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Evaluation of the Impact of Malaria
Control Interventions on All-cause
Mortality in Children Under-five in
Liberia
Victor ...
• Background
• Evaluation Objectives and Design
• Evaluation Results
o Trends in malaria intervention coverage
o Trends in...
• Substantial increase in funding for malaria control in the
past decade in Liberia
• Investment led to a progressive expa...
• To measure the degree to which malaria control
interventions have been implemented and expanded in
Liberia from 2005–201...
Evaluation Design
Plausibility Framework
Evaluation Results
Key milestones on malaria intervention
Year Milestones in Malaria Policy and Implementation
2000 • Firs...
Evaluation Results
Trends in Malaria Intervention Coverage
Source: 2005 Malaria Indicator Survey (MIS), 2007 Demographic H...
Evaluation Results
Trends in Malaria Intervention Coverage
% of women 15–49 with a live birth in the previous two years th...
Evaluation Results
Trends in Malaria Intervention Coverage
0
50
100
2007 2009 2011 2013
%ofchildrenunderfive
Sought treatm...
Evaluation Results
Trends in Malaria Morbidity
0
20
40
60
80
100
2005 2009 2011
%children6-59months
6-59 months 6-23 month...
Evaluation Results
Trends in Malaria Morbidity
% of children 6–59 months of age with severe anemia (hemoglobin <8g/dL)
0
1...
Evaluation Results
Trends in All-cause Child Mortality (ACCM)
0
20
40
60
80
100
120
140
NN PNN 1q0 4q1 5q0
Deathsper1,000l...
Evaluation Results
Trends in Contextual Factors
Contextual Factor Baseline (2007)
%
Endline (2013)
%
% point change
(2007 ...
Plausibility Analysis
Summary of trends in malaria control interventions, malaria morbidity and all-
cause child mortality...
Conclusion
• Data on malaria morbidity suggest a decline in parasitemia
prevalence and malaria cases; these declines are m...
This presentation has been supported by the President’s Malaria Initiative (PMI)
through the United States Agency for Inte...
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Evaluation of the Impact of Malaria Control Interventions on All-Cause Mortality in Children Under Five in Liberia

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Presented at the 2016 ASTMH conference

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Evaluation of the Impact of Malaria Control Interventions on All-Cause Mortality in Children Under Five in Liberia

  1. 1. Evaluation of the Impact of Malaria Control Interventions on All-cause Mortality in Children Under-five in Liberia Victor S. Koko National Malaria Control Program, Liberia November 16th, 2016 American Society of Tropical Medicine and Hygiene Conference
  2. 2. • Background • Evaluation Objectives and Design • Evaluation Results o Trends in malaria intervention coverage o Trends in malaria morbidity and all-cause child mortality • Plausibility Analysis and Conclusion Presentation Outline
  3. 3. • Substantial increase in funding for malaria control in the past decade in Liberia • Investment led to a progressive expansion of key malaria control interventions • Need to know the effect of the expansion of key interventions on malaria burden to inform future strategies and programs Background
  4. 4. • To measure the degree to which malaria control interventions have been implemented and expanded in Liberia from 2005–2013 • To assess malaria-related morbidity, mortality, and contextual factors before, during, and after expansion of malaria control interventions in Liberia • To assess the plausible attribution of the expansion of malaria control interventions to changes in malaria- related morbidity, all-cause and malaria-related mortality in Liberia Evaluation Objectives
  5. 5. Evaluation Design Plausibility Framework
  6. 6. Evaluation Results Key milestones on malaria intervention Year Milestones in Malaria Policy and Implementation 2000 • First National Malaria Control Strategy (2000–2005) adopted and implemented 2003 • Ministry of Health (MOH) reinstated and Malaria Steering Committee formed • Policy on IPTp adopted • ACTs introduced in Liberia as first-line treatment for malaria 2004 • First implementation of IRS in targeted areas (camps for internally displaced people in Montserrado and Bong Counties) 2005 • Second National Malaria Control Strategy (2005–2010) adopted and implemented • Implementation of IPTp begins • ACTs officially adopted by MOH as the first-line treatment for uncomplicated malaria and rolled out nationally • First ITN distribution through antenatal care and door-to-door distribution • First Malaria Indicator Survey conducted • Rapid diagnostic tests (RDTs) are officially introduced in Liberia and rolled out nationally 2007 • Demographic Health Survey conducted 2009 • IRS implemented in dwellings and among protected populations began in two counties • First rolling mass distribution of ITNs • Malaria Indicator Survey conducted 2010 • Third National Malaria Strategic Plan (2010–2015) adopted and implemented • Integrated Community Case Management, Private Sector ACT, Research, and Supply Chain Management units in the NMCP established 2011 • Malaria Indicator Survey conducted 2013 • Demographic Healthy Survey conducted
  7. 7. Evaluation Results Trends in Malaria Intervention Coverage Source: 2005 Malaria Indicator Survey (MIS), 2007 Demographic Health Survey (DHS), 2009 MIS, 2011 MIS, 2013 DHS * The 2005 MIS and 2007 DHS measured household ownership of any net % of households that own at least one insecticide-treated net % that slept under an ITN the previous night 0 20 40 60 80 100 2005 2007 2009 2011 2013 %ofhouseholds 0 20 40 60 80 100 2009 2011 2013 %usedITNthepreviousnight Children under five Pregnant women
  8. 8. Evaluation Results Trends in Malaria Intervention Coverage % of women 15–49 with a live birth in the previous two years that received one dose of SP and at least two doses of SP (IPTp) Source: 2005 MIS, 2009 MIS, 2011 MIS, 2013 DHS Note: For the 2005 MIS, no data is available on coverage of 1 dose of SP 0 20 40 60 80 100 2005 2009 2011 2013 %ofwomen15–49 1 dose of SP 2+ doses of SP (IPTp)
  9. 9. Evaluation Results Trends in Malaria Intervention Coverage 0 50 100 2007 2009 2011 2013 %ofchildrenunderfive Sought treatment from health provider Received diagnostic test for malaria Source: 2007 DHS, 2009 MIS, 2011 MIS, 2013 DHS % of children under five with fever in the previous two weeks for whom treatment was sought from a health provider, who received a diagnostic test for malaria, were treated with any antimalarial, and were treated with ACTs
  10. 10. Evaluation Results Trends in Malaria Morbidity 0 20 40 60 80 100 2005 2009 2011 %children6-59months 6-59 months 6-23 months 24-59 months 0 200 400 600 800 1000 1200 2009 2010 2011 2012 2013 #ofconfirmedcasesper 1,000population % of children 6-59 months with parasitemia prevalence (via RDT), by age group # of confirmed cases of malaria among children under five per 1,000 population Source: 2005 MIS, 2009 MIS, 2011 MIS Source: HMIS
  11. 11. Evaluation Results Trends in Malaria Morbidity % of children 6–59 months of age with severe anemia (hemoglobin <8g/dL) 0 10 20 30 40 50 2009 2011 %ofchildren6-59months 6-23 months 24-59 months 6-59 months Source: 2009 MIS, 2011 MIS
  12. 12. Evaluation Results Trends in All-cause Child Mortality (ACCM) 0 20 40 60 80 100 120 140 NN PNN 1q0 4q1 5q0 Deathsper1,000livebirths 2002-2006 2009-2013 Source: 2007 DHS and 2013 DHS NN = neonatal mortality (first month); PNN = post-neonatal mortality (1-11 months); 1q0 = infant mortality (first year); 4q1 = child mortality (1 year to 4 years); 5q0 = under-five mortality
  13. 13. Evaluation Results Trends in Contextual Factors Contextual Factor Baseline (2007) % Endline (2013) % % point change (2007 to 2013) Household has electricity 3.0 9.8 6.8* Household has telephone 28.7 64.6 35.9* Women 15-49 completed primary education 30.7 39.1 8.4* Basic immunizations (BCG, measles, DPT3, polio3) 39.0 54.8 15.8* Exclusive breastfeeding 29.1 55.2 26.1* Under five years, stunted 39.4 31.6 -7.8* Under five years, underweight 19.2 15.0 -4.2* Children 6–59 months receiving vitamin A supplementation 41.9 60.1 18.2* Four or more antenatal care visits 66.0 77.8 11.8* Tetanus toxoid (two or more doses) 74.6 84.1 9.5* Delivery at a health facility 36.9 55.8 18.9* Skilled attendant at birth 46.3 60.6 14.3* *Statistically significant change Source: 2007 DHS, 2013 DHS
  14. 14. Plausibility Analysis Summary of trends in malaria control interventions, malaria morbidity and all- cause child mortality -30 20 70 120 0 50 100 2005 2006 2007 2008 2009 2010 2011 2012 2013 Numberofdeathsper1,000livebirths Percentage ITN ownership ITN use (children under-five) ITN use (pregnant women) IPTp Care seeking for fever ACT use Source: 2005 MIS, 2007 DHS, 2009 MIS, 2011 MIS, 2013 DHS
  15. 15. Conclusion • Data on malaria morbidity suggest a decline in parasitemia prevalence and malaria cases; these declines are most likely due to the expansion of malaria control interventions between 2005 – 2013. • It is likely that intervention expansion is still in the early stages and did not reach high enough levels to have had a significant impact on ACCM during the evaluation period. • Other contextual factors likely contributed substantially to the declines observed in ACCM, and specifically in infant mortality.
  16. 16. This presentation has been supported by the President’s Malaria Initiative (PMI) through the United States Agency for International Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AIDOAA-L-14-00004. MEASURE Evaluation is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in partnership with ICF International; John Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. Views expressed are not necessarily those of PMI, USAID, or the United States government. www.measureevaluation.org

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