MALAGASY MALARIA TOOL BOX MONITORING AND EVALUATION MALARIA IN MADAGASCAR

描述(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。至关重要的是，国家疟疾控制方案和减少疟疾伙伴密切监测疟疾发病率和死亡率的趋势，并评估干预措施的复盖面和影响。此外，2008-2012年马达加斯加国家疟疾防治战略的目标是使该国实现预先消灭和最终消灭疟疾。需要高质量、有效和及时的监测，以监测实现这些目标的进展情况。在马达加斯加的不同地理区域，疟疾的流行病学、干预战略和卫生部门发展有很大差异。2007年，在最初的13个地理位置不同的地点启动了一个综合发烧哨点监测系统，截至2011年1月，该系统每年扩大到总共31个业务地点。监测系统选址的依据是各种标准，包括疟疾流行病学和疟疾干预复盖面方面的多样性，以便在各种情况下跟踪注重成果的管理指标。哨点监测网目前使用临床病例定义和标准报告方法报告每日发烧疾病监测信息(参考。Randrianasolo等人)。自成立以来，哨点监测系统的数据一直被用来定期监测疾病趋势，并及时发现了几起疫情，包括基孔肯雅热、裂谷热和疟疾。自2009历年以来，总统疟疾倡议支持了最初的13个哨点监测点，并于2010年开始支持另外2个监测点，使受总统疟疾倡议支持的地点总数达到15个。2010年3月，PMI对IPM的发烧哨点网络进行了质量评估，以评估收集的数据的质量和周期性，评估卫生部和合作伙伴在国内如何使用这些数据，并评估该系统的整体管理情况。2003年至2009年期间，通过国家卫生管理信息系统报告的疟疾病例和死亡人数呈现发病率和死亡率下降的趋势。总体而言，可归因于疟疾的住院死亡从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，在所有报告的门诊就诊中，疟疾约占4%，在所有住院的五岁以下儿童中，有14%被诊断出患有严重疟疾(InStat，2010)。尽管如此，疟疾仍然是五岁以下儿童死亡的主要原因，根据联合国儿童基金会的数据，每年约有2万名马达加斯加儿童死于疟疾。不幸的是，与许多国家一样，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等人)。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，这样的人口监测系统在莫拉曼加地区才刚刚开始。 这项工作的目标包括： 1.通过哨点监测网络确定马达加斯加疟疾的负担和监测趋势 2.确定昆虫学活动和方法，将昆虫学数据与人类疟疾病例数据联系起来，以便更准确地监测疟疾控制方案的进展情况。 3.评估疟疾方案的活动，特别是但不限于评估社区综合病例管理在减少疟疾相关发病率和死亡率方面的有效性。

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.