BASELINE MALARIOMETRIC SURVEY:

1
BASELINE MALARIOMETRIC SURVEY
Dr. Randa Youssef

• Methodology main findings of a survey
  implemented in 10 states in Sudan,
• 3 23 October 2005

2
Background Rationale

• Malaria is a considerable burden in some
  countries of the region
• Lack of comprehensive reliable information is
  an obstacle for
• Developing national malaria control activities
• Monitoring progress and evaluation of outcomes

3
Goal

• Generate baseline indicators for each state and
  for urban rural settings among different
  subgroups of the population

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Specific objectives

• 1. Prevalence of Malaria
• Prevalence of suspected cases of malaria in the 2
  weeks prior to the survey
• Parasitic prevalence rate at the time of the
  survey
• Prevalence of malaria among pregnant women and
  children below the age of 10 years
• Identification of prevalent species of plasmodium

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Specific objectives (cont.)

• 2. Coverage of malaria preventive measures
• Coverage with different types of mosquito nets
• Use of mosquito nets
• Coverage by IPT during pregnancy
• Types of drugs used for the prevention of malaria
  during pregnancy

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Specific objectives (concluded)

• 3. Treatment seeking behavior
• Time of seeking treatment in case of malaria
  associated fever
• Type of health care facility sought for the
  treatment of malaria
• Types of drugs used for the treatment of malaria

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Methods

• Survey strategy Cross sectional survey
• Survey setting
• 10 states with different patterns of endemicity
• - Hypo-mesoendemic Savannah area with
  seasonal malaria
• - Hyperendemic Stable perennial
  transmission

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Methods (cont.)

• Population Sampling
• - Survey domain State
• - Stratification Urban/rural
• - Sampling unit Household
• - Population Both sexes all age
  groups
• - Sampling frame Population census
• (Polio 2005)

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Methods (cont.)

• Population Sampling (cont.)
• - Sample size 1 per 1000 population
• proportionally allocated
• - Selection of
• enumeration area Systematically
• - Households 20 /enumeration area
• - Selection of
• households Starting from center and
  visiting all households

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(No Transcript)
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Methods (cont.)

• Survey instruments
• 1. Interview questionnaire
• - Household questionnaire
• - Members of the household
• - Housing conditions
• - Coverage types of mosquito nets
• - Individual questionnaire
• - Characteristics of members
• - History of fever in the 2 weeks prior to the
  survey and treatment for malaria
• - Subjective feeling of fever at the time of
  the survey
• - Sleeping under mosquito net the night of the
  survey
• - Current pregnancy status pregnancy in the
  last 2 years that ended in live birth

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Methods (cont.)

• Survey instruments (cont.)
• - Preventive treatment during pregnancy
• - Care received during pregnancy
• - Chemoprophylaxis and IPT for malaria
• 2. Recording of axillary temperature
• - Temperature gt 37.5o C considered fever
  
• 3. Examination of blood film
• - Both thin and thick blood film
• - Read twice at state and central Lab
• - Third reading for positive slides

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LIST AND IDENTIFICATION CODE OF SLIDE SUBMITTED
FOR EXAMINATION
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Methods (cont.)

• V. Procedures of data collection
• 1. Preparatory phase
• - Agreement on survey methods and indicators
  to be generated
• - Development and translation of survey
  tools
• - Development of database
• - Development of survey interview
  guidelines
• - Organization of the survey team job
  description
• - Securing of logistics
• - Training of trainers at the central level
  (TOT)

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Methods (cont.) Organization of the survey
team job description

• State level
• - Project coordinators
• Surveyors
• Field supervisors
• Data managers
• Lab technicians microscopist

• Central level
• - Project coordinator
• Lab technicians microscopist
• Consultant parasitologist
• Data managers
• Data operator supervisor
• Data operators
• Epidemiologist

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Methods (cont.)

• V. Procedures of data collection (cont.)
• 2. Piloting phase
• Conducted in two localities in Khartoum
  (urban rural)
• - Testing the questionnaire
• - Estimation of the time required
• - Revision and coding of the questionnaire
• - Testing the database
• - Estimate the time required for data entry
• - Estimate the number of surveyors data
  operators
• - Taking corrective actions in view of the
  outcome

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Methods (concluded)

• V. Procedures of data collection (concluded)
• 3. Implementation phase
• Extended for 20 days (3rd - 23rd of
  October)
• - Appointing of surveyors team formation
  
• - Training of surveyors
• - Data collection
• - Slide reading at the state laboratories
• - Slide reading at the central laboratories
• - Data revision coding
• - Data entry checking for feeding mistakes
  
• - Data analysis tabulation of the results

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Data quality

• Check on interview quality by revisiting a random
  sample of households
• Observation of mosquito nets to confirm
  availability type
• Minimize Dont know answer for the type of
  anti-malarial drugs received in case of fever
• Revision of the questionnaire and coding for
  consistency twice
• Third revision of a sample of the questionnaire
  which represents 25 of the visited households

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Data quality (concluded)

• Sending laboratory technicians from the central
  labs to states lab with limited capacity
• Organization of slide list with members ID to
  facilitate the incorporation of results after the
  data entry process
• Handling of slides followed a systematic
  organized process no slide loss or broken slides
  were reported
• 9. Reading of slides was performed twice in
  addition to a third reading at central laboratory
  

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Survey limitations

• Inability to reach the desired sample size
  with over-representation of women
• - Failure to access some enumeration area with
  no possibility of replacement at the last
  minute
• - Many of members of the households (especially
  men) were not available at the time of the
  visit and revisiting the households one more
  time was not possible

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Survey findings
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Types of mosquito nets present in the households,
October 2005
Percent
23
History of fever and treatment with anti-malarial
drugs among surveyed population, October 2005
Percent
24
Timing of treatment of malaria fever, October
2005
Percent
lt 24 Hrs
gt 72 Hrs
Dont know
gt24 - 48 Hrs
gt48 - 72 Hrs
25
Health sector sought for the treatment of malaria
fever, October 2005
Percent
Governmental
Private
NGOS
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Types of anti-malarial drugs used for the
treatment of malaria, October 2005
Percent
Chloroquine
ACT
Halofantrine
Dont know
Fansidar
Quinine
Others
Others Artemether traditional treatment
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Fever at the time of the survey among surveyed
population, October 2005
Percent
28
Parasitic prevalence among the surveyed
population, October 2005
Percent
29
Surveyed population who slept under mosquito net
the night of the survey, October 2005
Percent
30
Chemoprophylaxis received by women who were
pregnant had a live birth in the 2 years prior
to the survey, October 2005
Percent
IPT(2 doses of Fansidar) 1.8
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Conclusions
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Conclusions

• Successful collection of baseline information in
  10 states of Sudan with a population or more than
  17 millions.
• Findings confirm that malaria still imposes a
  high level of burden.
• Huge gap between program target coverage of ACT
  adopted as first and second line of national drug
  policy in 2004.

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Conclusions (concluded)

• Chloroquine is the most frequently used
  anti-malarial drug in all surveyed area despite
  that P. Falciparum is highly resistant to
  chloroquine
• Coverage with ITN is far below the Abuja target
  (60 by 2005) RBM (80 by 2010).
• Coverage with IPT is low in areas where IPT is a
  strategy for the prevention of malaria among
  pregnant women.

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Recommendations
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Recommendations

• Strengthening malaria laboratory diagnosis to
  overcome the problem of over-diagnosis
• WHO recommendations should be adopted to ensure
  availability, accessibility affordability of
  ACT by those who are in need
• Need to investigate strategies for scaling up the
  adopted drug policy by involving all relevant
  partners and avoid the use of ineffective drugs

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Recommendations (concluded)

• Scaling up of ITN coverage particularly in states
  with low coverage and in rural areas as well as
  for most vulnerable sector of the population
• Scaling up of the already developed prevention
  strategy during pregnancy including IPT in areas
  with high transmission
• Linking the database to available geographic
  information system for further spatial analysis
  of the information

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BASELINE MALARIOMETRIC SURVEY

• Methodology findings of a survey implemented in
  10 states in Sudan,
• 3 23 October 2005