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Module 4 Survey design TAS Global Programme to Eliminate Lymphatic Filariasis (GPELF) Training in monitoring and epidemiological assessment of mass drug administration for eliminating lymphatic filariasis Module 4 Survey design

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Learning objectives By the end of this module, you should understand how to determine: 1.a survey site 2.the sampling strategy 3.the sample size 4.a critical cut-off Slide 2

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Module 4 Survey design Overview Target population Survey site Sampling strategy Cluster sampling Systematic sampling Census Sample size Critical cut-off Slide 3

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Module 4 Survey design Determining survey site, sampling strategy and sample size Once the survey area (EU) has been defined, the next steps are to determine the survey site, sampling strategy and sample size. Slide 4 Cluster-based sampling Systematic sampling Census SchoolCommunity Sample size and critical cut-off Evaluation unit 1. Survey area 2. Survey site 3. Sampling strategy 4. Sample size

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Module 4 Survey design For school-based surveys: All children enrolled in selected grades (usually grades 1 and 2) should be considered eligible for the survey sample. For community-based household surveys: All children aged 6–7 years in the EU are eligible for inclusion. Target population Target group: Children aged 6–7 years Why?: Young children should have been protected from infection if MDA was successful in interrupting transmission. Positive test results in this age group therefore usually indicate recent transmission. Slide 5

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Module 4 Survey design If the net primary-school enrolment ratio in the EU is ≥ 75%, the survey can be conducted in schools. The net school enrolment ratio should be confirmed with the ministry of education. The enrolment ratios for the EU should be used, if available. Good judgement should be used if the rates in the EU vary. If the net primary-school enrolment ratio is < 75%, a community-based household survey should be conducted. Survey site Options: School-based survey Community-based household survey Slide 6 A TAS can be conducted in schools or in communities, depending on the proportion of 6- and 7-year-old children in schools.

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Module 4 Survey design Options: Cluster sampling o Cluster = sampling unit = school or enumeration area (smallest area for which census results are available, e.g. village or ward) o Select clusters, then systematically test only children in selected clusters o Advantage: fewer sites to visit Systematic sampling o Sample at all sites o Select children to test at fixed intervals o Advantage: smaller sample Census o No sampling required; test all children in target age range at all sites Sampling strategy Slide 7

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Module 4 Survey design Slide 8 Sampling strategy Choice between cluster and systematic sampling depends on: the total number of children in the target age range (6–7 years) the total number of clusters (i.e. schools or enumeration areas) in the EU A census should be conducted in areas where the total target population is small (i.e. < 400 children in areas where Anopheles or Culex is the principal vector; < 1000 children in areas where Aedes is the principal vector)

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Module 4 Survey design Slide 9 Cluster sampling Step 1: Randomly select clusters (schools or enumeration areas) to be visited Step 2: Randomly select children to be tested only within each selected cluster Often used when the population is large or there are many schools or enumeration areas

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Module 4 Survey design Slide 10 Systematic sampling Often used when the population is small to medium or if there are fewer than 40 schools or enumeration areas Step 1: Visit all schools or enumeration areas Step 2: Randomly select children to be tested in each school or enumeration area

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Module 4 Survey design Slide 11 Census Often used when the population is small < 400 children of target age in areas where Anopheles or Culex is the principal vector < 1000 children of target age in areas where Aedes is the principal vector Step 1: Visit all schools or enumeration areas Step 2: Test all children

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Module 4 Survey design Algorithm for survey site and sampling strategy Slide 12

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Module 4 Survey design Sample size Slide 13 Options: Table A.5.1 or A.5.2 in Annex 5 of the 2011 WHO monitoring and evaluation manual (pp. 73–74) Survey sample builder Sample size depends on the total population of target-age children in the EU and the sampling method used. Because Aedes spp. are more efficient vectors, the target level of antigenaemia is lower in these areas. As a result, the sample sizes will be larger than in areas where Anopheles, Culex or Mansonia is the vector.

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Module 4 Survey design Sample size Slide

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Module 4 Survey design Critical cut-off Slide 15 If the number of positive cases is at or below the established cut-off, the EU ‘passes’, and governments can decide to stop MDA. If the number of positive cases is above the established cut-off, at least two more rounds of MDA should be conducted. Critical cut-off: Threshold of infection prevalence below which transmission is assumed to be no longer sustainable, even in the absence of MDA. TAS provides an estimate of this threshold in the EU as the number of antigen- or antibody-positive cases.

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Module 4 Survey design Critical cut-off Slide

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Module 4 Survey design Critical cut-off in census Slide 17 In areas where a census is conducted, a point prevalence of infection is calculated. MDA can be stopped in: areas of transmission by Culex, Anopheles or Mansonia in which the prevalence is < 2% areas of transmission by Aedes in which the prevalence is <1%

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Module 4 Survey design Exercise Slide 18 1.Using Figure 3 on p. 25 of the 2011 WHO monitoring and evaluation manual: i.determine whether a school-based or a community-based survey is appropriate for the EU(s) defined in module 3. ii.determine whether a cluster, systematic or census sampling design is appropriate. 2.Using Table A.5.1or A.5.2 on pp. 73–74 of the 2011 WHO monitoring and evaluation manual: i.determine the sample size needed for the EU(s) defined in module 3. ii.determine the critical cut-off for the survey(s).

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