List ANALYSIS PROJECT: Interventions to Reduce Mortality Due to Malaria

List Analysis Projects

LiST ANALYSIS PROJECT: Interventions to reduce mortality due to malaria

Question:

The purpose of analysis was to estimate the impact of scaling up a package of interventions on U5 and maternal malaria deaths averted in two scale-up scenarios – conservative and according to Roll Back Malaria target

Countries of interest: 52 malaria endemic countries

Version used: Spectrum 4.34 Beta 3

Packages/Interventions of interest:

Direct impact on post neonatal deaths due to malaria:

Insecticide treated materials or indoor residual spraying - % of households with at least 1 insecticide treated net or covered by indoor residual spraying
Antimalarials – proportion of children 0-59 months with a fever receiving any appropriate antimalarial

Indirect impact on post neonatal deaths due to malaria:

Pregnant women protected via IPT or sleeping under an ITN - % pregnant women living in malaria endemic areas and receiving intermittent preventive treatment for malaria (2 doses of sulfadoxine-pryemthamine)
IPTP affect the risk for Intrauterine growth restriction, which impacts the risk for stunting, which impacts post neonatal deaths due to malaria

Direct impact on maternal deaths due to malaria:

Case management of malaria for pregnant women - % of pregnant women with malaria who are treated
Pregnant women protected via IPT or sleeping under an ITN

Target values:

Time frame: Base year of coverage 2008, Target year of coverage 2015

Target scale-up values for interventions for conservative scale up scenario:

Interventions / Proxy interventions to determine coverage change / Annual rate of coverage increase (%)
ITNs / Measles vaccine / 1.2
Antimalarials / ORS / 1.3
IPTp / Antenatal care / 0.4
Case mgt / Antenatal care / 0.4

Measles vaccine coverage was used as a proxy for ITNs, since in many countries bed nets are distributed during measles vaccine campaigns
% of under 5 with diarrhea given ORS sachets can be used as a proxy for antimalarials, since that is another treatment intervention for children that has good data
Antenatal care coverage for pregnant women (4+ visits) was used as a proxy for IPTp and case management of malaria for pregnant women, since those women can receive the IPT treatment when they go for their ANC visit.

Target scale-up values for interventions for scale up scenario according toRoll Back Malaria target:

Interventions / Target year 2015 coverage (%)
ITNs / 95
Antimalarials / 95
IPTp / 95
Case mgt / 95

Outputs of Interest:

Malaria deaths in children under 5 (Yearly and total)

Malaria deaths averted in children under 5 (Yearly and total) = (Malaria deaths in children U5 in no scale up scenario - Malaria deaths in children U5 in scale up scenario)

Under 5 malaria deaths averted by each scaled up intervention (Yearly and total)

Maternal malaria deaths (Yearly and total)

Maternal malaria deaths averted (Yearly and total) = (Maternal malaria deaths in no scale up scenario – Maternal malaria deaths in scale up scenario)

Maternal malaria deaths averted by each scaled up intervention (Yearly and total)

Baseline Coverage Values:

Population trendis obtained from the The2008 Revisionof theWorld Population Prospects published by the Population Division of the United Nations Department of Economic and Social Affairs of the United Nations Secretariat.

Child mortality estimates are obtained from The estimates from year 2008.5 were used.

Causes of death in children under 5 are obtained from the following article

Black, Robert E , Simon Cousens, Hope L Johnson, Joy E Lawn, Igor Rudan, Diego G Bassani, PrabhatJha, Harry Campbell, Christa Fischer Walker, Richard Cibulskis, Thomas Eisele, Li Liu, Colin Mathers, for the Child Health Epidemiology Reference Group of WHO and UNICEF (2010).Global, regional, and national causes of child mortality in 2008: a systematic analysis.Lancet. 375 (9730): 1969 - 1987.

Pregnant women protected via IPT or sleeping under an ITN / Case management of malaria (hospital) / Insecticide treated materials or indoor residual spraying / Antimalarials
Country / Region / Baseline coverage value (2008)
Angola / Southern Africa / 2.8 / 0.0 / 17.7 / 29.3
Bangladesh / South Asia / N/A / 0.0 / 2.0 / 8.2
Benin / West Africa / 3.0 / 0.0 / 24.5 / 54.0
Botswana / Southern Africa / N/A / 0.0 / 62.0 / 35.0
Burkina Faso / West Africa / 1.3 / 0.0 / 23.3 / 48.0
Burundi / East Africa / N/A / 0.0 / 8.3 / 30.0
Cambodia / Southeast Asia / N/A / 0.0 / 4.5 / 0.2
Cameroon / Central Africa / 5.8 / 0.0 / 3.7 / 57.8
Central African Republic (CAR) / Central Africa / 9.0 / 0.0 / 15.1 / 57.0
Chad / Central Africa / 9.0 / 0.0 / 1.0 / 55.8
Congo / Central Africa / 3.1 / 0.0 / 8.0 / 48.0
Côte d'Ivoire / West Africa / 8.0 / 0.0 / 10.3 / 2.8
Democratic Republic of Congo (DRC) / Central Africa / 5.1 / 0.0 / 5.8 / 29.8
Djibouti / East Africa / N/A / 0.0 / 30.2 / 0.9
Equatorial Guinea / Central Africa / N/A / 0.0 / 1.0 / 49.0
Eritrea / East Africa / N/A / 0.0 / 59.0 / 3.6
Ethiopia / East Africa / N/A / 0.0 / 53.3 / 9.5
Gabon / Central Africa / 25.0 / 0.0 / 25.0 / 25.0
Gambia / West Africa / 32.5 / 0.0 / 49.0 / 62.6
Ghana / West Africa / 40.9 / 0.0 / 28.2 / 60.8
Guinea / West Africa / 3.9 / 0.0 / 0.5 / 43.5
Guinea-Bissau / West Africa / 7.4 / 0.0 / 39.0 / 27.2
Haiti / Caribbean / N/A / 0.0 / 6.4 / 5.1
India / South Asia / N/A / 0.0 / 2.0 / 8.2
Indonesia / Southeast Asia / N/A / 0.0 / 10.8 / 0.8
Kenya / East Africa / 12.3 / 0.0 / 48.9 / 15.5
Liberia / West Africa / 47.7 / 0.0 / 47.2 / 29.9
Madagascar / Southern Africa / 39.0 / 0.0 / 50.6 / 52.1
Malawi / Southern Africa / 46.7 / 0.0 / 37.8 / 21.1
Mali / West Africa / 11.2 / 0.0 / 50.0 / 31.7
Mauritania / West Africa / N/A / 0.0 / 11.9 / 20.7
Mozambique / Southern Africa / 16.2 / 0.0 / 22.7 / 36.7
Myanmar / Southeast Asia / N/A / 0.0 / 2.0 / 3.0
Niger / West Africa / 0.3 / 0.0 / 43.0 / 33.0
Nigeria / West Africa / 6.5 / 0.0 / 8.0 / 33.2
Pakistan / Central Asia / N/A / 0.0 / 2.0 / 4.0
Papua New Guinea / Pacific / N/A / 0.0 / 32.9 / 19.0
Rwanda / East Africa / 17.7 / 0.0 / 55.6 / 5.6
Sao Tome and Principe / Central Africa / N/A / 0.0 / 36.0 / 17.3
Senegal / West Africa / 49.0 / 0.0 / 16.4 / 22.0
Sierra Leone / West Africa / 12.0 / 0.0 / 50.0 / 30.0
Solomon Islands / Pacific / 1.2 / 0.0 / 48.5 / 19.0
Somalia / East Africa / 0.9 / 0.0 / 12.0 / 9.0
Sudan / East Africa / N/A / 0.0 / 27.6 / 54.2
Tanzania / East Africa / 30.7 / 0.0 / 39.2 / 56.7
Timor-Leste / Southeast Asia / N/A / 0.0 / 40.9 / 5.7
Togo / West Africa / 18.1 / 0.0 / 38.4 / 47.7
Uganda / East Africa / 17.6 / 0.0 / 15.9 / 61.3
Viet Nam / Southeast Asia / N/A / 0.0 / 18.8 / 2.6
Yemen / Middle-East / N/A / 0.0 / 2.0 / 24.6
Zambia / Southern Africa / 61.9 / 0.0 / 53.3 / 57.9
Zimbabwe / Southern Africa / 6.8 / 0.0 / 27.4 / 23.6

Notes:
* Yellow fill in: Numbers are estimates from the region's average coverage value
*N/A: IPTp is not recommended in the country

Results:

From year 2008 – 2015, a total of more than 2,600,000 children under 5 deaths and 11,000 maternal deaths were averted due to the scale up of coverage of ITNs, Antimalarials, IPTp, and case management of malaria to 95% (RBM target). Similarly, from year 2008-2015, a total of more than 470,000children under 5 deaths and 632 maternal deaths were averted due to the scale up of coverage of the same package of interventions to their respective conservative values as shown in the above table.