Shared at the 2017 American Society of Tropical Medicine and Hygiene Annual Meeting

1. Background
Quantifying Gaps in Insecticide-Treated Net Use to Better Plan
and Target Malaria Interventions in Madagascar
Malaria is a public health challenge in Madagascar, with
some areas at risk of epidemics. With support from multiple
partners the country is scaling-up its key malaria
interventions; however, intervention coverage remains below
the targets set by the national malaria control program
(NMCP). In this context, and as Madagascar considers
subnational pre-elimination strategies, there is a need
to quantify the gaps and identify specific subpopulations with
low coverage to better target interventions.
Results
Data from the 2016 Malaria Indicator Survey
(MIS) were compared to the NMCP’s 2016
targets set in Madagascar Malaria Strategic Plan
(MMSP) 2013–2017. The study focused on
coverage of Insecticide-Treated Net (ITN) use
among children under five years of age and
pregnant women. To identify gaps, we calculated
the difference, in percentage points, between
indicators from the MIS and the corresponding
2016 targets in the MMSP 2013–2017 Strategic
Plan.
Conclusions
Figure 1: Use of ITN, 2016 MIS data versus NMCP 2016 targets
Jean-Marie NGbichi1, Maurice Ye1, Laurent Kapesa2, Arsène Ratsimbasoa3, Yazoume Ye1
1MEASURE Evaluation, ICF; 2USAID/PMI Madagascar; 3Direction de la Lutte contre le Paludisme (DLP), Ministry of Health, Madagascar
Figure 2: Use of ITN, overall gap in percentage points
Overall, gaps in ITN use were 17 and 19 percentage points, respectively, with children
under age five and pregnant women (Figure 2).
Gaps of 17 and 20 percentage points were observed in
urban areas, respectively, in children under age five and
pregnant women. The gaps were lower in rural areas,
respectively, 10 and 12 percentage points in children
under age five and pregnant women, who presented
higher gaps in both areas (Figure 3).
Overall, the gaps in ITN use increased in the wealthiest
groups (19 to 31 percentage points), both in children
under age five and pregnant women. Furthermore, the
gaps were much higher in pregnant women compared to
children under age five (Figure 4).
Gaps in use of ITN were observed in all epidemiological
zones. The gaps increased in sub-arid epidemic prone
areas and were notably higher in Highland zones, of
which some are pre-elimination areas, both in children
under age five and pregnant women (Figure 5).
While acknowledging Madagascar’s efforts in malaria control, the study has identified gaps in use of ITN in the country’s Highland zones, of which some are pre-elimination areas. The
study results inform on the need to better target resources during program planning and implementation. Furthermore, deeper secondary analyses could help identify factors driving
these gaps in coverage of malaria control interventions and improve program performance.
17
19
17
CHILDREN UNDER AGE 5 PREGNANT WOMEN ALL POPULATION*
Gap in % points
90 88 85
73 69 68
CHILDREN UNDER AGE 5 PREGNANT WOMEN ALL POPULATION*
NMCP target 2016 Madagascar MIS 2016
* Household population for MIS 2016 and general population for NMCP target * Household population for MIS 2016 and general population for NMCP target
17
20
10
12
CHILDREN UNDER AGE 5 PREGNANT WOMEN
Gap in urban area Gap in rural area
Figure 3: Use of ITN, difference in percentage
points, by place of residence
10
14
21
19
16
3
18
25
31
26
LOWEST SECOND MIDDLE FOURTH HIGHEST
Children under age 5 Pregnant women
Figure 4: Use of ITN, gap in percentage points,
by socioeconomic status
Figure 5: Use of ITN, gap in percentage points,
by malaria epidemiological zones
4 7 8
56
4 7
15
54
EQUATORIAL
ZONE
TROPICAL
ZONE
SUBDARID HIGHLAND
Children under age 5 Pregnant women
The 2016 MIS data show that percentages of ITN use were overall below the NMCP
targets, Respectively, 73%, 69%, and 68% with children under age five, pregnant
women, and the population in general (Figure 1).
Methods
Source: http://www.mara.org
This publication has been supported by the President’s Malaria Initiative (PMI) through the United States Agency for International
Development (USAID) under the terms of MEASURE Evaluation cooperative agreement AIDOAA-L-14-00004. MEASURE Evaluation is
implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in partnership with ICF International; John
Snow, Inc.; Management Sciences for Health; Palladium; and Tulane University. Views expressed are not necessarily those of PMI, USAID, or the
United States government.
Source: The New Times,