Malaria Control and Elimination Impact Monitoring and Evaluation

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Malaria Control and EliminationImpact Monitoring
and Evaluation

• South West Asia Regional Meeting
• ACCOUNTABILITY AND IMPACT
• (7 Years or 5 Years in Asia of GFATM Malaria
  Investment Global Malaria Control Efforts)

Jeffrey Scott Morey (GFATM), Ferdinand Laihad
(WHO), Ghazem Zamani (WHO), Charles Katende
(GFATM), Shiva Murugasampillay (WHO)
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Content

• Approved GFATM Malaria Grants
• Goal of malaria control and elimination
• Malaria Impact Indicators
• Tools for measuring impact
• Questions on evidence of Impact
• GFATM Project districts
• GFATM Program districts
• National Malaria control program
• Next steps in Impact monitoring and evaluation
  (assessment).

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Approved Malaria Grants
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The Goal of the fight against malaria

• To reduce the burden of malaria in endemic
  countries.
• Malaria control reducing the disease burden to a
  level at which it is no longer a public health
  problem ( API of 5/1000, SPR lt5 or prevalence
  less than 1)
• Reduce the geographical extent of endemic areas
  through elimination where it is feasible.
• Malaria elimination interrupting local
  mosquito-borne malaria transmission in a defined
  geographical area, i.e. zero incidence of locally
  contracted cases, although imported cases will
  continue to occur. Continued intervention
  measures are required.
• Ultimately to eradicating the disease globally.
• Malaria eradication permanent reduction to zero
  of the worldwide incidence of malaria infection.

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Country Global Impact Commitment

• 2000 United Nations Millennium Development Goals
• Goal 6, Target 8 to have halted by 2015 and
  begun to reverse the incidence of malaria.
• Indicator 21. Prevalence and death rates
  associated with malaria
• Indicator 22. Proportion of population in
  malaria-risk areas using effective malaria
  prevention and treatment measures
• In 2005 , The World Health Assembly goals for
  malaria are reduction in morbidity and mortality
  by gt50 by 2010 and by 75 in 2015 compared to
  2000.
• In 2008 The Roll Back Malaria Partnership added
  new goal as part of global malaria Action Plan
  near zero for all deaths by 2015

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Malaria Impact Indicators
High Transmission
Low transmission

• Malaria prevalence rate in 2-9 years
• Anaemia rate
• Trends in Annual parasite incidence rate. (API)
• Malaria mortality rate
• Case fatality rate
• Trends in slide positivity rate by year (SPR)
• Proportion of OPD cases due to Malaria
• Proportion of INP cases due to malaria.

• Trends in annual parasite incidence rate. (API)
• Trends in annual malaria mortality rate
• Trends in slide positivity rate by year (SPR)

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GFATM- Performance Framework- Menu
Data Sources
Malaria Impact Indicators

• National Health Accounts
• DHS/DHS (Demographic and Health Survey)
• MICS (Multiple Indicator Cluster Survey)
• MIS (Malaria Indicator Survey)
• SAMS (Service Availibility Mapping Survey)
• BSS (Behavioral and Surveillance Survey)
• Sentinel surveillance
• MOH (routine HIS or HMIS)
• Serological surveys
• Prevalence surveys
• Facility-based survey
• Key informant survey
• TraC Survey
• Civil registration systems (vital/disease
  specific registration)
• Census
• Health service statistics
• Patient register
• Clinical cohort follow-up studies
• Community services assessment

• Death rates associated with Malaria all-cause
  under-5 mortality rate in highly endemic areas
• Incidence of clinical malaria cases (estimated
  and/or reported)
• Anaemia prevalence in children under 5 years of
  age
• Prevalence of malaria parasite infection
• Laboratory-confirmed malaria cases seen in heath
  facilities
• Laboratory-confirmed malaria deaths seen in
  health facilities
• Malaria-attributed deaths in sentinel Demographic
  surveillance sites
• API (Annual Parasite Index) (specific to Latin
  America and Asia)

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Tools for Measuring Impact

• Sample Survey Community based malaria prevalence
  survey
• Routine Disease surveillance. Malaria
  surveillance system
• Routine Health/Management Information System
• Malaria case based notification and reporting
• Sentinel surveillance.
• Stratification and mapping
• Timeliness, Completeness, Representativeness

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Question.1. is there an overall impact on malaria
?
Question.2. is there an impact on malaria due to
GFATM projects or programs ?
Question.3. How can we have more rapid malaria
project, program and health system impact ?

• Baseline, trends and validity of the information

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South East Asia Malaria Impact
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EMRO- Region Malaria Impact
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Sri-Lanka Vivax Impact Trend
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Iran Malaria Impact Trend
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Afghanistan Malaria Impact Trend
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Afghanistan P.Vivax and PF Impact Trend
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GFATM Impact Performance Tracking
Rd.4 India Annual Parasite Incidence SPR
Rd.5.Bangladesh Malaria cases
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GFATM Impact Performance Tracking
Rd.4 India Malaria Deaths
Rd.5 Bangladesh Malaria deaths
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GFATM Impact Performance Tracking
Nepal. Rd.5 Malaria cases and deaths
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GFATM Impact Performance Tracking
Rd.5. Bhutan API Deaths Targets
Rd.4.Sri Lanka API and Targets
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Bangladesh Malaria Prevalence-2007
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Bangladesh Malaria Prevalence Survey-2007
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Afghanistan Prevalence Survey

• In 2002, cross section survey of 4 336
  individuals in 50 districts from altitudes 333 to
  2956 meters conducted during the peak
  transmission season
• P.falciparum revealed an overall prevalence of
  2.0 being 2.7 in altitude less than 1 500
  meters.
• P.falciparum accounts for 29.0 of malaria
  infections and 26.5 of infections in altitude
  less than 1 500 meters.

• In Nov 2008 out of the 10 736 blood samples
  examined by microscopy
• 45 were positive for the parasite yielding a
  prevalence of 0.4.
• Nearly two thirds (66.7) of positive cases were
  positive for P. vivax while 33.3 were positive
  for p. Falciparum.
• Positive cases for malaria parasite were
  encountered among the population surveyed
• in only four provinces namely Kunar (2.2),
  Nangarhar (1.4), Baghlan (0.3) and Faryab

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Malaria Transmission in Afghanistan
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Intensity of Malaria Transmission in Sri Lanka (
Represented District-wise ) 2008
API
gt 1
Jaffna 4
0.6 0.9
0.1 0.5
Kilinochchi 393
0.06 - 0.09
Mullativu 45
0.01 - 0.05
Mannar 44
Vavuniya 70
0 - 0.009
Trincomalie 17
Anuradhapura 5
Polonnaruwa 1
Puttalam 6
Batticaloa 4
Kurunegala 7
Matale 0
Kandy 3
Ampara 3
Gampaha 1
Badulla 3
Kegalle 1
NEliya 2
Colombo 3
Moneragala 3
Kalutara 0
Ratnapura 3
Hambantota 2
Galle 2
Matara 1
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(No Transcript)
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India High Burden and Low burden-2007
API
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Impact Difference Control to Elimination

• Effective Control (India. Pakistan, Afghanistan,
  Nepal, Bangladesh )
• Focus on universal coverage of populations and
  patients
• Measure effectiveness of what is being
  accomplished
• Elimination (Bhutan, Sri Lanka, parts of India
  and Pakistan)
• Focus on specific states, districts, localities,
  population and patients
• Measure what remains to be accomplished

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Questions on Impact assessment

• Yes we are making progress and impact but,
  but----?
• Need to focus on few impact indicators
• API and Mortality is routine reporting- How
  complete is the reporting from the public health
  facilities ?
• What about private sector ? What about
  self-medications ?
• Sampling for the surveys ??
• How are we delivering our interventions ? Right
  Coverage and Mix of interventions and delivery
  mechanisms ?
• How to focus on high burden and low burden areas
  ?Shrinking the malaria endemic areas ?
• Neglected Border districts and tribal populations
  

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Next steps on Malaria Impact

• Compile country and regional malaria impact
  report
• Country impact assessment desk review with focus
  on districts and sub-districts with mapping
• Country impact validation studies
• Build partnership with national and international
  institutions' who work on this
• (MOH,WHO and ICCDRB,NIMR,AIPH,LSHTM etc).