MICS4 Survey Design Workshop Multiple Indicator Cluster Surveys Survey Design Workshop Questionnaire for Children Under Five: Malaria

MICS4 Survey Design Workshop Global goals and targets MDG 6: Combat HIV/AIDS, malaria and other diseases –Target 6.C By 2015 have halted and begun to reverse the incidence of malaria and other major diseases Indicator 6.6 Incidence and death rates associated with malaria Indicator 6.7 % of children under five sleeping under ITNs (MICS) Indicator 6.8 % of children under five treated with anti-malarials (MICS) RBM Global Malaria Action Plan (2008) –Achieve universal coverage…with interventions for prevention and case management by 2010 (MICS) –Halve the malaria burden between 2000 and 2010 –Eliminate malaria in 8-10 countries by 2015…and in the long-term eradicate malaria worldwide…

MICS4 Survey Design Workshop Background WHO estimates million malaria episodes in 2006, resulting in nearly 1 million deaths About 90 per cent of all malaria deaths occur in sub-Saharan Africa, most among children under five Significant funding toward malaria control, and significant progress in scaling up ITNs in recent years Major focus by RBM partners on achieving universal coverage targets by end-2010

MICS4 Survey Design Workshop MICS Indicators # 3.18: Anti-malarial treatment of children under age 5 - % under fives with fever receiving any anti-malarial medicine # 3.17: Anti-malarial treatment of children under 5 the same or next day - % under fives with fever who were treated with any anti-malarial drug within the same or next day of onset of symptoms (NEW) # 3.16: Malaria diagnostics usage - % under fives with fever receiving a finger or heel stick for malaria testing (NEW)

MICS4 Survey Design Workshop Survey questions Questions ML.1 – ML.10 in U5 questionnaire –ML.1: Fever prevalence (Same as MICS3) –ML.2: Malaria diagnostics use (New) At the time of the illness, did (NAME) have blood taken from his/her finger or heel for testing? –ML.3 – ML.10: Anti-malarial treatment (by timing, place of treatment and drug type) (Same as MICS3)

MICS4 Survey Design Workshop Methodological issues Survey preparation Different anti-malarial medicines used in different countries Develop list of local anti-malarial drugs and brand names (with photos or samples, if possible) Obtain list of first-line anti-malarial treatment (available on WHO website). Note that most African countries recommend ACT for first-line treatment of uncomplicated malaria

MICS4 Survey Design Workshop Methodological issues MICS often carried out in the dry season for logistical reasons; not during times of peak malaria transmission. MICS does not measure coverage among sub-national populations at risk for malaria transmission Responses limited by caregivers knowledge of drugs given to treat fever, and recall of treatment timing after fever onset Does not measure proper dosage or treatment administration

MICS4 Survey Design Workshop Methodological issues Fever may not be the result of malaria infection Issue even more problematic with roll out of diagnostics, coupled with major declines in malaria cases – interpreting trends may become more complicated in future Comparing historical data based on presumptive fever treatment with coverage based on diagnosed cases will inevitably show declining coverage over time – but in fact reflects more rational use of anti-malarial medicines New question on diagnostics use will help to interpret trends