Background
Methods
Study area
Study design
Stratum | Transmission intensity (P. falciparum cases per 1000 population per year in 2013) | Catchment population in area | Number of villages | Interventions during high transmission season (October 2014 to January 2015) |
---|---|---|---|---|
1 | Very low transmission (< 5 cases/1000/year) | 4753 | 5 | Case investigation with FTAT/FSTAT+ focal drug administration for outbreak |
2 | Low transmission (≥ 5 and < 15 cases/1000/year) | 9695 | 6 | PECADOM++ |
3 | Low-moderate transmission (≥ 15 cases/1000/year) | 24,925 | 46 | MTAT at the beginning of the 2014 transmission season (September 2014) followed by PECADOM++ |
Objectives
Study procedures
Census
Case investigation with reactive case detection
PECADOM++
Mass test and treat
Data collection and analysis
Costing
Results
Case investigation
PECADOM++
MTAT
Coverage and socio-demographic characteristics
RDT positivity rate and risk factors for RDT positivity
Covariates | N (% of total population < 10 years) | n (distribution of RDT-positive population (%) < 10 years) | Univariable odds ratio (95% CI) p-value | Multivariable adjusted odds ratio (95% CI) p-value |
---|---|---|---|---|
Sociodemographic characteristics | ||||
Sex | ||||
Female | 4136 (50.0%) | 60 (43.2%) | 1.0 (ref) | 1.0 (ref) |
Male | 4140 (50.0%) | 79 (56.8%) | 1.32 (0.94–1.85) p = 0.106 | 1.31 (0.89–1.94) p = 0.175 |
Age | ||||
< 5 years | 4304 (52.0%) | 45 (32.4%) | 1.0 (ref) | 1.0 (ref) |
5–9 years | 3972 (48.0%) | 94 (67.6%) | 2.29 (1.60–3.28) p < 0.001 | 2.64 (1.75–3.99) p < 0.001 |
Individual malaria risk factors | ||||
Used a bed net on previous night | ||||
No | 2749 (33.2%) | 41(29.5%) | 1.0 (ref) | 1.0 (ref) |
Yes | 5527 (66.8%) | 98 (70.5%) | 1.19 (0.83–1.72) p = 0.348 | 1.01 (0.64–1.60) p = 0.961 |
Travelled outside of district in previous two weeks | ||||
No | 8133 (98.3%) | 138 (99.3%) | 1.0 (ref) | 1.0 (ref) |
Yes | 143 (1.7%) | 1 (0.7%) | 0.41 (0.06–2.94) p = 0.373 | 0.79 (0.10–6.43) p = 0.827 |
Axillary temperature ≥ 37.5 °C or reported fever within previous 24 h | ||||
No | 7971 (96.3%) | 99 (71.2%) | 1.0 (ref) | 1.0 (ref) |
Yes | 305 (3.7%) | 40 (28.8%) | 12.00 (8.15–17.68) p < 0.001 | 13.64 (8.18–22.74) p < 0.001 |
Used anti-malarial in previous month | ||||
No | 8243 (99.6%) | 135 (97.1%) | 1.0 (ref) | 1.0 (ref) |
Yes | 33 (0.4%) | 4 (2.9%) | 8.28 (2.87–23.89) p < 0.001 | 4.11 (1.06–15.90) p < 0.040 |
Household-level risk factors | ||||
> 1 RDT positives in household | ||||
No | 8026 (97.0%) | 77 (55.4%) | 1.0 (ref) | 1.0 (ref) |
Yes | 250 (3.0%) | 62 (44.6%) | 34.05 (23.65–49.01) p < 0.001 | 21.72 (13.83–34.10) p < 0.001 |
Other members of household travelled in previous month | ||||
No | 6712
(81.1%) | 126 (90.6%) | 1.0 (ref) | 1.0 (ref) |
Yes | 1564 (18.9%) | 13 (9.4%) | 0.44 (0.25–0.78) p = 0.005 | 0.90 (0.46–1.74) p = 0.746 |
Health facility catchment area | ||||
Dounde | 946 (11.4%) | 7 (5.0%) | 1.0 (ref) | 1.0 (ref) |
Salalatou | 1410 (17.0%) | 86 (61.9%) | 8.71 (4.01–18.91) p < 0.001 | 6.74 (2.36–19.23) p < 0.001 |
Oudalaye | 929 (11.2%) | 10 (7.2%) | 1.46 (0.55–3.85) p = 0.445 | 2.25 (0.58–8.72) p = 0.242 |
Niaghana Tidel | 666 (8.0%) | 14 (10.1%) | 2.88 (1.16–7.18) p = 0.023 | 1.64 (0.49–5.50) p = 0.421 |
Mbem mbem | 1726 (20.9%) | 11 (7.9%) | 0.86 (0.33–2.23) p = 0.757 | 1.09 (0.32–3.73) p = 0.892 |
Gassane | 2599 (31.4%) | 11 (7.9%) | 0.57 (0.22–1.48) p = 0.247 | 0.58 (0.17–1.93) p = 0.373 |
Constant | 0.00 (0.00–0.01) p < 0.001 | |||
Total | 8276 | 139 | 8276 | 8276 |
Covariates | N (% of total population ≥ 10 years) | n (distribution of RDT-positive population (%) ≥ 10 years) | Univariable odds ratio (95% CI) p-value | Multivariable adjusted odds ratio (95% CI) p-value |
---|---|---|---|---|
Sociodemographic characteristics | ||||
Sex | ||||
Female | 6209 (58.2%) | 59 (40.1%) | 1.0 (ref) | 1.0 (ref) |
Male | 4455 (41.8%) | 88 (59.9%) | 2.10 (1.51–2.93) p < 0.001 | 1.93 (1.10–3.36) p = 0.021 |
Age (years) | ||||
10–14 years | 2420 (22.7%) | 67 (45.6%) | 1.0 (ref) | 1.0 (ref) |
15–19 years | 1731 (16.2%) | 27 (18.4%) | 0.56 (0.35–0.87) p = 0.011 | 0.67 (0.38–1.17) p = 0.156 |
20–29 years | 2601 (24.4%) | 22 (15.0%) | 0.30 (0.18–0.49) p < 0.001 | 0.31 (0.17–0.56) p < 0.001 |
30–39 years | 1588 (14.9%) | 14 (9.5%) | 0.31 (0.17–0.56) p < 0.001 | 0.36 (0.18–0.72) p = 0.004 |
40–49 years | 923 (8.7%) | 6 (4.1%) | 0.23 (0.10–0.53) p < 0.001 | 0.22 (0.08–0.56) p = 0.002 |
50–59 years | 644 (6.0%) | 4 (2.7%) | 0.22 (0.08–0.60) p = 0.003 | 0.20 (0.07–0.63) p = 0.006 |
60+ years | 757 (7.1%) | 7 (4.8%) | 0.33 (0.15–0.72) p = 0.005 | 0.33 (0.14–0.79) p = 0.013 |
Education | ||||
None/illiterate | 8635 (81.0%) | 119 (81.0%) | 1.0 (ref) | 1.0 (ref) |
Primary/Arabic school | 1784 (16.7%) | 21 (14.3%) | 0.85 (0.53–1.36) p = 0.503 | 0.65 (0.33–1.30) p = 0.227 |
Secondary/university | 227 (2.1%) | 6 (4.1%) | 1.94 (0.85–4.46) p = 0.117 | 6.12 (1.97–19.08) p = 0.002 |
Other | 18 (0.2%) | 1 (0.7%) | 4.21 (0.56–31.89) p = 0.164 | 7.05 (0.86–57.67) p = 0.068 |
Occupation | ||||
Farmer/shepherd | 3368 (31.6%) | 52 (35.4%) | 1.0 (ref) | 1.0 (ref) |
Student | 982 (9.2%) | 12 (8.2%) | 0.79 (0.42–1.48) p = 0.462 | 0.70 (0.27–1.85) p = 0.473 |
Housekeeper | 4315 (40.5%) | 33 (22.4%) | 0.49 (0.32–0.76) p < 0.001 | 0.84 (0.40–1.74) p = 0.633 |
Unemployed | 1633 (15.3%) | 43 (29.3%) | 1.72 (1.15–2.59) p = 0.009 | 1.25 (0.70–2.25) p = 0.447 |
Other | 366 (3.4%) | 7 (4.8%) | 1.24 (0.56–2.76) p = 0.592 | 1.18 (0.44–3.15) p = 0.738 |
Individual malaria risk factors | ||||
Used a bed net on previous
night | ||||
No | 3893 (36.5%) | 55 (37.4%) | 1.0 (ref) | 1.0 (ref) |
Yes | 6771 (63.5%) | 92 (62.6%) | 0.96 (0.69–1.35) p = 0.818 | 0.77 (0.51–1.18) p = 0.233 |
Travelled outside of district in previous two weeks | ||||
No | 10,315 (96.7%) | 144 (98.0%) | 1.0 (ref) | 1.0 (ref) |
Yes | 349 (3.3%) | 3 (2.0%) | 0.61 (0.19–1.93) p = 0.403 | 0.82 (0.18–3.81) p = 0.805 |
Axillary temperature ≥ 37.5 °C or reported fever within previous 24 h | ||||
No | 10,319 (96.8%) | 101 (68.7%) | 1.0 (ref) | 1.0 (ref) |
Yes | 345 (3.2%) | 46 (31.3%) | 15.56 (10.78–22.47) p < 0.001 | 24.75 (15.20–40.30) p < 0.001 |
Used anti-malarial in previous month | ||||
No | 10,610 (99.5%) | 138 (93.9%) | 1.0 (ref) | 1.0 (ref) |
Yes | 54 (0.5%) | 9 (6.1%) | 15.18 (7.28–31.65) p < 0.001 | 8.67 (3.30–22.77) p < 0.001 |
Household-level risk factors | ||||
> 1 RDT positives in household | ||||
No | 10,349 (97.0%) | 88 (59.9%) | 1.0 (ref) | 1.0 (ref) |
Yes | 315 (3.0%) | 59 (40.1%) | 26.87 (18.89–38.22) p < 0.001 | 20.10 (12.90–31.31) p < 0.001 |
Other members of household travelled outside of district in previous two weeks | ||||
No | 8430 (79.1%) | 132 (89.8%) | 1.0 (ref) | 1.0 (ref) |
Yes | 2234 (20.9%) | 15 (10.2%) | 0.42 (0.25–0.73) p = 0.002 | 0.62 (0.32–1.20) p = 0.159 |
Health facility catchment area | ||||
Dounde | 1321 (12.4%) | 13 (8.8%) | 1.0 (ref) | 1.0 (ref) |
Salalatou | 1703 (16.0%) | 57 (38.8%) | 3.48 (1.90–6.39) p < 0.001 | 2.53 (1.18–5.43) p = 0.017 |
Oudalaye | 1012 (9.5%) | 14 (9.5%) | 1.41 (0.66–3.02) p = 0.374 | 2.16 (0.83–5.57) p = 0.113 |
Niaghana tidel | 3602 (33.8%) | 18 (12.2%) | 3.03 (1.55–5.93) p < 0.001 | 2.02 (0.86–4.75) p = 0.107 |
Mbem mbem | 889 (8.3%) | 26 (17.7%) | 0.90 (0.44–1.83) p = 0.777 | 1.03 (0.43–2.47) p = 0.940 |
Gassane | 2137 (20.0%) | 19 (12.9%) | 0.51 (0.25–1.03) p = 0.062 | 0.43 (0.18–1.03) p = 0.058 |
Constant | 0.01 (0.00–0.02) p < 0.001 | |||
Total | 10,664 | 147 | 10,664 | 10,664 |
Impact evaluation
Covariates | Incidence risk ratio (95% CI) | p value |
---|---|---|
Time effects | ||
Pre-intervention | 1.0 (Ref.) | – |
Post-intervention | 0.87 (0.69–1.09) | 0.232 |
Group effects | ||
Comparison group | 1.0 (Ref.) | – |
Treated group | 0.93 (0.65–1.34) | 0.697 |
Intervention effect (interaction term) | 0.62** (0.45–0.84) | 0.002 |
HFCA-level variables | ||
Average number of bed nets per sleeping space | 4.96* (1.45–16.99) | 0.011 |
Average number of people per household | 0.95* (0.90–1.00) | 0.038 |
Environmental variables | ||
Rainfall (2 mo. lag) | 1.01** (1.01–1.02) | <0.001 |
NDVI (2 mo. lag) | 1.05** (1.04–1.06) | <0.001 |
Constant | 0.00** (0.00–0.00) | <0.001 |
Observations | 542 | |
Number of HFCAs | 13 |