Intervention Assessment A separate Intervention Assessment protocol has been drawn
up to measure the success or failure of the intervention at specific times.
Indicators include entomological, parasitological, disease incidence and economic
variables as well as community perceptions. Assessment and monitoring of these
parameters are carried out before, during and after spraying intervention.
The effectiveness of the malaria control programme in the
long-term will be assessed by the incidence of malaria over time in Mozambique
as well as in the neighbouring malarious areas of South Africa and Swaziland.
The success will not only be measured using process (e.g. spraying coverage)
and biological markers (e.g. parasite prevalence rates, health facility patient
numbers and mosquito vector reductions), but by assessing the effects on tourism
using tourist facility occupancy rates, job creation and malaria risk perceptions,
in all three countries over the course of the period 2000 to 2005. A full assessment of the effects of the intervention strategy,
based on scientific principles, will be carried out to to evaluate the programme's
efficacy, to enable fine tuning of control, and to document cost and effectiveness,
data vital to other programmes in the malarious areas of the continent.
Indicators for the Intervention Assessment will include parasite index, disease
incidence, morbidity and mortality, mosquito abundance, mosquito species composition
both before and following control.
The effective implementation of this 5 year project as well
as its assessment relies on accurate malaria case information which will be
housed in the Health Information System of the Ministry of Health in Mozambique
and the MRC in Durban. Case management capability at health facilities in
the study areas will be upgraded through a nurses training programme and an
adequate supply of anti-malarial drugs. The Health
Information System will further be upgraded on an ongoing basis towards
allowing evaluation of intervention measures. Data on malaria morbidity and
mortality will be accessed from the hospitals and clinics.
Vector Assessment This includes measurement of vector density, species identity, distribution, behaviour, infectivity, survival
rate and susceptibility to insecticide under use. Traps to catch mosquitoes exiting from houses were fitted to homes at 14 sentinel sites in Mozambique. These are cleared daily by the homeowners and the
mosquitoes preserved in labeled and dated containers for analysis. Zone 1: Bela Vista, Boane, Catuane, Changalane, Namaacha
, Salamanga, Ponto do ouro, Zitundo. Quality of spraying and the duration of Prevalence Assessment Pre- and post-intervention parasite prevalence and levels of
morbidity and mortality are assessed using clinic data and cross sectional
parasite surveys prior to and after spraying. ( see baseline
survey ) Parasite prevalence surveys are undertaken each year in June
at the sentinel sites to evaluate the efficacy
of the intervention. Malaria Information Systems The effectiveness of the malaria control programme in the
longterm will be assessed by the incidence of the disease over time in Mozambique
as well as in the neighbouring malarious areas of South Africa and Swaziland.
Malaria Information Systems (MIS) were developed and implemented for the partner-sectors,
based on the input and output requirements of each, in order to collect current
as well as historical data. This will indicate the trends both within
each country and across the region, and allow an evaluation of the effectiveness
of the spraying programme. Initially, only hospital admissions of malaria were notifiable
in Mozambique. However, by the end of 2001, all cases of malaria, both confirmed
and suspected, were captured within the Mozambique Health Information System
on a weekly basis. Each health facility is currently required to send
monthly malaria reports on suspected and confirmed cases to the District Directorate
of Health which collates the district information. They are then sent to the
Definitive diagnosis, previously only available at hospitals,
is being phased in at clinics in Maputo province which will allow accurate
malaria incidence data for the region.
While the individual regions will be responsible for the collection
and analysis of their own data, the data for all regions of the SDI and this
project more specifically, will be centrally collated and analysed in collaboration
with the Malaria Research Programme of the Medical Research Council, SA.(
see GIS component
) Malaria and Tourism Indicators of the success of the malaria programme are not
only measured using biological markers e.g. infection rates and mosquito vector
reductions, but also by the effects on tourism e.g. bed occupancy, job creation
and risk perceptions, in all 3 countries. Studies in this regard are underway to assess the effect of
malaria, both perceived and real, on local and international tourists, and
the resulting impact on bed occupancy and job creation. Small geographic scale
malaria risk maps have been produced in order to dispense appropriate malaria
risk information to tourist facility owners, tourists and the media. A tourist
information booklet dispensing appropriate information regarding prohylaxis
in risk areas has been produced and released to tourism facilities. See Malaria and
Tourism The intervention assessment component of the project is being
extended in collaboration with the Center for International Development of
the Harvard Business School, USA, to evaluate both the micro and macro economic
effects of malaria control. This will include monitoring household security
(pre- and post-intervention) at a population level, time lost in industry
due to malaria illness, and the analysis of specific macro economic
indicators. Intervention Assessment
Zone 1A: Matola Rio, Matola C, Catembe, Beluluane 24, Beluluane A,
Mussumbuluco
Zone 2: Sabie, Ressano Garcia, Faztene, Moamba, Batelao
Zone 3: Motaze, Chicutso - Manjangue, Magude Sede, Mapulanguene,
Panjane, Maguiguane, Mawadla, Mawandlha, Chicutso Sede, Chobela
insecticide
activity are measured using bioassays. The latter are carried out on
a monthly basis by personnel from the Mocambican Ministry of Health in collaboration
with scientists from Mpumalanga and the MRC for five days per month
over a period of 6 months. ( see baseline
survey )
Provincial
Directorate of Health which collates these data for the Province and submits
them to the Planning and Co-operation Department within the Ministry of Health.