In the SEACAT evaluation, there will be a phased introduction of combination anti-malarial therapy at
provincial level in Mozambique (Maputo, Moamba Province), Swaziland (Lowveld region) and South Africa (KwaZulu Natal, Mpumalanga and Northern Province). Policy makers at these
sites will determine treatment policy, supported by data collected at baseline and biannually on the following endpoints: in vivo resistance, molecular markers of resistance
, gametocyte carriage, drug utilisation, cost effectiveness
and the distribution and intensity of malaria transmission. These endpoints will be compared over time, for each site, before and after a change in first line therapy.
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In a given year, sites will be compared against each other to further describe the effect of antimalarial
therapy (monotherapy or CAT) on the emergence of resistance. Each site will be evaluated biannually, with evaluations being conducted in KwaZulu-Natal, Mpumalanga and Swaziland in year 1, followed by
Mozambique and Northern Province in year 2. A site manager will be dedicated to each of the three sites
evaluated in year 1. Two site managers will be dedicated to the evaluation of Mozambique in year 2, and the third to Northern Province. This cycle will be repeated three times.Capacity building will underpin each component of the proposed evaluation, to ensure sustainability, and validity of the study.
The feasibility, effectiveness and cost-effectiveness of implementing such a policy change at a provincial
level will allow informed decision-making on the use of this strategy at a national level in sub-Saharan
Africa. Equally important is the ability of national and provincial malaria control programmes to comprehensively evaluate all aspects of case management and the support systems required to ensure
effective management within their programmes. These issues are of enormous and urgent importance to southern Africa, and the African region. Background Information on Sites
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