MALAGASY MALARIA TOOL BOX MONITORING AND EVALUATION MALARIA IN MADAGASCAR

描述（由申请人提供）：疟疾是马达加斯加的一个主要公共卫生问题，在该国约90%的地区流行。但是，整个人口都被认为有患这种疾病的风险。由于来自多个来源的资金增加，马达加斯加控制疟疾的措施正在扩大。国家疟疾控制规划和减疟伙伴必须密切监测疟疾发病率和死亡率的趋势，并评估干预措施的覆盖范围和影响。此外，马达加斯加制定了《2008-2012年国家疟疾控制战略》，其目标是推动该国实现疟疾的预消除和最终消除。需要进行高质量、有效和及时的监测，以监测实现这些目标的进展情况。疟疾的流行病学、干预战略和保健部门的发展在马达加斯加各地理区域之间差别很大。2007年，在13个最初地理位置不同的地点开始了一个综合发热哨点监测系统，并于2011年1月每年扩大到总共31个工作地点。监测系统站点是根据各种标准选择的，包括疟疾流行病学和疟疾干预覆盖方面的多样性，以便在各种环境中跟踪疟疾防治指标。哨点监测网络目前使用临床病例定义和标准报告方法报告每日发热性疾病监测信息（参考文献Randrianasolo等）。自建立以来，哨点监测系统的数据已用于定期监测疾病趋势，并及时确定了几次疫情，包括基孔肯雅热、裂谷热和疟疾。自2009日历年以来，总统疟疾行动支持了最初的13个哨点监测点，并于2010年开始支持另外2个哨点，使总统疟疾行动支持的哨点总数达到15个。2010年3月，PMI对IPM的发热哨点网络进行了质量评估，以评估所收集数据的质量和周期性，评估卫生部和合作伙伴在国内使用数据的情况，并评估该系统的整体管理情况。通过国家卫生保健信息系统报告的疟疾病例和死亡情况显示，2003年至2009年期间发病率和死亡率呈下降趋势。总体而言，疟疾导致的住院死亡率从2003年的17%下降到2009年的6%（国家疟疾控制方案，2010年4月）。2009年，疟疾在所有报告的门诊就诊中估计占4%，在所有入院的5岁以下儿童中，有14%被诊断患有严重疟疾（INSTAT， 2010年）。尽管如此，疟疾仍然是5岁以下儿童死亡的主要原因，据儿童基金会称，每年约有20 000名马达加斯加儿童死于疟疾。不幸的是，在许多国家，特别是在非洲，常规卫生信息系统产生的信息的质量和可靠性很差，卫生信息系统很少提供关于社区一级疟疾负担的信息（参考文献：REMMEJHF等）。监测非洲疟疾死亡率趋势的唯一选择可能是通过特定地点的人口监测系统。幸运的是，这种人口监测系统在莫拉曼加地区才刚刚开始。

DESCRIPTION (provided by applicant): Malaria is a major public health problem in Madagascar where it is endemic in approximately 90% of the country. But, the entire population is considered to be at risk for the disease. Measures to control malaria in Madagascar are being scaled up thanks to the increased funding from multiple sources. It is essential that the National Malaria Control Programme and Roll Back Malaria Partners closely monitor the trends in malaria morbidity and mortality and evaluate the coverage and impact of interventions. Moreover, with the Madagascar National Strategy for Malaria Control, 2008-2012, has been designed with the goal of moving the country towards malaria pre-elimination and eventually elimination. High quality, effective and prompt surveillance is needed to monitor progress towards these goals. The epidemiology of malaria, intervention strategies and health sector development vary considerably among geographical regions of Madagascar. In 2007 an integrated fever sentinel surveillance system was begun in 13 initial geographically distinct sites and expanded yearly to a total of 31 operational sites as of January 2011. The surveillance system sites were chosen based on various criteria including diversity in terms of malaria epidemiology and malaria intervention coverage in order to track RBM indicators in various settings. The sentinel surveillance network currently reports daily febrile disease surveillance information using clinical case definitions and standard reporting methodology (ref. Randrianasolo et al). Since it's inception, data from the sentinel surveillance system have been used to regularly monitor disease trends and have identified several outbreaks in a timely manner, including chikungunya, rift valley fever and malaria. Since calendar year 2009, the President's Malaria Initiative (PMI), has supported the initial 13 sentinel surveillance sites and in 2010 began supporting 2 additional sites bringing the total to 15 total sites supported by PMI. In March 2010, PMI conducted a quality assessment of the IPM's fever sentinel site network to evaluate the quality and periodicity of data collected, to assess how the data is used in country by the MoH and partners and to assess the overall management of the system. Reported malaria cases and deaths through the national HMIS system have shown decreasing trends in morbidity and mortality between 2003 and 2009. Overall, hospital deaths attributed to malaria decreased from 17% in 2003 to 6% in 2009 (National Malaria Control Program, April, 2010). In 2009, malaria was responsible for an estimated 4% of all reported outpatient visits and 14% of all children under five years of age admitted to a hospital were diagnosed with severe malaria (INSTAT, 2010). In spite of this, malaria remains a leading cause of under-five mortality and, according to UNICEF, kills approximately 20,000 Malagasy children every year. Unfortunately, as in many countries, especially in Africa, the quality and reliability of information generated by the routine health information system is poor and the health information system rarely provides information on the burden of malaria at the community level (ref : REMMEJHF et al). The only option for monitoring trends in malaria mortality in Africa may be through demographic surveillance systems in specific sites. Fortunately such demographic surveillance system is just beginning in the district of Moramanga. The objectives of this work include: 1. Identify the burden and monitor trends of malaria in Madagascar through sentinel surveillance, network 2. Identify entomological activities and methodologies to link entomological data with human malaria case data in order to more accurately monitor the progress of the malaria control program. 3. Evaluate malaria program activities especially but not limited to assessing the effectiveness of integrated community case management in reducing malaria associated morbidity and mortality.