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Malaria indicator survey to support national control programmes in Malawi from ACT Consortium on Vimeo.

Scientific title: Determining sub-national intervention coverage and malaria impact estimates in young children and older age groups using a continuous Malaria Indicator Survey in Chikhwawa district, Malawi

What did we know before this research?
In areas where malaria transmission rates are moderate to high, the progress of malaria control is mainly evaluated using national household surveys such as Malaria Indicator Surveys (MIS), Demographic Health Surveys (DHS) or UNICEF Multiple Indicator Cluster Surveys (MICS). These are then complemented by data from Health Management Information Systems (HMIS).

Household surveys provide estimates of national and regional population every two to five years. However, this focus on average estimates does not take into account that the levels of transmission are very diverse within countries and districts. Also, control efforts include additional interventions - such as indoor residual spraying (IRS) - that target highly affected areas.

It is widely recognised that more accurate estimates could help optimise the efforts to control malaria transmission at the national level, but there are no recommended standardised survey tools for monitoring and evaluation (M&E) at the district level.

What does this study add?
There is increasing focus on reducing malaria transmission and using ACT drugs at population level. The use of ‘rolling’ household surveys - where data is collected over one or several years by small permanent teams - could become a complementary tool to national malaria surveys in selected settings, to determine the progress of malaria control. This includes disease transmission, disease burden, intervention coverage and access to ACT drugs within districts.

This is a complementary study to the ACTia trial that will determine the value and feasibility of using long-term local continuous Malaria Indicator Surveys to provide timely and local data that can inform more targeted control efforts. It will also determine the added value of expanding such surveys to children under five – to include older children and adults.

The research team
Principal Investigators

Dr Anja Terlouw, Liverpool School of Tropical Medicine

Prof David Lalloo, Liverpool School of Tropical Medicine

Dr. Sanie Sesay, Liverpool School of Tropical Medicine, UK and University of Malawi

Other Investigators

Dr Kamija Phiri, Associate Professor, COM
Prof Peter Diggle, University of Liverpool/University of Lancaster
Emanuele Giorgi, PhD student, University of Lancaster

Latest on this research
The field work ended in June 2013, completing a full period of three years of a continuous Malaria Indicator Survey until the end of the ACTia trial. Analysis is currently ongoing.

Preliminary findings show how low-cost continuous malaria surveys like these can be used to identify the variation in the coverage of both malaria transmission and interventions, and access to ACT across an area over time. By using the same indicators as national surveys, these provide complementary, timely, local data to inform more targeted control efforts and use of resources by local programme managers.