Selection of Priority Geographic Areas

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by Judd L Walson, MD, MPH
University of Washington
Dept. of Global Health, Internal Medicine (Infectious Disease), Pediatrics adn Epidemiology

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  • Integrated Prevention Campaigns: Evidence for Impact and Efficiency, Global Potential, and SustainabilitySelection of priority geographic settingsIPC global applicability: potential coverage, health impacts, costs
  • Population: Total country population, 2010 data. Source: World Bank - http://data.worldbank.org/indicator/SP.POP.TOTLTotal DALY burden: Total annual DALYs for diarrhea, malaria and HIV/AIDS. Source: calculated as sum of DALYs across the 3 diseases.DALYs per capita: DALYs per person, calculated as total DALY burden divided by population. Under-5 mortality rate: Deaths in children <5 yrs per 1,000 live births, in 2011. Source: IHME http://www.healthmetricsandevaluation.org/ghdx/record/child-mortality-estimates-and-mdg-4-attainment-country-1990-2011Overall mortality (adult + child): Crude death rate, per 1,000 people (number of deaths per year, in 2010, estimated at midyear. Source: The World Bank. http://data.worldbank.org/indicator/SP.DYN.CDRT.IN/countriesLife expectancy: Average LE for males and females at birth. Source: The World Bank. Life expectancy at birth, total (years): http://data.worldbank.org/indicator/SP.DYN.LE00.IN.Diarrhea burden: proportion of childhood(<5) deaths due to diarrhea. Source: Black et al, Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010.Annual deaths: Total number of deaths from diarrheal disease in children <5 yrs. Source: Black et al, Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010.DALYs: Total DALYs from diarrheal disease in children < 5 yrs. Source: derivation.Improved drinking water coverage: % of population using an improved drinking water source, 2010 data. Source: Global Health Observatory Data Repository - Water, sanitation and hygiene, Exposure: http://apps.who.int/ghodata/?vid=360#Malaria burden (WHO): Malaria deaths per 100,000 people (all ages) per year. Source: WHOMalaria burden (IHME): Malaria deaths per 100,000 people (0–4 years) per year. Source: IHMEAnnual deaths: Total number of deaths from malaria in children <5 yrs. Source: Black et al, Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010.DALYs: Total DALYs from malaria in children < 5 yrs. Source: derivation.Total PAR (WHO): Percent of the population at risk for malaria (all types) in 2010. Value = total from high- and low-transmission areas. Source: WHO World Malaria Report 2011.Malaria endemicity: % of the population in malaria endemic areasITN coverage: % of households owning at least 1 insecticide-treated net. Countries with greater than 100% reported have been corrected to 100, and are designated with an asterisk. Source: World Malaria Report 2011, Annex 4. 2010 data. http://www.who.int/malaria/world_malaria_report_2011/en/HIV burden: Prevalence in 15-49 year olds. Source: AIDSInfo database, via Gapminder.orgAnnual deaths: Total number of deaths from HIV/AIDS (children+adults). Source: UNAIDS AIDSInfo database.DALYs: Total DALYs from HIV/AIDS. Source: derivation.Pregnant women tested, coverage: % of pregnant women tested for HIV based on facility registers for ANC, L&D and postpartum care. Denominator = # pregnant women giving birth in the last 12 months. Source: Global Health Observatory Data RepositoryART coverage (CD4<350): Source: Gapminder.org
  • Population: Total country population, 2010 data. Source: World Bank - http://data.worldbank.org/indicator/SP.POP.TOTLTotal DALY burden: Total annual DALYs for diarrhea, malaria and HIV/AIDS. Source: calculated as sum of DALYs across the 3 diseases.DALYs per capita: DALYs per person, calculated as total DALY burden divided by population. Under-5 mortality rate: Deaths in children <5 yrs per 1,000 live births, in 2011. Source: IHME http://www.healthmetricsandevaluation.org/ghdx/record/child-mortality-estimates-and-mdg-4-attainment-country-1990-2011Overall mortality (adult + child): Crude death rate, per 1,000 people (number of deaths per year, in 2010, estimated at midyear. Source: The World Bank. http://data.worldbank.org/indicator/SP.DYN.CDRT.IN/countriesLife expectancy: Average LE for males and females at birth. Source: The World Bank. Life expectancy at birth, total (years): http://data.worldbank.org/indicator/SP.DYN.LE00.IN.Diarrhea burden: proportion of childhood(<5) deaths due to diarrhea. Source: Black et al, Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010.Annual deaths: Total number of deaths from diarrheal disease in children <5 yrs. Source: Black et al, Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010.DALYs: Total DALYs from diarrheal disease in children < 5 yrs. Source: derivation.Improved drinking water coverage: % of population using an improved drinking water source, 2010 data. Source: Global Health Observatory Data Repository - Water, sanitation and hygiene, Exposure: http://apps.who.int/ghodata/?vid=360#Malaria burden (WHO): Malaria deaths per 100,000 people (all ages) per year. Source: WHOMalaria burden (IHME): Malaria deaths per 100,000 people (0–4 years) per year. Source: IHMEAnnual deaths: Total number of deaths from malaria in children <5 yrs. Source: Black et al, Global, regional, and national causes of child mortality in 2008: a systematic analysis. Lancet 2010.DALYs: Total DALYs from malaria in children < 5 yrs. Source: derivation.Total PAR (WHO): Percent of the population at risk for malaria (all types) in 2010. Value = total from high- and low-transmission areas. Source: WHO World Malaria Report 2011.Malaria endemicity: % of the population in malaria endemic areasITN coverage: % of households owning at least 1 insecticide-treated net. Countries with greater than 100% reported have been corrected to 100, and are designated with an asterisk. Source: World Malaria Report 2011, Annex 4. 2010 data. http://www.who.int/malaria/world_malaria_report_2011/en/HIV burden: Prevalence in 15-49 year olds. Source: AIDSInfo database, via Gapminder.orgAnnual deaths: Total number of deaths from HIV/AIDS (children+adults). Source: UNAIDS AIDSInfo database.DALYs: Total DALYs from HIV/AIDS. Source: derivation.Pregnant women tested, coverage: % of pregnant women tested for HIV based on facility registers for ANC, L&D and postpartum care. Denominator = # pregnant women giving birth in the last 12 months. Source: Global Health Observatory Data RepositoryART coverage (CD4<350): Source: Gapminder.org
  • Number of existing MDA platforms: Number of LF, STH, SCH, and IPTp (malaria) MDA programs in place
  • Economic Stability: Euler Holmes Rating (AA-D)Violent conflict: In State of Conflict (yes or no) – State DepartmentCorruption: Corruption Rating (From 0 very corrupt to 10, very clean)Health Expenditure: Government expenditure on health as a percentage of total government expenditure 2010 (%)Physician Density: per 1,000 peopleNumber of existing MDA platforms: Number of LF, STH, SCH, and IPTp (malaria) MDA programs in place
  • Selection of Priority Geographic Areas

    1. 1. PANEL 2: Selection of Priority Geographic Areas Judd L Walson, MD, MPH University of Washington Depts of Global Health, Internal Medicine (Infectious Disease), Pediatrics and EpidemiologyIntegrated Prevention Campaigns: Evidence for Impact and 07/25/2012 Efficiency, Global Potential, and Sustainability
    2. 2. OBJECTIVEAssess country opportunity and feasibilityfor implementation of an HIV, malaria anddiarrhea IPC
    3. 3. Opportunity Index (OI)Designed to:  Summarize large amount of data from disparate sources  Summarize burden of diseases that may be impacted by the IPC  Reflect existing relevant interventions that may affect diarrhea, malaria, or HIV burden  Facilitate identification of countries where opportunity for IPC implementation is greatest 3
    4. 4. OI: At a Glance Diarrhea Malaria HIV Childhood Pregnant Overall Improved Malaria Total DALY DALYs per Under-5 Life Diarrhea Annual malaria Annual Total PAR Annual women ART coverage Country Population mortality DALYs drinking water burden DALYs ITN coverage HIV burden DALYs burden capita mortality rate expectancy burden deaths burden deaths (WHO) deaths tested, (CD4<350) rate coverage (WHO) (IHME) coverageBotswana 146,889 0.0732 2,006,945 46.4 13.1 53 7.0 101 3,086 96 0.4 12.5 15 458 65 21 24.8 5,800 143,346 >95 83Malaysia 144,598 0.0051 28,401,017 4.7 4.7 74 1.0 35 1,069 100 0.1 0.0 6 183 Unknown 65 0.5 5,800 143,346 77 23Peru 144,195 0.0050 29,076,512 24.3 5.4 74 4.5 658 20,102 85 0.0 0.0 17 519 47 0 0.4 5,000 123,574 78 37Iran, Islamic Rep. 136,895 0.0019 73,973,630 24.2 5.4 73 9.8 4,480 136,864 96 Unknown 0.0 1 31 Unknown 1 0.2 Unknown Unknown Unknown 4Algeria 133,241 0.0038 35,468,208 19.2 4.9 73 12.8 3,876 118,412 83 Unknown Unknown 0 0 0 100* 0.1 600 14,829 Unknown 25Mauritania 124,229 0.0359 3,459,773 78.2 9.7 58 15.7 1,936 59,145 50 6.1 144.3 1,645 50,255 90 64 0.7 600 14,829 3 25Morocco 118,772 0.0037 31,951,412 33.1 5.8 72 12.4 2,917 89,115 83 0.0 Unknown 0 0 0 Unknown 0.1 1,200 29,658 <1 27Eritrea 109,745 0.0209 5,253,676 70.4 7.7 61 21.4 2,188 66,844 Unknown 0.5 169.3 29 886 100 17 0.8 1,700 42,015 27 37Brazil 109,400 0.0006 194,946,470 20.9 6.4 73 5.3 3,543 108,239 98 0.0 0.1 38 1,161 26 0 0.45 Unknown Unknown 79 60Gabon 91,943 0.0611 1,505,463 67.0 8.9 62 5.9 180 5,499 87 12.0 146.3 888 27,128 100 0 5.2 2,400 59,315 55 47Papua New Guinea 85,470 0.0125 6,858,266 65.7 7.6 62 5.2 728 22,240 40 9.0 24.0 1,018 31,100 100 26 0.9 1,300 32,129 24 52Uzbekistan 85,287 0.0030 28,562,400 41.0 4.7 68 12.0 2,549 77,872 87 0.0 0.0 0 0 Unknown 100* 0.1 300 7,414 88 UnknownBolivia 80,848 0.0081 9,929,849 54.1 7.3 66 15.2 2,158 65,927 Unknown Unknown 0.5 3 92 Unknown Unknown 0.2 600 14,829 Unknown 19Honduras 80,331 0.0106 7,600,524 21.8 4.9 73 9.8 605 18,483 87 0.0 0.0 2 61 42 0 0.8 2,500 61,787 62 33Tajikistan 77,802 0.0113 6,878,637 43.7 6.2 67 19.2 2,304 70,387 64 0.0 0.3 0 0 Unknown 5 0.2 300 7,414 62 11Dominican Republic 77,649 0.0078 9,927,320 27.6 5.9 73 9.2 677 20,682 86 0.1 0.0 4 122 80 0 0.9 2,300 56,844 41 47Argentina 74,545 0.0018 40,412,376 14.2 7.7 76 0.9 94 2,872 Unknown 0.0 0.0 0 0 9 100* 0.5 2,900 71,673 >95 70Korea, Dem. Rep. 67,271 0.0028 24,346,229 23.0 9.9 69 12.1 2,202 67,271 Unknown Unknown 0.0 0 0 Unknown 1 Unknown Unknown Unknown Unknown 0Ecuador 66,226 0.0046 14,464,739 19.4 5.0 75 5.5 388 11,853 94 0.0 0.1 0 0 52 5 0.4 2,200 54,372 92 30Mexico 61,161 0.0005 113,423,047 18.1 4.7 77 5.5 2,002 61,161 96 0.0 0.0 0 0 5 100* 0.3 Unknown Unknown 34 54
    5. 5. OI: Top 10 DALY Burden Countries Top 10 countries based on total DALY burden (diarrhea, malaria, HIV): Diarrhea Malaria HIV Improved Pregnant Total DALY DALYs per Diarrhea Annual Malaria burden Annual Annual Country DALYs drinking water DALYs ITN coverage HIV burden DALYs women tested, burden capita burden deaths (WHO) deaths deaths coverage coverageNigeria 18,229,334 0.1151 18.7 201,368 6,151,810 58 2.7 217,357 6,640,275 49 3.6 220,000 5,437,250 14India 11,648,828 0.0095 13.0 237,482 7,255,095 92 0.1 6,292 192,221 1 0.3 170,000 4,201,511 23South Africa 7,855,389 0.1571 8.7 6,293 192,252 91 0.2 51 1,558 100* 17.8 310,000 7,661,579 >95DRC 6,014,548 0.0912 18.5 102,679 3,136,852 45 35.5 94,196 2,877,696 69 Unknown Unknown Unknown 11Uganda 3,810,069 0.1140 16.0 30,391 928,448 72 25.1 42,549 1,299,876 57 6.5 64,000 1,581,745 63Kenya 3,793,934 0.0936 20.5 38,802 1,185,404 59 64.0 20,666 631,348 37 6.3 80,000 1,977,182 83Tanzania 3,621,080 0.0808 11.6 20,211 617,448 53 35.3 28,745 878,162 100* 5.6 86,000 2,125,470 86Ethiopia 2,906,138 0.0350 22.8 73,341 2,240,574 44 1.9 21,786 665,564 62 Unknown Unknown Unknown 26Afghanistan 2,742,023 0.0797 28.9 89,709 2,740,618 50 0.1 46 1,405 13 Unknown Unknown Unknown UnknownMozambique 2,650,507 0.1133 11.9 13,105 400,359 47 14.3 13,789 421,255 38 11.5 74,000 1,828,893 87 *PEPFAR countries 5
    6. 6. OI – A Closer Look Diarrhea Malaria HIV Improved Childhood Pregnant Under-5 Overall Malaria ART Total DALY DALYs per Life Diarrhea Annual drinking malaria Annual Total PAR ITN HIV Annual women Country Population mortality mortality DALYs burden DALYs DALYs coverage burden capita expectancy burden deaths water burden deaths (WHO) coverage burden deaths tested, rate rate (WHO) (CD4<350) coverage (IHME) coverage Diarrhea Improved Under-5 Overall Total DALY DALYs per Life Diarrhea Annual drinking Country Population mortality mortality DALYs burden capita expectancy burden deaths water rate rate coverage Malaria HIV Childhood PregnantMalaria ART malaria Annual Total PAR ITN HIV Annual womenburden DALYs DALYs coverage burden deaths (WHO) coverage burden deaths tested,(WHO) (CD4<350) (IHME) coverage 6
    7. 7. OI: Identifying the Opportunity Diarrhea Total DALY DALYs per Diarrhea Annual Improved drinking Country DALYs burden capita burden deaths water coverageNigeria 18,229,334 0.1151 18.7 201,368 6,151,810 58India 11,648,828 0.0095 13.0 237,482 7,255,095 92South Africa 7,855,389 0.1571 8.7 6,293 192,252 91DRC 6,014,548 0.0912 18.5 102,679 3,136,852 45Uganda 3,810,069 0.1140 16.0 30,391 928,448 72Kenya 3,793,934 0.0936 20.5 38,802 1,185,404 59Tanzania 3,621,080 0.0808 11.6 20,211 617,448 53Ethiopia 2,906,138 0.0350 22.8 73,341 2,240,574 44Afghanistan 2,742,023 0.0797 28.9 89,709 2,740,618 50Mozambique 2,650,507 0.1133 11.9 13,105 400,359 47 Malaria HIV Pregnant Malaria burden Annual ITN HIV Annual DALYs DALYs women tested, (WHO) deaths coverage burden deaths coverage 2.7 217,357 6,640,275 49 3.6 220,000 5,437,250 14 0.1 6,292 192,221 1 0.3 170,000 4,201,511 23 0.2 51 1,558 100* 17.8 310,000 7,661,579 >95 35.5 94,196 2,877,696 69 Unknown Unknown Unknown 11 25.1 42,549 1,299,876 57 6.5 64,000 1,581,745 63 64.0 20,666 631,348 37 6.3 80,000 1,977,182 83 35.3 28,745 878,162 100* 5.6 86,000 2,125,470 86 1.9 21,786 665,564 62 Unknown Unknown Unknown 26 0.1 46 1,405 13 Unknown Unknown Unknown Unknown 14.3 13,789 421,255 38 11.5 74,000 1,828,893 87
    8. 8. DALYs per Capita
    9. 9. Opportunity Exists
    10. 10. Feasibility Index Identify key characteristics of successful programs Feasibility Indicator SourceEconomic Risk Rating Euler Hermes Economic Country Risk RatingViolent conflict State Department country profile pagesCorruption Transparency InternationalGovt. investment in health Government health expenditure as % of total government expenditure (WHO data) Grouped into high, medium and low feasibility 10
    11. 11. Feasibility Index Economic Health Country Violent conflict Corruption Stability Expenditure YES: Ongoing civil/rebel conflict inNigeria D 2.4 6.4 Niger River Delta YES: Minor regional ongoingIndia B civil/rebel conflict in northeast India 3.1 4.1 and on western borderSouth Africa BB YES: 4.1 9.3DRC D YES: Ongoing civil/rebel conflict 2.0 1.7 YES: Minor ongoing rebel conflict inUganda C 2.4 11.6 the northKenya D YES: 2.2 5.4Tanzania C NO 3.0 18.1 YES: Minor conflict on border withEthiopia D 2.7 11.4 SomaliaAfghanistan D YES: Ongoing civil/rebel conflict 1.5 3.7Mozambique C NO 2.7 14.2 11
    12. 12. Country Profile12  Expands on and provides context for information in the Opportunity and Feasibility Indices  Provides subnational information where possible  Provides detailed information for planning and implementation of campaigns, including country specific cost data
    13. 13. Acknowledgments• Aliya Jiwani • James G. Kahn• Elliot Marseille • Alastair Matheson• Stephane VerguetOpportunity Index – Lisa Manhart, GillianLevine, Patricia Pavlinac, AdamAkullian, Arianna Rubin

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