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Documenting malaria case management coverage in Zambia: a systems effectiveness approach.
Megan Littrell1, John M Miller, Micky Ndhlovu
1PATH Malaria Control and Evaluation Partnership (MACEPA), Seattle, WA, USA. mlittrell@path.org.
Malaria Journal
|October 29, 2013
Summary
Measuring malaria case management effectiveness requires a new approach beyond traditional surveys. A systems effectiveness framework using household and facility data is crucial for tracking progress and identifying gaps in malaria treatment.
Area of Science:
- Global Health
- Epidemiology
- Health Systems Research
Background:
- National malaria control programs need robust methods to document progress and investments.
- Traditional population-based surveys are insufficient for measuring malaria case management due to declining denominators of febrile children receiving treatment.
Purpose of the Study:
- To examine an alternative sequence of indicators using a systems effectiveness approach to measure malaria case management.
- To assess the feasibility and cogency of applying health facility and population-based data to the systems effectiveness framework for malaria case management coverage.
Main Methods:
- Utilized data from Zambia's 2012 Malaria Indicator Survey (MIS) and 2011 Health Facility Survey (HFS).
- Assessed fever treatment-seeking behavior (MIS) and health facility management of febrile patients (HFS), including diagnostic testing, artemisinin combination therapy (ACT) prescription, and patient comprehension.
Main Results:
- Systems effectiveness for malaria case management in children under five was estimated at 25%.
- Systems effectiveness for malaria case management in individuals aged five and above was estimated at 15%.
Conclusions:
- Progress tracking in malaria case management necessitates a combination of household surveys for treatment-seeking behavior and facility data for appropriate patient management.
- The systems effectiveness framework, integrating facility and population data, is a feasible approach to document malaria case management coverage and pinpoint areas for program improvement.
- In Zambia, treatment-seeking behavior emerged as the primary factor limiting systems effectiveness in malaria case management.
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