Indicators in Malaria Program Phases By Bayo S Fatunmbi [Technical Officer, Monitoring & Evaluation] ERAR-GMS, WHO Cambodia & Dr. Michael Lynch Epidemiologist.

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Indicators in Malaria Program Phases

Indicators in Malaria Program PhasesByBayo S Fatunmbi[Technical Officer, Monitoring & Evaluation] ERAR-GMS, WHO Cambodia& Dr. Michael LynchEpidemiologist Strategy Economics and Elimination UnitWHO Headquarters

Indicators in Malaria Program phases: Learning objectivesAt the end of the session, participants should be able:To understand the specific indicators in different phases of malaria eliminationTo adapt generic indicators to country malaria context: transmission reduction and eliminationTo identify few relevant indicators for transitioning from control to elimination; andTo provide country data on selected prioritized indicatorsIndicators in Transmission Reduction PhaseIndicator Definition / CalculationPurposeConfirmed malaria cases (number and rate per month or per year)Number of confirmed malaria cases x 1000 / Population at risk of malariaTo measure trends in malaria morbidity and to identify locations of ongoing malaria transmission. This indicator is the most important measure of progress and management in low-incidence areas.Inpatient malaria cases (number and rate per month or per year)Number of inpatient malaria cases x 10,000 / Population at risk of malariaTo monitor the impact of programs on severe disease. This indicator may reflect the impact of treatment, as treatment attenuates clinical progression from uncomplicated to severe disease.Inpatient malaria deaths (number and rate per month or per year)Number of inpatient malaria deaths x 100,000 / Population at risk of malariaTo monitor the impact of programs on the number of malaria deathsIndicators in Transmission Reduction PhaseIndicator Definition / CalculationPurposeMalaria test positivity rate (RDT and/or blood slide)Number of confirmed malaria cases x 1000 / Number of patients receiving a parasitological testTo reflect trends in malaria morbidity and identify areas with the most intense malaria transmission. Percentage of cases disaggregated by speciesNumber of confirmed malaria cases by species x 100 / Number of confirmed malaria casesTo reflect the proportion of cases due to various species and provide information on the likelihood of observing severe casesPercentage of inpatient cases with a discharge diagnosis of malariaNumber of inpatient cases with a discharge diagnosis of malaria x 100 / Total number of inpatientsTo monitor the impact of programs on severe disease. Percentage of inpatient deaths due to malariaNumber of inpatient deaths due to malaria x 100 / Total number of inpatient deathsTo monitor the impact of programs on the number of malaria deaths. Indicators in Transmission Reduction PhaseIndicator Definition / CalculationPurposeAnnual blood examination rateNumber of patients receiving a parasitological test x 100 / Population at risk of malariaTo reflect the extent of diagnostic testing in a population; aids interpretation of other surveillance indicators.Percentage of suspected malaria cases that have had a diagnostic testNumber of patients receiving a parasitological test x 100 / Number of suspected cases of malariaWHO recommends that all suspected malaria cases should receive a diagnostic test by microscopy or RDT, regardless of age. The indicator reflects the extent to which malaria programs are able to achieve this goal and where further effort may be required. Completeness of health facility reportingNumber of health facilities reports received x 100 / Number of health facilities expectedRegular monitoring and follow-up can improve the completeness of reporting until all health facilities are consistently reporting every month. Aids interpretation of other surveillance indicators.Monitoring & Evaluation in Malaria EliminationEmphasis is on: Program operational aspects input, process, output, outcome and impactEpidemiological changes resulting from implementationInterpreting results and informing program decisionsDocumentation and ReportingKey message:Select indicators as relevant to program phase, review periodically SME coordinating working group / committee is usefulDevelop an indicator framework that ensures common understanding by all stakeholders

Malaria Elimination indicators (1):IndicatorTarget or NormData SourceImpact:Number and incidence rate of confirmed malaria cases by classification, sex, age group, risk group (e.g. school children, migrant workers) Immediate notification Number of foci by classification Immediate notification Quantity and quality of surveillance: Annual blood examination rate by district and focus detected passively and actively Indicative target in endemic, residual active, new active and residual non-active foci: 8% of population in focus

Indicative target in cleared up and new potential foci: 13% of population in focus District monthly and annual reports database Malaria Elimination indicators (2):IndicatorTarget or NormData SourceQuantity and quality of surveillance: % of expected monthly reports received from health facilities and laboratories (with number of patients tested for malaria and number positive) Target: 100% District monthly reports database % of confirmed cases fully investigated (including case investigation form, focus investigation form and active case detection) Target: 100% Malaria case investigation database % of foci fully investigated (malaria focus investigation form completed, including data from an entomological investigation) and registered (on register, with maps of each focus) Target: 100% Malaria focus database Malaria Elimination indicators (3):IndicatorTarget or NormData SourceQuantity and quality of surveillance: Time from first symptom (fever) to first contact with the health system Norm: within 48 h Malaria case investigation database Time from first contact to testing Norm: within 24 h Malaria case investigation database Time from positive test result to start of treatment Norm: same day Malaria case investigation database Time from positive test result to notification of the national malaria programme (to district or intermediate level, with copy to central level) Norm: same day Malaria case investigation database Malaria Elimination indicators (4):IndicatorsTarget or NormData SourceQuantity and quality of surveillance: Percentage of malaria testing laboratories participating in quality management system (all positive slides and 10% of negatives sent for retesting and the blind proficiency test completed each year) Target: 100% External quality assurance database Percentage of past 5 years with national annual malaria programme report Target: 100% Country Group work ExerciseSelect the most advanced province in terms of transition to malaria elimination in your country Review the generic indicators as proposed by WHO and identify 4 that reflects surveillance system performanceDefine and apply the identified indicators to the selected province Provide 2014 data from the province for each of the identified indicators

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