Cost-effectiveness Evaluation of Vector Control Strategies in Mozambique
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 3,915
- 试验地点
- 3
- 主要终点
- Cost per case averted in children five years of age and under at health facility level by adding Actellic-IRS
研究概览
简要总结
This study aims to provide National Malaria Control Programs (NMCP), international donors and other key stakeholders with clear evidence on the impact and cost-effectiveness of using indoor residual spraying (IRS) with a non-pyrethroid insecticide in a high malaria transmission area that has universal long-lasting insecticidal net (LLIN) coverage. This is an interventional study with IRS serving as the research intervention.
The district of Mopeia, in the province of Zambezia, Mozambique will be the study site. This is a high transmission area with a malaria parasite prevalence of 54% in children. The Ministry of Health distributed LLINs in Mopeia in 2014-2015.
The NMCP through funding from President's Malaria Initiative Africa Indoor Residual Spraying Project (PMI-AIRS) was able to cover half a district with indoor residual spraying. A simplified census took place in mid-2016 to determine the number of children five years of age and under in the district and enumerate and map the households to assist in implementation.
From the 115 villages/bairros existent in Mopeia, 86 clusters were randomized in a government randomization ceremony to either receive IRS with Actellic or maintain no IRS. The IRS was implemented through a partnership between the NMCP and PMI-AIRS according to standard operational and consent procedures. From each cluster, a cohort of 18 children five years of age and under will be followed monthly to assess malaria incidence at the community level in both IRS and non-IRS villages. There will be 774 children in the IRS villages and 774 children in the no-IRS villages (total cohort will be 1548). Additionally, the routine health centre reporting system will be strengthened to assess malaria incidence in children five years of age and under by passive case detection. Three cross sectional studies in April 2017, April 2018, and April 2019 will assess changes in net use, health seeking behaviour and malaria prevalence at the community level.
Entomological data will be collected from both IRS and non-IRS areas to assess the vector dynamics and insecticide resistance pattern of the local vector populations from sprayed and unsprayed areas. Data on the costs of the implementation as well as health-related expenditures at health system and household levels will be collected prospectively throughout the study. These costs will be determined using both health system and societal perspectives.
The incidence rate in IRS and no-IRS areas will be combined with the micro-costing data to calculate the cost per case averted at community and health facility level.
These findings will be disseminated to the NMCP and international donors and stakeholders to complement the World Health Organization (WHO) guidance on combining indoor residual spraying and long-lasting insecticidal nets.
详细描述
Mopeia is a district in the Zambezia Province. Mopeia borders the district of Morrumbala to the North, the district of Chinde and the province of Sofala to the South, the districts of Nicoadala and Inhassunge in the East and the Provinces of Sofala and Tete in the West. It has an area of 7671 km2. The projected population for 2016 is 162.188 individuals with 31.927 (19.7%) under five years of age (National Institute of Statistics, Mozambique). There are three administrative posts, eleven localities and 224 villages (Bairros) and approximately 34.603 households. There are 12 health facilities (PMI-AIRS Mozambique, unpublished data). There is little socio-economic data available from Mopeia.
The malaria burden is high in Zambezia with a parasite prevalence of 54% in under-fives [19]. The parasite prevalence in children 1-15 years of age in Mopeia is 47.8% (38.7%-57.1%) [20]. The mean rapid diagnostic test (RDT) positivity rate during a recent enhanced surveillance exercise at health facilities was 62.8% (range 50-72%) [21]. The same data suggest high incidence at health facilities, showing 470 cases per 1000 children during the same period (June-Nov 2014). Mopeia recently received 175.297 LLINs in 2013 and IRS with pyrethroids in 2014 [22]. Residents of Mopeia will receive new LLINs in early 2017.
Data from February 2015 in the neighbouring districts of Mocuba and Morrumbala show Pyrethroid resistance in the local Anopheles gambiae s.l. population [23]. Further north, in the district of Milange, tested Anopheles gambiae s.l. remain susceptible to pyrethroids [23]. See table 2 below for further details. Mopeia has been selected to receive IRS because of its high malaria transmission intensity, the presence of LLINs in the district, and the aforementioned regional indications of reduced pyrethroid susceptibility in the target vector population, and the existence of IRS infrastructure and capacity from previous campaigns.
The villages selected for spraying will receive IRS with Actellic according to standard operating and consent procedures [24] in addition to existing LLINs. Non IRS areas will have existing LLINs, but will not receive IRS. In late 2017 (year two), IRS will be repeated using the same village selection and insecticide. Additionally in 2017, the whole district will be subject to universal LLIN distribution.
Individuals enrolled in the cohort were recruited independent of their household acceptance or refusal of spray. IRS status will be confirmed with questionnaires during the monthly active cohort visits and during the cross-sectional surveys, including questions about wall replastering/painting and net usage (SSPs COST 001, 002 and 003). Additional information will be obtained through cone bioassays.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Health Services Research
- 盲法
- Single (Outcomes Assessor)
入排标准
- 年龄范围
- 6 Months 至 —（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •all consenting adults, assenting minors (12-18) and caregivers of children under 12
排除标准
- •all infants 0-6 months of age
结局指标
主要结局
Cost per case averted in children five years of age and under at health facility level by adding Actellic-IRS
时间窗: 24 months
Incidence at health facility level by passive case detection (with enhanced surveillance and quality control) along with implementation costing data using an ingredients approach
次要结局
- Parasite prevalence(12 months)
- Cost per malaria case averted in children five years of age and under at the community(24months)
- Entomological Indicators(24 months)
- Health Behavior(24 months)