Impact Evaluation of House-to-House Approach to IPT Delivery in Malawi

1. Launching the Malaria Impact Evaluation Program Impact Evaluation of House-to-House Approach to IPT Delivery in Malawi

2. Questions • What is the impact of overlaying house to house delivery of IPT on the timing and coverage of IPT use relative to health facility delivery alone? • What is the impact of improving the information of the Village Health Register on the delivery of IPTs and possibly other outcomes in the Essential Health Package (EHP)? • What is the impact of health facility-based delivery of ITNs to pregnant women attending ANC?

3. Indicators • Main outcome indicators: • Timing and coverage for IPT1 and IPT2 • Other possible indicators for which further discussion is required • maternal anemia • birth weight • placenta parasitemia

4. Evaluation Design • House to house delivery of IPT • Intervention will be rolled out country-wide at time T. • It will include IPT training of HSAs and delivery of SP for IPT use to HSAs. • The evaluation will compare cohorts of pregnant women at different stages of pregnancy: i) women in the second or third trimester of pregnancy at time T (control); and ii) women at earlier stages of pregnancy and possibly prospective (treatment). • The comparison will be made at bi-monthly intervals. • Impact will be measured as the difference in the outcomes between treatment and control in the same cohorts (e.g. women in fifth month of pregnancy in control and treatment)

5. Evaluation Design • Value of local information • At completion of evaluation (1) half of the HSAs areas will be randomly assigned to receive the information collected for evaluation (1) in two forms: i) to update and improve information on the registry, and ii) to inform the localities. (treatment) • The other half of the HSA areas will be provided with the information 6 months later (control). • The evaluation will compare treatment areas and control areas during these first six months • The comparison will be made at bi-monthly intervals. • Impact will be measured as the difference in the outcomes between treatment and control

6. Sample and Data • Random sample of 100 HSA areas defined as the cluster of villages covered by each HSA • Scouting (Census) of all households in 100 HSA areas (400*100=40000 households) to identify pregnant women (LMP) • Sample, approximately 100 HSA areas, all pregnant women (est. 50-70) • Sample size=5,000-7,000 women • Questionnaire will include timing and coverage of IPT and covariates and determinants of IPT demand • Survey of HSA and health facilities in covered areas

8. Staffing Plan • Malaria • Dr. Habib Somanje, Director of Preventive Health Services • Dr. Storn Binton Kabuluzi, Manager, Malaria Control Program • Ms. Doreen N. Ali, Deputy Manager, Malaria Control • Monitoring • Mr. Christon Mescheck Moyo, Deputy Director of Health Management Information System (HMIS) • Mr. Thokozani Chrispian Sambakunsi, HMIS officer • Dr. Seshu Babu Vinjamuri, M&E Technical Assistant • Impact evaluation • Arianna Legovini WB/Pedro Carneiro UCL/IFS • Data collection and lab work • National Statistical Organization (NSO)/Center for Social Research/Community Health Sciences Unit-Epidemiology • College of Medicine, Malaria Alert Center • Wellcome Trust Lab

9. Timeline • Training of HSAs June-July 2007 • Delivery of IPTs to HSAs (Sept 2007) • Scouting and baseline data collection (Jul-Aug 2007) • Data follow ups (Oct 07, Dec 07, Feb 08, Apr 08, Jun 08, Aug 08) • Results from evaluation (1) • Sharing of information with half of the HSAs areas (May 08) • Results from evaluation (2) • Sharing of information with half of the HSAs areas (Sept 08)

10. Budget • Data Collection • Pre-testing • Training of enumerators • Scouting $40,000 (visit 1) • Baseline Survey (6,000*$30) $180,000 (visit 2) • Follow ups ($4*6,000*6) $144,000 (visit 3-9) • Facility and HAS surveys $? • Evaluation supervision $30,000 • Analysis • Consultant fees $70,000 • Travel $50,000 • Staff time

11. Financing • Malaria Booster Program • Donors