimed to assess malaria burden at household level in Kongo central province, Democratic Republic of Congo (DRC), and the impact of community participatory Water, Sanitation and Hygiene (WASH) Action programme. Methods Mixed method research was conducted in two semi-rural towns, Mbanza-Ngungu (a WASH action site) and Kasangulu (a WASH control site) in DRC between 1 January 2017 through March 2018, involving 625 households (3,712 household members). Baseline and post-intervention malaria surveys were conducted with the use of World Bank/WHO Malaria Indicator Questionnaire. An action research consisting of a six-month study was carried out which comprised two interventions: a community participatory WASH action programme aiming at eliminating mosquito breeding areas in the residential environment and a community anti-malaria education campaign. The latter was implemented at both study sites. In addition, baseline and post-intervention malaria rapid diagnostic test (RDT) was performed among the respondents. Furthermore, a six-month hospital-based epidemiological study was conducted at selected referral hospitals at each site from 1 January through June 2017 to determine malaria trend. Results Long-lasting insecticide-treated net (LLIN) was the most commonly used preventive measure (55%); 24% of households did not use any measures. Baseline malaria survey showed that 96% of respondents (heads of households) reported at least one episode occurring in the previous six months; of them only 66.5% received malaria care at a health setting. In the Action Research, mean incident household malaria cases decreased significantly at WASH action site (2.3 ± 2.2 cases vs. 1.2 ± 0.7 cases, respectively; p < 0.05), whereas it remained unchanged at the Control site. Similar findings were observed with RDT results. Data collected from referral hospitals showed high malaria incidence rate, 67.4%. Low household income (ORa = 2.37; 95%CI: 1.05–3.12; p < 0.05), proximity to high risk area for malaria (ORa = 5.13; 95%CI: 2–29-8.07; p < 0.001), poor WASH (ORa = 4.10; 95%CI: 2.11–7.08; p < 0.001) were predictors of household malaria. Conclusion This research showed high prevalence of positive malaria RDT among the responders and high household malaria incidence, which were reduced by a 6-month WASH intervention. DRC government should scale up malaria control strategy by integrating efficient indoor and outdoor preventive measures and improve malaria care accessibility.
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Affiliation(s)
- Nlandu Roger Ngatu
- Department of Public Health, Kagawa University Graduate School of Medicine, Miki-cho, 761-0793, Japan.
| | - Basilua Andre Muzembo
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Nattadech Choomplang
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
| | | | - Roger Wumba
- Department of Tropical Medicine, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | | | | | | | - Tomoko Suzuki
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Koji Wada
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Hasan Al Mahfuz
- Department of Public Health, Kagawa University Graduate School of Medicine, Miki-cho, 761-0793, Japan
| | - Tomohiko Sugishita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Miyazaki
- Center for Spatial Information Science, University of Tokyo, Tokyo, Japan
| | - Shunya Ikeda
- Department of Public Health, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Tomohiro Hirao
- Department of Public Health, Kagawa University Graduate School of Medicine, Miki-cho, 761-0793, Japan
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9
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Ateba FF, Sagara I, Sogoba N, Touré M, Konaté D, Diawara SI, Diakité SAS, Diarra A, Coulibaly MD, Dolo M, Dolo A, Sacko A, Thiam SM, Sissako A, Sangaré L, Diakité M, Koita OA, Cissoko M, Traore SF, Winch PJ, Febrero-Bande M, Shaffer JG, Krogtad DJ, Marker HC, Doumbia S, Gaudart J. Spatio-Temporal Dynamic of Malaria Incidence: A Comparison of Two Ecological Zones in Mali. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4698. [PMID: 32629876 PMCID: PMC7370019 DOI: 10.3390/ijerph17134698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023]
Abstract
Malaria transmission largely depends on environmental, climatic, and hydrological conditions. In Mali, malaria epidemiological patterns are nested within three ecological zones. This study aimed at assessing the relationship between those conditions and the incidence of malaria in Dangassa and Koila, Mali. Malaria data was collected through passive case detection at community health facilities of each study site from June 2015 to January 2017. Climate and environmental data were obtained over the same time period from the Goddard Earth Sciences (Giovanni) platform and hydrological data from Mali hydraulic services. A generalized additive model was used to determine the lagged time between each principal component analysis derived component and the incidence of malaria cases, and also used to analyze the relationship between malaria and the lagged components in a multivariate approach. Malaria transmission patterns were bimodal at both sites, but peak and lull periods were longer lasting for Koila study site. Temperatures were associated with malaria incidence in both sites. In Dangassa, the wind speed (p = 0.005) and river heights (p = 0.010) contributed to increasing malaria incidence, in contrast to Koila, where it was humidity (p < 0.001) and vegetation (p = 0.004). The relationships between environmental factors and malaria incidence differed between the two settings, implying different malaria dynamics and adjustments in the conception and plan of interventions.
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Affiliation(s)
- François Freddy Ateba
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
- Department of Mathematics, University of Quebec at Montreal (UQAM), Montréal, QC H2X 3Y7, Canada
| | - Issaka Sagara
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
- Department of Public Health Education and Research, Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali;
| | - Nafomon Sogoba
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
| | - Mahamoudou Touré
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
| | - Drissa Konaté
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
| | - Sory Ibrahim Diawara
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
| | - Séidina Aboubacar Samba Diakité
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
| | - Ayouba Diarra
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
| | - Mamadou D. Coulibaly
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
| | - Mathias Dolo
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
| | - Amagana Dolo
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
| | - Aissata Sacko
- Department of Public Health Education and Research, Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali;
| | - Sidibe M’baye Thiam
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
| | - Aliou Sissako
- Laboratory of Applied Molecular Biology (LBMA), Science and Technologies Faculty (FST), University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (A.S.); (L.S.); (O.A.K.)
| | - Lansana Sangaré
- Laboratory of Applied Molecular Biology (LBMA), Science and Technologies Faculty (FST), University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (A.S.); (L.S.); (O.A.K.)
| | - Mahamadou Diakité
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
| | - Ousmane A. Koita
- Laboratory of Applied Molecular Biology (LBMA), Science and Technologies Faculty (FST), University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (A.S.); (L.S.); (O.A.K.)
| | - Mady Cissoko
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
- APHM, INSERM, IRD, SESSTIM, Hop Timone, BioSTIC, Biostatistic & ICT, Aix Marseille Université, 13005 Marseille, France
| | - Sékou Fantamady Traore
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
| | - Peter John Winch
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (P.J.W.); (H.C.M.)
| | - Manuel Febrero-Bande
- Department of Statistics, Mathematical Analysis and Optimization, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain;
| | - Jeffrey G. Shaffer
- Department of Global Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America, 1440 Canal Street New Orleans, LA 70112, USA; (J.G.S.); (D.J.K.)
| | - Donald J. Krogtad
- Department of Global Biostatistics and Data Science, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, United States of America, 1440 Canal Street New Orleans, LA 70112, USA; (J.G.S.); (D.J.K.)
| | - Hannah Catherine Marker
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA; (P.J.W.); (H.C.M.)
| | - Seydou Doumbia
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
- Department of Public Health Education and Research, Faculty of Medicine and Odonto-Stomatology, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali;
| | - Jean Gaudart
- Malaria Research and Training Center, Faculty of Medicine, Pharmacy and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako BP 1805, Mali; (F.F.A.); (I.S.); (N.S.); (M.T.); (D.K.); (S.I.D.); (S.A.S.D.); (A.D.); (M.D.C.); (M.D.); (A.D.); (S.M.T.); (M.D.); (M.C.); (S.F.T.)
- APHM, INSERM, IRD, SESSTIM, Hop Timone, BioSTIC, Biostatistic & ICT, Aix Marseille Université, 13005 Marseille, France
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Gowelo S, Chirombo J, Spitzen J, Koenraadt CJM, Mzilahowa T, van den Berg H, Takken W, McCann R. Effects of larval exposure to sublethal doses of Bacillus thuringiensis var. israelensis on body size, oviposition and survival of adult Anopheles coluzzii mosquitoes. Parasit Vectors 2020; 13:259. [PMID: 32416733 PMCID: PMC7229702 DOI: 10.1186/s13071-020-04132-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/11/2020] [Indexed: 12/02/2022] Open
Abstract
Background Application of the larvicide Bacillus thuringiensis var. israelensis (Bti) is a viable complementary strategy for malaria control. Efficacy of Bti is dose-dependent. There is a knowledge gap on the effects of larval exposure to sublethal Bti doses on emerging adult mosquitoes. The present study examined the effect of larval exposure to sublethal doses of Bti on the survival, body size and oviposition rate in adult Anopheles coluzzii. Methods Third-instar An. coluzzii larvae were exposed to control and sublethal Bti concentrations at LC20, LC50 and LC70 for 48 h. Surviving larvae were reared to adults under standard colony conditions. Thirty randomly selected females from each treatment were placed in separate cages and allowed to blood feed. Twenty-five gravid females from the blood-feeding cages were randomly selected and transferred into new cages where they were provided with oviposition cups. Numbers of eggs laid in each cage and mortality of all adult mosquitoes were recorded daily. Wing lengths were measured of 570 mosquitoes as a proxy for body size. Results Exposure to LC70Bti doses for 48 h as third-instar larvae reduced longevity of adult An. coluzzii mosquitoes. Time to death was 2.58 times shorter in females exposed to LC70Bti when compared to the control females. Estimated mortality hazard rates were also higher in females exposed to the LC50 and LC20 treatments, but these differences were not statistically significant. The females exposed to LC70 concentrations had 12% longer wings than the control group (P < 0.01). No differences in oviposition rate of the gravid females were observed between the treatments. Conclusions Exposure of An. coluzzii larvae to sublethal Bti doses reduces longevity of resultant adults and is associated with larger adult size and unclear effect on oviposition. These findings suggest that anopheline larval exposure to sublethal Bti doses, though not recommended, could reduce vectorial capacity for malaria vector populations by increasing mortality of resultant adults.![]()
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Affiliation(s)
- Steven Gowelo
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands. .,Training and Research Unit of Excellence, School of Public Health, College of Medicine, Blantyre, Malawi.
| | - James Chirombo
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Jeroen Spitzen
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | | | | | - Henk van den Berg
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Willem Takken
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands
| | - Robert McCann
- Laboratory of Entomology, Wageningen University & Research, Wageningen, The Netherlands.,Training and Research Unit of Excellence, School of Public Health, College of Medicine, Blantyre, Malawi.,Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, USA
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11
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Ashton RA, Prosnitz D, Andrada A, Herrera S, Yé Y. Evaluating malaria programmes in moderate- and low-transmission settings: practical ways to generate robust evidence. Malar J 2020; 19:75. [PMID: 32070357 PMCID: PMC7027277 DOI: 10.1186/s12936-020-03158-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 02/09/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Many countries have made substantial progress in scaling-up and sustaining malaria intervention coverage, leading to more focalized and heterogeneous transmission in many settings. Evaluation provides valuable information for programmes to understand if interventions have been implemented as planned and with quality, if the programme had the intended impact on malaria burden, and to guide programmatic decision-making. Low-, moderate-, and heterogeneous-transmission settings present unique evaluation challenges because of dynamic and targeted intervention strategies. This paper provides illustration of evaluation approaches and methodologies for these transmission settings, and suggests how to answer evaluation questions specific to the local context. METHODS The Roll Back Malaria Monitoring and Evaluation Reference Group formed a task force in October 2017 to lead development of this framework. The task force includes representatives from National Malaria Programmes, funding agencies, and malaria research and implementing partners. The framework builds on existing guidance for process and outcome evaluations and impact evaluations specifically in high transmission settings. RESULTS The theory of change describes how evaluation questions asked by national malaria programmes in different contexts influence evaluation design. The transmission setting, existing stratification, and data quality and availability are also key considerations. The framework is intended for adaption by countries to their local context, and use for evaluation at sub-national level. Confirmed malaria incidence is recommended as the primary impact indicator due to its sensitivity to detect changes in low-transmission settings. It is expected that process evaluations provide sufficient evidence for programme monitoring and improvement, while impact evaluations are needed following adoption of new mixes of interventions, operational strategies, tools or policies, particularly in contexts of changing malaria epidemiology. Impact evaluations in low-, moderate-, or heterogeneous-transmission settings will likely use plausibility designs, and methods highlighted by the framework include interrupted time series, district-level dose-response analyses, and constructed control methods. Triangulating multiple data sources and analyses is important to strengthen the plausibility argument. CONCLUSIONS This framework provides a structure to assist national malaria programmes and partners to design evaluations in low-, moderate- or heterogeneous-transmission settings. Emphasizing a continuous cycle along the causal pathway linking process evaluation to impact evaluation and then programmatic decision-making, the framework provides practical guidance in evaluation design, analysis, and interpretation to ensure that the evaluation meets national malaria programme priority questions and guides decision-making at national and sub-national levels.
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Affiliation(s)
- Ruth A Ashton
- MEASURE Evaluation, Center for Applied Malaria Research and Evaluation, Tulane School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2300, New Orleans, LA, USA.
| | | | | | - Samantha Herrera
- MEASURE Evaluation, ICF, Rockville, MD, USA.,Save the Children, Washington, DC, USA
| | - Yazoumé Yé
- MEASURE Evaluation, ICF, Rockville, MD, USA
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12
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Ashton RA, Bennett A, Al-Mafazy AW, Abass AK, Msellem MI, McElroy P, Kachur SP, Ali AS, Yukich J, Eisele TP, Bhattarai A. Use of Routine Health Information System Data to Evaluate Impact of Malaria Control Interventions in Zanzibar, Tanzania from 2000 to 2015. EClinicalMedicine 2019; 12:11-19. [PMID: 31388659 PMCID: PMC6677660 DOI: 10.1016/j.eclinm.2019.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 03/27/2019] [Accepted: 05/28/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Impact evaluations allow countries to assess public health gains achieved through malaria investments. This study uses routine health management information system (HMIS) data from Zanzibar to describe changes in confirmed malaria incidence and impact of case management and vector control interventions during 2000-2015. METHODS HMIS data from 129 (82%) public outpatient facilities were analyzed using interrupted time series models to estimate the impact of artemisinin-based combination therapy (ACT), indoor residual spray, and long-lasting insecticidal nets. Evaluation periods were defined as pre-intervention (January 2000 to August 2003), ACT-only (September 2003 to December 2005) and ACT plus vector control (2006-2015). FINDINGS After accounting for climate, seasonality, diagnostic testing rates, and outpatient attendance, average monthly incidence of confirmed malaria showed no trend over the pre-intervention period 2000-2003 (incidence rate ratio (IRR) 0.998, 95% CI 0.995-1.000). During the ACT-only period (2003-2005), the average monthly malaria incidence rate declined compared to the pre-intervention period, showing an overall declining trend during the ACT-only period (IRR 0.984, 95% CI 0.978-0.990). There was no intercept change at the start of the ACT-only period (IRR 1.081, 95% CI 0.968-1.208), but a drop in intercept was identified at the start of the ACT plus vector control period (IRR 0.683, 95% CI 0.597-0.780). During the ACT plus vector control period (2006-2015), the rate of decline in average monthly malaria incidence slowed compared to the ACT-only period, but the incidence rate continued to show an overall slight declining trend during 2006-2015 (IRR 0.993, 95% CI 0.992-0.994). INTERPRETATION This study presents a rigorous approach to the use of HMIS data in evaluating the impact of malaria control interventions. Evidence is presented for a rapid decline in malaria incidence during the period of ACT roll out compared to pre-intervention, with a rapid drop in malaria incidence following introduction of vector control and a slower declining incidence trend thereafter.
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Affiliation(s)
- Ruth A. Ashton
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Corresponding author at: School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2300, New Orleans, LA, USA.
| | - Adam Bennett
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, USA
| | - Abdul-Wahid Al-Mafazy
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, United Republic of Tanzania
| | - Ali K. Abass
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, United Republic of Tanzania
| | | | - Peter McElroy
- U.S. President's Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - S. Patrick Kachur
- Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
- Mailman School of Public Health, Columbia University, NY, New York, USA
| | - Abdullah S. Ali
- Zanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, United Republic of Tanzania
| | - Joshua Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Thomas P. Eisele
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Achuyt Bhattarai
- U.S. President's Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
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13
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Rowe AK. Assessing the Health Impact of Malaria Control Interventions in the MDG/Sustainable Development Goal Era: A New Generation of Impact Evaluations. Am J Trop Med Hyg 2019; 97:6-8. [PMID: 28990917 PMCID: PMC5619937 DOI: 10.4269/ajtmh.17-0509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
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14
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The President's Malaria Initiative contributed to reducing malaria burden in sub-Saharan Africa between 2004 and 2014: Evidence from generalized estimating equation analysis. PLoS One 2019; 14:e0217103. [PMID: 31125380 PMCID: PMC6534374 DOI: 10.1371/journal.pone.0217103] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 05/03/2019] [Indexed: 11/27/2022] Open
Abstract
The President’s Malaria Initiative (PMI) launched in 2005 as a key player in malaria prevention and treatment in sub-Saharan Africa (SSA). Several country-specific evaluations have demonstrated great progress in reducing under-five mortality associated with scaling up malaria interventions in PMI priority countries. Documentation of PMI’s specific contributions was limited, until the publication of Jakubowski, et al., which used difference-in-difference analysis to show a higher reduction of under-five mortality in PMI-supported countries than in others. To generate more evidence, this study used rigorous statistical analyses to assess the reduction in mortality attributable to PMI support. The study used generalized estimating equations and a series of matching procedures to evaluate the impact of PMI on under-five mortality and on population coverage of insecticide-treated nets (ITNs), indoor residual spraying (IRS), and artemisinin-based combination therapy (ACT) in SSA. The analyses used country-level secondary data and controlled for several country-level characteristics assumed to influence outcome measures of interest, PMI program participation, or both. The Mahalanobis distance metric, with 1:1 nearest neighbor matching adjusting for bias in population size in the particular country, showed a reduction in under-five mortality by approximately 12 per 1,000 live births (95% Confidence Interval [CI]: 20.6–3.1; p = 0.012). There were statistically significant increases in the population coverage of ITNs, IRS, and ACTs in PMI countries over the implementation period. ITN use in the population was 0.23% higher (95% CI average treatment effect on the treated: 0.17–0.30; p<0.001) in PMI-recipient countries than in non-PMI countries. The findings show that PMI contributed significantly to increasing the coverage of malaria control interventions and reducing under-five mortality in SSA.
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Kayentao K, Florey LS, Mihigo J, Doumbia A, Diallo A, Koné D, Doumbo O, Eckert E. Impact evaluation of malaria control interventions on morbidity and all-cause child mortality in Mali, 2000-2012. Malar J 2018; 17:424. [PMID: 30428880 PMCID: PMC6236933 DOI: 10.1186/s12936-018-2573-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/09/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Major investments have been made since 2001, with intensification of malaria control interventions after 2006. Interventions included free distribution of insecticide-treated nets (ITN) to pregnant women and children under 5 years old, the introduction of artemisinin combination therapy (ACT) for malaria treatment, and indoor residual spraying of insecticides. Funders include the Government of Mali, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US President's Malaria Initiative. METHODS Data from nationally representative household surveys conducted from 2000 to 2015 was used to performed the trend analysis for malaria intervention coverage, prevalence of morbidities among children under 5 years old [parasitemia and severe anaemia (< 8 g/dl)], and all-cause mortality of children under 5 (ACCM). Prevalence of contextual factors likely to contribute to ACCM were also assessed. The impact of these interventions was assessed on malaria morbidity and mortality using a plausibility argument. With the assumption that malaria contributes significantly to under-five mortality in settings with high malaria transmission, associations between malaria control interventions and all-cause under-five mortality (ACCM) were assessed taking into account other contextual factors related to child survival. RESULTS Intervention coverage improved significantly from 2006 to 2012. Household ownership of ITN increased from 49% in 2006 to 84% in 2012. ITN use also increased over the same period, from 26% in 2006 to 69% in 2012 among children under 5 and from 28% in 2006 to 73% in 2012 among pregnant women. The coverage of intermittent preventive treatment in pregnancy (IPTp) using two or more doses of SP increased from 10% in 2006 to 29% in 2012. In 2010, 23% of febrile children under 5 received ACT, as opposed to 19% in 2012. The prevalence of Plasmodium falciparum infection increased from 2010 (38.6%) to 2012 (51.6%), followed by a decrease in 2015 (35.8%). The prevalence of severe anaemia decreased from 2010 (26.3%) to 2012 (20.6%) and continued to decline in 2015 (19.9%). An impressive decline in ACCM was observed, from 225 in 1997-2001 to 192 in 2002-2006 and 95 in 2008-2012. Changes in contextual factors such as climate, socio-economic, nutrition, and coverage of maternal and child health interventions over the evaluation period did not favour reductions in ACCM, and are therefore unlikely to explain the observed results. CONCLUSIONS Taken as a whole, the evidence supports the conclusion that malaria control interventions substantially contributed to the observed decline in ACCM in Mali from 2000 to 2012, even in the context of continued high prevalence of parasitaemia explained by contextual factors such as climate change and political instability.
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Affiliation(s)
- Kassoum Kayentao
- Malaria Research and Training Center (MRTC), University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali.
| | - Lia S Florey
- President's Malaria Initiative (PMI), U.S. Agency for International Development (USAID), Washington, District of Columbia, USA
| | - Jules Mihigo
- US President's Malaria Initiative, United States Agency for International Development (USAID), Bamako, Mali
| | | | - Aliou Diallo
- US President's Malaria Initiative, United States Agency for International Development (USAID), Bamako, Mali
| | - Diakalia Koné
- National Malaria Control Programme (NMCP), Bamako, Mali
| | - Ogobara Doumbo
- Malaria Research and Training Center (MRTC), University of Sciences, Techniques and Technologies of Bamako (USTTB), Bamako, Mali
| | - Erin Eckert
- President's Malaria Initiative (PMI), U.S. Agency for International Development (USAID), Washington, District of Columbia, USA
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16
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Thwing J, Eckert E, Dione DA, Tine R, Faye A, Yé Y, Ndiop M, Cisse M, Ndione JA, Diouf MB, Ba M. Declines in Malaria Burden and All-Cause Child Mortality following Increases in Control Interventions in Senegal, 2005-2010. Am J Trop Med Hyg 2017; 97:89-98. [PMID: 28990913 PMCID: PMC5619933 DOI: 10.4269/ajtmh.16-0953] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Malaria is endemic in Senegal. The national malaria control strategy focuses on achieving universal coverage for major interventions, with a goal of reaching preelimination status by 2018. Senegal began distribution of insecticide-treated nets (ITNs) and introduced artemisinin-based combination therapy in 2006, then introduced rapid diagnostic tests in 2007. We evaluated the impact of these efforts using a plausibility design based on malaria’s contribution to all-cause under-five mortality (ACCM) and considering other contextual factors which may influence ACCM. Between 2005 and 2010, household ownership of ITNs increased from 20% to 63%, and the proportion of people sleeping under an ITN the night prior to the survey increased from 6% to 29%. Malaria parasite prevalence declined from 6% to 3% from 2008 to 2010 among children under five. Some nonmalaria indicators of child health improved, for example, increase of complete vaccination coverage from 58% to 64%; however, nutritional indicators deteriorated, with an increase in stunting from 16% to 26%. Although economic indicators improved, environmental conditions favored an increase in malaria transmission. ACCM decreased 40% between 2005 and 2010, from 121 (95% confidence interval [CI] 113–129) to 72 (95% CI 66–77) per 1,000, and declines were greater among age groups, epidemiologic zones, and wealth quintiles most at risk for malaria. After considering coverage of malaria interventions, trends in malaria morbidity, effects of contextual factors, and trends in ACCM, it is plausible that malaria control interventions contributed to a reduction in malaria mortality and to the impressive gains in child survival in Senegal.
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Affiliation(s)
- Julie Thwing
- President's Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin Eckert
- President's Malaria Initiative, U.S. Agency for International Development, Washington, District of Columbia
| | | | - Roger Tine
- Université Cheikh Anta Diop, Dakar, Senegal
| | - Adama Faye
- Université Cheikh Anta Diop, Dakar, Senegal
| | - Yazoume Yé
- MEASURE Evaluation/ICF International, Rockville, Maryland
| | | | | | | | - Mame Birame Diouf
- U.S. Agency for International Development, Dakar, Senegal.,President's Malaria Initiative, U.S. Agency for International Development, Washington, District of Columbia
| | - Mady Ba
- National Malaria Control Program, Dakar, Senegal
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17
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Thomson MC, Ukawuba I, Hershey CL, Bennett A, Ceccato P, Lyon B, Dinku T. Using Rainfall and Temperature Data in the Evaluation of National Malaria Control Programs in Africa. Am J Trop Med Hyg 2017; 97:32-45. [PMID: 28990912 PMCID: PMC5619931 DOI: 10.4269/ajtmh.16-0696] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/29/2016] [Indexed: 11/17/2022] Open
Abstract
Since 2010, the Roll Back Malaria (RBM) Partnership, including National Malaria Control Programs, donor agencies (e.g., President's Malaria Initiative and Global Fund), and other stakeholders have been evaluating the impact of scaling up malaria control interventions on all-cause under-five mortality in several countries in sub-Saharan Africa. The evaluation framework assesses whether the deployed interventions have had an impact on malaria morbidity and mortality and requires consideration of potential nonintervention influencers of transmission, such as drought/floods or higher temperatures. Herein, we assess the likely effect of climate on the assessment of the impact malaria interventions in 10 priority countries/regions in eastern, western, and southern Africa for the President's Malaria Initiative. We used newly available quality controlled Enhanced National Climate Services rainfall and temperature products as well as global climate products to investigate likely impacts of climate on malaria evaluations and test the assumption that changing the baseline period can significantly impact on the influence of climate in the assessment of interventions. Based on current baseline periods used in national malaria impact assessments, we identify three countries/regions where current evaluations may overestimate the impact of interventions (Tanzania, Zanzibar, Uganda) and three countries where current malaria evaluations may underestimate the impact of interventions (Mali, Senegal and Ethiopia). In four countries (Rwanda, Malawi, Mozambique, and Angola) there was no strong difference in climate suitability for malaria in the pre- and post-intervention period. In part, this may be due to data quality and analysis issues.
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Affiliation(s)
- Madeleine C. Thomson
- International Research Institute for Climate and Society, Palisades, New York
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Israel Ukawuba
- International Research Institute for Climate and Society, Palisades, New York
| | - Christine L. Hershey
- President's Malaria Initiative, United States Agency for International Development, Washington, District of Columbia
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California
| | - Pietro Ceccato
- International Research Institute for Climate and Society, Palisades, New York
| | - Bradfield Lyon
- International Research Institute for Climate and Society, Palisades, New York
| | - Tufa Dinku
- International Research Institute for Climate and Society, Palisades, New York
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18
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Hershey CL, Bhattarai A, Florey LS, McElroy PD, Nielsen CF, Yé Y, Eckert E, Franca-Koh AC, Shargie E, Komatsu R, Smithson P, Thwing J, Mihigo J, Herrera S, Taylor C, Shah J, Mouzin E, Yoon SS, Salgado SR. Implementing Impact Evaluations of Malaria Control Interventions: Process, Lessons Learned, and Recommendations. Am J Trop Med Hyg 2017; 97:20-31. [PMID: 28990921 PMCID: PMC5619934 DOI: 10.4269/ajtmh.17-0064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 05/30/2017] [Indexed: 11/07/2022] Open
Abstract
As funding for malaria control increased considerably over the past 10 years resulting in the expanded coverage of malaria control interventions, so did the need to measure the impact of these investments on malaria morbidity and mortality. Members of the Roll Back Malaria (RBM) Partnership undertook impact evaluations of malaria control programs at a time when there was little guidance in terms of the process for conducting an impact evaluation of a national-level malaria control program. The President's Malaria Initiative (PMI), as a member of the RBM Partnership, has provided financial and technical support for impact evaluations in 13 countries to date. On the basis of these experiences, PMI and its partners have developed a streamlined process for conducting the evaluations with a set of lessons learned and recommendations. Chief among these are: to ensure country ownership and involvement in the evaluations; to engage stakeholders throughout the process; to coordinate evaluations among interested partners to avoid duplication of efforts; to tailor the evaluation to the particular country context; to develop a standard methodology for the evaluations and a streamlined process for completion within a reasonable time; and to develop tailored dissemination products on the evaluation for a broad range of stakeholders. These key lessons learned and resulting recommendations will guide future impact evaluations of malaria control programs and other health programs.
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Affiliation(s)
- Christine L. Hershey
- President’s Malaria Initiative, U.S. Agency for International Development, Washington, District of Columbia
| | - Achuyt Bhattarai
- Malaria Branch and President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lia S. Florey
- The DHS Program, ICF International, Rockville, Maryland
| | - Peter D. McElroy
- Malaria Branch and President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carrie F. Nielsen
- Malaria Branch and President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Yazoume Yé
- MEASURE Evaluation, ICF International, Rockville, Maryland
| | - Erin Eckert
- President’s Malaria Initiative, U.S. Agency for International Development, Washington, District of Columbia
| | | | - Estifanos Shargie
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Ryuichi Komatsu
- The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | | | - Julie Thwing
- Malaria Branch and President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jules Mihigo
- President’s Malaria Initiative, Centers for Disease Control and Prevention, Bamako, Mali
| | | | | | - Jui Shah
- MEASURE Evaluation, ICF International, Rockville, Maryland
| | - Eric Mouzin
- Roll Back Malaria Partnership, Geneva, Switzerland
| | - Steven S. Yoon
- Malaria Branch and President’s Malaria Initiative, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - S. René Salgado
- President’s Malaria Initiative, U.S. Agency for International Development, Washington, District of Columbia
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19
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Ashton RA, Bennett A, Yukich J, Bhattarai A, Keating J, Eisele TP. Methodological Considerations for Use of Routine Health Information System Data to Evaluate Malaria Program Impact in an Era of Declining Malaria Transmission. Am J Trop Med Hyg 2017; 97:46-57. [PMID: 28990915 PMCID: PMC5619932 DOI: 10.4269/ajtmh.16-0734] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/24/2016] [Indexed: 12/01/2022] Open
Abstract
Coverage of malaria control interventions is increasing dramatically across endemic countries. Evaluating the impact of malaria control programs and specific interventions on health indicators is essential to enable countries to select the most effective and appropriate combination of tools to accelerate progress or proceed toward malaria elimination. When key malaria interventions have been proven effective under controlled settings, further evaluations of the impact of the intervention using randomized approaches may not be appropriate or ethical. Alternatives to randomized controlled trials are therefore required for rigorous evaluation under conditions of routine program delivery. Routine health management information system (HMIS) data are a potentially rich source of data for impact evaluation, but have been underused in impact evaluation due to concerns over internal validity, completeness, and potential bias in estimates of program or intervention impact. A range of methodologies were identified that have been used for impact evaluations with malaria outcome indicators generated from HMIS data. Methods used to maximize internal validity of HMIS data are presented, together with recommendations on reducing bias in impact estimates. Interrupted time series and dose-response analyses are proposed as the strongest quasi-experimental impact evaluation designs for analysis of malaria outcome indicators from routine HMIS data. Interrupted time series analysis compares the outcome trend and level before and after the introduction of an intervention, set of interventions or program. The dose-response national platform approach explores associations between intervention coverage or program intensity and the outcome at a subnational (district or health facility catchment) level.
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Affiliation(s)
- Ruth A. Ashton
- Center for Applied Malaria Research and Evaluation, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Adam Bennett
- Malaria Elimination Initiative, Global Health Group, University of California San Francisco, San Francisco, California
| | - Joshua Yukich
- Center for Applied Malaria Research and Evaluation, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Achuyt Bhattarai
- President's Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joseph Keating
- Center for Applied Malaria Research and Evaluation, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
| | - Thomas P. Eisele
- Center for Applied Malaria Research and Evaluation, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana
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20
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Hershey CL, Florey LS, Ali D, Bennett A, Luhanga M, Mathanga DP, Salgado SR, Nielsen CF, Troell P, Jenda G, Yé Y, Bhattarai A. Malaria Control Interventions Contributed to Declines in Malaria Parasitemia, Severe Anemia, and All-Cause Mortality in Children Less Than 5 Years of Age in Malawi, 2000-2010. Am J Trop Med Hyg 2017; 97:76-88. [PMID: 28990920 PMCID: PMC5619935 DOI: 10.4269/ajtmh.17-0203] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 05/30/2017] [Indexed: 12/01/2022] Open
Abstract
Malaria control intervention coverage increased nationwide in Malawi during 2000-2010. Trends in intervention coverage were assessed against trends in malaria parasite prevalence, severe anemia (hemoglobin < 8 g/dL), and all-cause mortality in children under 5 years of age (ACCM) using nationally representative household surveys. Associations between insecticide-treated net (ITN) ownership, malaria morbidity, and ACCM were also assessed. Household ITN ownership increased from 27.4% (95% confidence interval [CI] = 25.9-29.0) in 2004 to 56.8% (95% CI = 55.6-58.1) in 2010. Similarly intermittent preventive treatment during pregnancy coverage increased from 28.2% (95% CI = 26.7-29.8) in 2000 to 55.0% (95% CI = 53.4-56.6) in 2010. Malaria parasite prevalence decreased significantly from 60.5% (95% CI = 53.0-68.0) in 2001 to 20.4% (95% CI = 15.7-25.1) in 2009 in children aged 6-35 months. Severe anemia prevalence decreased from 20.4% (95% CI: 17.3-24.0) in 2004 to 13.1% (95% CI = 11.0-15.4) in 2010 in children aged 6-23 months. ACCM decreased 41%, from 188.6 deaths per 1,000 live births (95% CI = 179.1-198.0) during 1996-2000, to 112.1 deaths per 1,000 live births (95% CI = 105.8-118.5) during 2006-2010. When controlling for other covariates in random effects logistic regression models, household ITN ownership was protective against malaria parasitemia in children (odds ratio [OR] = 0.81, 95% CI = 0.72-0.92) and severe anemia (OR = 0.82, 95% CI = 0.72-0.94). After considering the magnitude of changes in malaria intervention coverage and nonmalaria factors, and given the contribution of malaria to all-cause mortality in malaria-endemic countries, the substantial increase in malaria control interventions likely improved child survival in Malawi during 2000-2010.
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Affiliation(s)
- Christine L. Hershey
- President’s Malaria Initiative, Agency for International Development, Washington, District of Columbia
| | - Lia S. Florey
- The DHS Program, ICF International, Rockville, Maryland
| | - Doreen Ali
- National Malaria Control Program, Lilongwe, Malawi
| | - Adam Bennett
- Global Health Group, University of California San Francisco School of Medicine, San Francisco, California
| | | | | | - S. René Salgado
- President’s Malaria Initiative, Agency for International Development, Washington, District of Columbia
| | - Carrie F. Nielsen
- President’s Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Peter Troell
- President’s Malaria Initiative, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Gomezgani Jenda
- President’s Malaria Initiative, Agency for International Development, Lilongwe, Malawi
| | - Yazoume Yé
- MEASURE Evaluation, ICF International, Rockville, Maryland
| | - Achuyt Bhattarai
- President’s Malaria Initiative, Malaria Branch, Centers for Disease Control and Prevention, Atlanta, Georgia
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