Monitoring and evaluation – nets

John Miller

Monitoring and Evaluation

RBM/WHO Malaria

April 18, 2023

M&E and MERG

• Global malaria database established – May 2002• Africa Malaria Report 2003

– www.rbm.who.int or globalatlas.who.int/GlobalAtlas

• Global Malaria Report 2004• M&E Reference Group (MERG)

– Washington, DC (May 2003)– 4 task forces (mortality, morbidity, anemia, surveys/tools)

– Kampala/Nairobi (November 2003)

Available net data

• Net coverage

• Taxes and Tariffs

• ITN Project database

• Net procurement

• Other ?– GFATM requested proposasls/ITNs

Sources of net coverage data

WHO Africa Regional Office (AFRO)• MICS2 (www.childinfo.org) (23)• World Health Surveys (www3.who.int/whs) (18*)• RBM Baseline surveys (17)• DHS (www.measuredhs.com) (13) - malaria module• NETMARK (www.netmarkafrica.org) (5)• AFRO IDS exit interviews (3-4?)• Market surveys (2)• Misc. (literature, MOH reports, PVO/NGO reports,

market surveys)

EM RO• MICS2 (Somalia, northern Sudan)

• World Health Surveys (Pakistan)*

• National malaria survey (Afghanistan)

With net data available

•not available until November 2003DHS = Demographic and Health Survey, IDS = Integrated Disease Surveillance, MICS = Multiple Indicator Cluster Survey, WHS = World Health Survey

PAHO (Americas)• MICS2 (Suriname)

• DHS (Colombia, Nicaragua)

• World Health Surveys (Chile, Ecuador, Guat., Mex., Paraguay, Uruguay )*

WPRO/SEARO• MICS2 (PDR Laos, Viet Nam, Indonesia) • World Health Surveys (Bangladesh, India, PDR Laos, Malaysia,

Myanmar, Nepal, Philippines, Sri Lanka, Viet Nam, )*• DHS (Cambodia)• Routine reporting - ‘Nets treated in last round’ – Kunming

indicators

EURO• MICS2 (Azerbaijan, Turkmenistan)

Net coverage surveys in Zambia

• MICS 1999

• NETMARK 2000

• RBM baseline survey 2001

• DHS 2001-02

• Measles campaign survey 2002 or 03 (?)

• IDS exit interviews from HF (?)

Limitations and next steps

• Understanding available information– Accessing more studies/surveys– Timing, malaria seasonality, malaria distribution– Equity gap

• Next (continued) steps– Standardization of coverage questions (DHS malaria module)

– Working with exiting or new surveys mechanisms to integrate coverage assessment

• National, stand-alone malaria surveys• EPI cluster surveys• AIS (AIDS surveys, MacroDHS)

Use of nets and ITNs among children under age 5 in Zambia

21.9%

13.7%16.5% 16.1%

19.5%17.2% 18.3%

16.5%13.6% 13.6%

10.5%

19.4%17.6%

22.5%

18.1%

13.6%

21.6%

7.6%

17.4% 16.3%

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

Urb

an

Ru

ral

Ma

le

Fe

ma

le

< 6

mo

nth

s

6-1

1 m

on

ths

12

-23

mo

nth

s

24

-35

mo

nth

s

36

-47

mo

nth

s

48

-59

mo

nth

s

Ce

ntr

al

Co

pp

erb

elt

Ea

ste

rn

Lu

ap

ula

Lu

saka

No

rth

ern

No

rth

-We

ste

rn

So

uth

ern

We

ste

rn

To

tal

MICS 1999 - any nets

DHS 2001-02 - any nets

MICS 1999 - ITNs

DHS 2001-02 - ITNs

RBM Partnership - Category One

Country WHO Region 1998 1999 2000 2001 2002 2003 2004Benin AFRO RBM DHS

Eritrea AFRO RBM DHS

Ethiopia AFRO DHS RBM WHS

Ghana AFRO DHS RBM SPA DHS/WHS

Kenya AFRO DHS MICS RBM DHS/WHS

Malawi AFRO DHS RBM WHS

Mali AFRO DHS WHS

Nigeria AFRO DHS RBM DHS

Senegal AFRO DHS* MICS DHS/WHS

Sudan EMRO MICS

Tanzania, UR AFRO DHS HBS/RBM AIS

Uganda AFRO DHS/RBM AIS

Zambia AFRO MICS RBM DHS WHS

Zimbabwe AFRO DHS RBM WHS

Household Surveys

Household Survey Status in Africa south of the Sahara (as of 1 September 2003)

•partial DHS,last full DHS 1997•AIS = AIDS survey (MacroDHS)•DHS = Demographic and Health Survey•HBS = Household Budget Survey•MICS = Multiple Indicator Cluster Survey•RBM = RBM baseline survey•WHS = World Health Survey

Net procurement by WHO (2000-03) and UNICEF (1999-2002) destined for Africa

-

200,000

400,000

600,000

800,000

1,000,000

1,200,000

1,400,000

1,600,000M

ala

wi

Eth

iopia

Mo

zam

biq

ue

Su

dan

Ma

li

Nig

eria

Ghana

Ke

nya

An

gola

Zam

bia

Se

nega

l

DR

C

So

ma

lia

Eri

trea

Zim

babw

e

Bu

rundi

Nig

er

Be

nin

Lib

eria

Ugand

a

Bu

rkin

a F

aso

Ma

da

gasc

ar

Rw

an

da

Togo

Bo

tsw

ana

Ma

uri

tan

ia

Gam

bia

Congo

Nam

ibia

Cote

d I

voir

e

Sie

rra L

eo

ne

Chad

Guin

ea-B

issa

u

Com

oro

s

Sa

o T

om

e &

Pri

n.

Cam

ero

on

Guin

ea

CA

R

Eq

. G

uin

ea

Sw

azi

lan

d

So

uth

Afr

ica

Gabon

UR

Tan

zan

ia

Nu

mb

er

of

ne

ts

UNICEF WHO

Source: Roll Back Malaria, 2003

Source: Roll Back Malaria, 2003

Estimated total number of mosquito nets and ITNs currently available in 43 countries in Africa south of the Sahara

-

500

1,000

1,500

2,000

2,500

3,000

3,500

UR

Ta

nza

nia

Ken

ya

Nig

eria

Mal

i

Sud

an, N

ort

h

Mad

aga

scar

Co

ngo,

DR

Sou

th A

fric

a

Gha

na

Gui

nea

Zam

bia

Moz

ambi

que

Ug

anda

Ch

ad

Ben

in

Bur

kina

Fas

o

Ca

me

roo

n

Nig

er

Gui

nea

-Bis

sau

Ang

ola

Erit

rea

Co

te d

Ivo

ire

Som

alia

CA

R

Mau

rita

nia

Mal

awi

Zim

babw

e

Gab

on

Sen

egal

Sie

rra

Leo

ne

Tog

o

Co

ngo

Gam

bia

Eth

iopi

a

Libe

ria

Rw

and

a

Bur

und

i

Na

mib

ia

Bot

swa

na

Co

mo

ros

Sao

Tom

e &

Prin

.

Eq.

Gu

inea

Sw

azila

nd

Est

imat

ed N

um

ber

of

net

s o

r IT

Ns

(000

s)

Any mosquito nets

ITNs

Source: Roll Back Malaria, 2003

Target populations = children under age 5 and pregnant women

Total number of mosquito nets or ITNs as a percentage of total target populations in 43 countries in Africa south of the Sahara

0%

20%

40%

60%

80%

100%

120%

140%

160%

Gui

nea-

Bis

sau

Gab

on

Sao

Tom

e &

Prin

.

Gam

bia

Mau

ritan

ia

Mal

i

Erit

rea

Gui

nea

CA

R

Com

oros

Mad

agas

car

Ben

in

UR

Tan

zani

a

Zam

bia

Cha

d

Ken

ya

Gha

na

Sud

an,

Nor

th

Con

go

Nam

ibia

Bot

swan

a

Tog

o

Sie

rra

Leon

e

Libe

ria

Bur

kina

Fas

o

Sou

th A

fric

a

Som

alia

Moz

ambi

que

Eq.

Gui

nea

Cam

eroo

n

Nig

er

Ang

ola

Con

go,

DR

Sen

egal

Zim

babw

e

Cot

e d

Ivoi

re

Mal

awi

Uga

nda

Bur

undi

Nig

eria

Rw

anda

Sw

azila

nd

Eth

iopi

a

Per

cen

t

Any mosquito nets

ITNs

Source: Roll Back Malaria, 2003

Abuja Summit target populations in 43 countries in Africa south of the Sahara

60,02974,027

100,049

573,855

23,329 13,998

123,378

344,313

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

Total population Children under 5years of age

Pregnant women Total (children under5 and pregnant

women)

Total population(60%)

Children under 5years of age (60%)

Pregnant women(60%)

Total (children under5 and pregnantwomen) (60%)

Est

imat

ed P

op

ula

tio

n (

000s

)

All areas

All malaria risk areas

Endemic malaria risk areas

60% Abuja targets - population

Source: Roll Back Malaria, 2003

Abuja Summit target populations and currently available nets in households in 43 countries in Africa south of the Sahara

60,02974,027

344,313

13,998

26,341

3,971

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

Estimated totalmosquito nets

currently available

Estimated total ITNscurrently available

Total population(60%)

Children under 5years of age (60%)

Pregnant women(60%)

Total (children under5 and pregnantwomen) (60%)

Est

imat

ed N

ets

or

Po

pu

lati

on

s (0

00s) All areas

All malaria risk areas

Endemic malaria risk areas

60% Abuja targets - population

0

25

50

75

0 20 40 60 80

% of households possessing net(s)

% o

f chi

ldre

n sl

eepi

ngun

der

net

Benin

GambiaKenya

MalawiMozambique

NigeriaRwanda

Senegal

TanzaniaUganda

ZambiaZimbabwe

Source: Korenromp, Miller et al, 2003

Correlation between reported household possession and use for children under 5 years of mosquito nets in Africa.

• Not all households that possess at least one mosquito net have children under age 5 or pregnant women that use mosquito nets

0

5

10

15

20

25

0 10 20 30

% of households possessing ITN(s)

% o

f chi

ldre

n sl

eepi

ngun

der

ITN

MozambiqueUgandaNigeriaZambia

SenegalKenya

Source: Korenromp, Miller et al, 2003

Correlation between reported household possession and use for children under 5 years of ITNs in Africa.

• Not all households that possess at least one ITN have children under age 5 that use ITNs• More ITNs than the total number of children and pregnant women will be needed to

achieve 60% ‘use’ targets • Targeting of ITN distribution and monitoring is important!!

Abuja Summit target households and currently available nets in households in 43 countries in Africa south of the Sahara

17,168

3,971

26,341

89,173

112,009

72,005

-

20,000

40,000

60,000

80,000

100,000

120,000

140,000

Estimated total mosquitonets currently available

Estimated total ITNscurrently available

All With children under 5years of age

With pregnant women Total (children under 5or pregnant women)

Est

imat

ed N

ets

or

Ho

use

ho

lds

(000

s) All areas

All malaria risk areas

Endemic malaria risk areas

Households

Source: Roll Back Malaria, 2003

PSI World Relief Plan International

Canadian Physicians for Aid and Relief

Synod of Livingstonia

ITN Projects in Malawi

Data source: ITN Project database 2002

Map ProductionPublic Health Mapping Group, Communicable Diseases (CDS), World Health Organization© World Health Organization 2003

The boundaries and names shown and the designations used on this map do not imply the expression of an opinion whatsoever on the part of the World Health Organizationconcerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.