MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies
MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies
MALARIA ELIMINATION IN ZANZIBAR - Soper Strategies
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TABLE 7: PRE-<strong>ELIM<strong>IN</strong>ATION</strong> AND <strong>ELIM<strong>IN</strong>ATION</strong> <strong>IN</strong>DICATORS<br />
Epidemiology Foci<br />
Investigation<br />
Activity Indicator Target (targets<br />
between brackets are<br />
not WHO defined)<br />
# Active foci reported<br />
per year<br />
Proportion of reported<br />
foci fully investigated<br />
# cases within a focus<br />
Total population at risk<br />
within a focus<br />
When moving towards elimination, M&E objectives do not change.<br />
The phase specific activities will still need to be monitored and<br />
evaluated, but they shift from a “population” level approach to a<br />
“foci” or even an “individual case” type of approach. The former<br />
looks at coverage of malaria control intervention and prevalence of<br />
malaria in the general population, while the latter evaluates every<br />
single case. In terms of service coverage monitoring, outcome<br />
and process indicators need to be adapted to the activities they<br />
are supposed to evaluate, but in essence the methodologies are<br />
no different from those used in a control program. However,<br />
demonstrating the interruption of local transmission will require<br />
different methods for data collection and will also require proof<br />
that any potential case, even if non-symptomatic, would have<br />
been detected.<br />
The drafts of the M&E Plan and the Early Detection and Response<br />
Plan (2008-2012) of the ZMCP specify the goals and objectives<br />
of malaria-related M&E and discuss the different data sources<br />
-<br />
(100%)<br />
Surveillance NMSS Completeness (100%)<br />
Case<br />
Management<br />
Vector<br />
Control<br />
Entomological<br />
Surveillance<br />
Tracking<br />
Burden<br />
Timeliness Decrease in time<br />
between diagnosis,<br />
reporting and<br />
investigation<br />
# cases reported per<br />
year<br />
Proportion of cases fully<br />
investigated<br />
Diagnosis Total population at risk<br />
Proportion of<br />
case confirmed by<br />
microscopy<br />
Microscopy QA/QC<br />
in place<br />
Treatment Proportion of cases<br />
treated according to the<br />
guidelines<br />
IRS Number and proportion<br />
of at-risk households<br />
that have been sprayed<br />
Larval<br />
Control<br />
(Adapted from WHO, 2007)<br />
Number and proportion<br />
of reported active foci<br />
that were sprayed<br />
Proportion o fknown/<br />
potential breeding sites<br />
treated with chemicals/<br />
fish<br />
Larviciding Proportion of breeding<br />
sites positive for<br />
mosquito larvae<br />
-<br />
-<br />
-<br />
(100%)<br />
-<br />
(100%)<br />
-<br />
(100%)<br />
> 90% (but numbers<br />
of at-risk households<br />
decreases over time<br />
> 90%<br />
> 90%<br />
< 5%<br />
2 | Operational Feasibility<br />
used and variables collected. Although elimination is mentioned,<br />
the currently proposed M&E plan focuses on malaria prevention<br />
and control. However, recognizing the potential implications of<br />
the recently observed low prevalence, the plan also extensively<br />
discusses the need for a routine malaria early detection and<br />
response system.<br />
When moving towards elimination, some of the proposed<br />
indicators and the methods to collect them in the current<br />
M&E plan will need to be adapted or changed. Based on the<br />
WHO recommendations, necessary changes to the M&E plan if<br />
Zanzibar decides to pursue elimination are explored here.<br />
DATA SOURCES AND <strong>IN</strong>DICATORS FOR <strong>MALARIA</strong><br />
<strong>ELIM<strong>IN</strong>ATION</strong><br />
M&E Routine Data Collection<br />
Malaria-related M&E data are collected both through routine<br />
reporting and periodic surveys. The routine systems in place<br />
are the national Health Management and Information System<br />
(HMIS), the health facility-based sentinel surveillance system<br />
(HFBSS), and the ZMCP’s malaria diagnosis quality assurance<br />
program.<br />
When moving towards elimination, the M&E system will need<br />
to demonstrate that all cases have been reported and that the<br />
necessary action has been taken to prevent onward transmission.<br />
This requirement means that the current system of sentinel<br />
surveillance through the 6 HFBSS sites, representing only a<br />
sample of facilities and areas, will need to eventually be abandoned.<br />
All health facilities will need to comply with the standards<br />
currently only applicable to the sentinel sites. In addition, during<br />
elimination and maintenance, the malaria burden will no longer<br />
be evaluated based on the results of surveys (prevalence), but<br />
rather on the number of cases reported from facilities (incidence).<br />
The M&E system will need to collect relevant data in order to<br />
assess whether incidence is being appropriately measured. Key<br />
indicators and data to be collected have been discussed in the<br />
surveillance chapter and some practical recommendations are<br />
given below (programmatic monitoring).<br />
Data Management<br />
The data management will need to be evaluated for completeness,<br />
speed, and accuracy in order to prove beyond doubt that all cases<br />
have been detected and documented. In addition, all cases will<br />
need to be notified as soon as possible to allow for rapid response.<br />
Specific indicators will need to be established to evaluate the<br />
timelines of the reporting system at all levels of the reporting<br />
chain. Potential indicators in this area could include:<br />
�� Time between positive diagnosis at the facility level and<br />
reception of the notification at the ZMCP<br />
�� Time between reception of the malaria case notification and<br />
the arrival of the case investigation team at the health facility<br />
�� Time between the arrival at the health facility and the start of<br />
the preventive measure in the foci<br />
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