Abstract
BackgroundIn the last decade, an important scale-up was observed in malaria control interventions. Madagascar entered the process for pre-elimination in 2007. Policy making needs operational indicators, but also indicators about effectiveness and impact of malaria control interventions (MCI). This study is aimed at providing data about malaria infection, morbidity, and mortality, and MCI in Madagascar.MethodsTwo nationwide surveys were simultaneously conducted in 2012–2013 in Madagascar: a study about non-complicated clinical malaria cases in 31 sentinel health facilities, and a cross-sectional survey (CSS) in 62 sites. The CSS encompassed interviews, collection of biological samples and verbal autopsies (VA). Data from CSS were weighted for age, sex, malaria transmission pattern, and population density. VA data were processed with InterVA-4 software.ResultsCSS included 15,746 individuals of all ages. Parasite rate (PR) as measured by rapid diagnostic tests was 3.1%, and was significantly higher in five to 19 year olds, in males, poorer socio-economic status (SES) quintiles and rural areas. Long-lasting insecticidal nets (LLIN) use was 41.7% and was significantly lower in five to 19 year olds, males and wealthier SES quintiles. Proportion of persons covered by indoor residual spraying (IRS) was 66.8% in targeted zones. Proportion of persons using other insecticides than IRS was 22.8%. Coverage of intermittent preventive treatment during pregnancy was 21.5%. Exposure to information, education and communication messages about malaria was significantly higher in wealthier SES for all media but information meetings. The proportion of fever case managements considered as appropriate with regard to malaria was 15.8%. Malaria was attributed as the cause of death in 14.0% of 86 VA, and 50% of these deaths involved persons above the age of five years. The clinical case study included 818 cases of which people above the age of five accounted for 79.7%. In targeted zones, coverage of LLIN and IRS were lower in clinical cases than in general population.ConclusionsThis study provides valuable data for the evaluation of effectiveness and factors affecting MCI. MCI and evaluation surveys should consider the whole population and not only focus on under-fives and pregnant women in pre-elimination or elimination strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/1475-2875-13-465) contains supplementary material, which is available to authorized users.
Highlights
IntroductionAn important scale-up was observed in malaria control interventions
In the last decade, an important scale-up was observed in malaria control interventions
Interventions studied In Madagascar, malaria control relies on the following interventions: i) long-lasting insecticidal nets (LLIN) distribution; ii) indoor residual spraying (IRS) campaigns; iii) intermittent preventive treatment of pregnant women (IPTp); iv) testing of fever cases by rapid diagnostic tests (RDT) or microscopy; v) treatment of non-complicated malaria cases by artemisinin-based combination therapy (ACT); and, vi) information, education and communication (IEC) campaigns
Summary
An important scale-up was observed in malaria control interventions. In 2012–2013, a project aimed at measuring the coverage and effectiveness of malaria control interventions in Madagascar in terms of infection, morbidity and mortality, and the factors associated with their effectiveness as measured by both quantitative and qualitative approaches was set up. This project was named MEDALI (an acronym for Mission d’Etude des Déterminants de l’Accès aux Méthodes de Lutte antipaludique et de leur Impact), and took place in Madagascar. Are presented i) the design and methodology of the quantitative surveys of the MEDALI project; ii) a nationwide assessment of malaria infections, morbidity and mortality; and, iii) an evaluation of the coverage of malaria control interventions in all population groups
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