Consultative meeting that examined alignment and discrepancies between health facility and household survey data in Malawi

Abstract

Malawi is midway through its current Malaria Strategic Plan 2017–2022, which aims to reduce malaria incidence and deaths by at least 50% by 2022. Malariometric data are available with health surveillance data housed in District Health Information Software 2 (DHIS2) and household survey data from two recent Malaria Indicator Surveys (MIS) and a Demographic and Health Survey (DHS). Strengths and weaknesses of the data were discussed during a consultative meeting in Lilongwe, Malawi in July 2019. The first 3 days included in-depth exploration and analysis of surveillance and survey data by 13 participants from the National Malaria Control Programme, district health offices, and partner organizations. Key indicators derived from both DHIS2 and MIS/DHS sources were analysed with three case studies, and presented to stakeholders on the fourth day of the meeting. Applications of the findings to programmatic decision-making and strategic plan evaluation were critiqued and discussed.

Asymptomatic Plasmodium falciparum malaria prevalence among adolescents and adults in Malawi, 2015–2016

“…Additionally, 49.0% of the nets used by pregnant women for sleeping were less than one year old, compared with 37.2% in the general population. While the general population receives bed nets every three years as part of regular mass distribution campaigns, Malawi’s National Malaria Control Programme has given out free LLINs to pregnant women through antenatal care clinics since 2006 11 with 79–87% of pregnant women who attended antenatal clinics receiving LLINs in 2015–16 11 . Although WHO recommendations allow for up to three years between mass distribution campaigns 34 , field research in Benin, Malawi, Rwanda, Senegal, and Tanzania suggests that ITNs have a limited lifespan of two years before protection is compromised by holes, insecticide-resistance, and reduced concentrations of insecticide 35 – 39 .…”

“…Despite existing limitations, this analysis provides valuable input into an understudied yet critical group to consider in efforts to interrupt ongoing malaria transmission. Malawi spent an estimated $82 million on malaria control in 2016 45 and malaria accounts for 30% of all outpatient visits and 34% of inpatient hospital admissions 11 . Households often amass high direct and indirect costs due to clinical malarial disease, despite free diagnosis and treatment 46 .…”

“…Households often amass high direct and indirect costs due to clinical malarial disease, despite free diagnosis and treatment 46 . One of the primary goals of the Malawi Malaria Strategic Plan 2017–2022 is to achieve universal LLIN coverage for all households 11 . Research from Madagascar shows that while LLIN mass distribution campaigns may only provide community protection for one year, protection can be sustained when campaigns are followed by continuous LLIN distribution to eligible households, including recently married couples, immigrants, children of vaccination age, and homes with uncovered sleeping areas 47 .…”

“…Cluster level covariates included region, urban/rural place of residence, elevation, month of data collection, landcover, the proportion of a cluster with bed nets, and the proportion of a cluster that slept under an LLIN. As transmission intensity is seasonal in Malawi, with peak transmission between January and May due to greater rainfall 11 , 24 , we also examined environmental variables at the cluster level including current month’s average daily maximum temperature, and the prior month’s precipitation. Modeled monthly precipitation and monthly average daily maximum temperature raster files, created from both in-situ weather station data and satellite imagery, were acquired from the Climate Hazards Center at the University of California, Santa Barbara 16 , 17 .…”

“…In Malawi, malaria risk has been found to be modified by several environmental factors, including elevation, rainfall, temperature, and proximity to active agriculture 7 – 9 . Insecticide-treated bed nets (ITN) are Malawi’s primary vector control strategy 10 , with bed nets given to all households with pregnant women, newborn babies, and to the general population every three years through mass distribution campaigns 11 . ITNs act as both a physical and chemical barrier to repel and kill mosquitoes which land on the net 12 .…”