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Evaluation of the Impact of Malaria Control Interventions in Sub-Saharan Africa

Evaluation of the Impact of Malaria Control Interventions in Sub-Saharan Africa. President’s Malaria Initiative (PMI). Roll Back Malaria (RBM) Partnership Objectives. Reduce global malaria cases from 2000 levels by 50% in 2010 Reduce global malaria deaths from 2000 levels by 50% in 2010.

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Evaluation of the Impact of Malaria Control Interventions in Sub-Saharan Africa

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  1. Evaluation of the Impact of Malaria Control Interventions in Sub-Saharan Africa President’s Malaria Initiative (PMI)

  2. Roll Back Malaria (RBM) Partnership Objectives • Reduce global malaria cases from 2000 levels by 50% in 2010 • Reduce global malaria deaths from 2000 levels by 50% in 2010

  3. Impact Evaluation Collaborations and Partnerships • Led by the Malaria and Other Parasitic Diseases Division (MOPDD) with ongoing collaboration, support, and communication from the Global Fund, RBM, WHO, UNICEF, PMI, implementing partners, local researchers, and other institutions

  4. Impact Evaluation Objective:Determine reduction in malaria-related mortality in children <5 years old in 15 PMI countriesWhat was reduction in mortality? Was 50% target reached?

  5. Impact Evaluation Principles • Measure progress towards 2010 goals as part of a global effort • Utilize Roll Back Malaria Monitoring and Evaluation Reference Group (RBM MERG) framework • Evaluate impact of • Combined malaria control interventions • Combined efforts of host country governments and partners

  6. Many Tools to Measure Impact • Population-based surveys such as the DHS, MIS, MICS (some with verbal autopsy) • Demographic surveillance and sentinel sites • Health facility and HMIS data • Malaria mortality and risk models (e.g., LiST)

  7. Challenges to Measuring Mortality • No reliable way to directly measure malaria-related mortality in most of Africa • Low coverage of vital registration systems • Validity of cause of death data unknown • All-cause mortality remains best indicator of impact

  8. RBM Framework for Impact Evaluation • Determine if: • All-cause under-five mortality decreased • Malaria morbidity (anemia, parasitemia) decreased • Malaria control interventions increased • Alternate explanations for decreased mortality exist 2. Conclude whether it is plausible that scale up of malaria control interventions reduced malaria-related deaths Adapted from Rowe et al, Trop Med Int Health 12: 1524-1539

  9. Methodology Increased intervention coverage Fewer illnesses (decreased anemia, parasitemia) Decreased malaria-associated mortality Other possible explanations (e.g., rainfall, immunizations) Conclusion: malaria control efforts reduced malaria-associated mortality

  10. Example Use of this Methodology:Bioko Island, Equatorial Guinea(AJTMH 80(6), 2009, pp. 882-888) • Coverage 70-95%, depending on intervention: • IRS-8 rounds • ACTs • LLINs • IPTp • Infection prevalence • 42% 18% • Moderate/severe anemia • 15% 2% • Fever prevalence decreased • 14% 6% <5 mortality decreased from 152 per 1,000 births to 55 per 1,000 No other explanations for mortality decrease available Conclusion: malaria control efforts reduced malaria-associated mortality

  11. Interpreting Non-Malaria Factors • Many factors influencing mortality in children <5 • Many possible alternative explanations along causal pathway from intervention scale-up to mortality reduction • Challenging to identify, measure, and account for non-malaria programs and factors

  12. Reporting Talking points, advocacy products RBM Progress and Impact Series Core Report Journal articles

  13. Thank you!Questions?

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