Background
The malaria post
Monitoring and evaluation
Community-based early diagnosis and treatment within a regional malaria elimination programme in Eastern Myanmar
Methods
Study design and study population
M&E data collection
Selection of malaria posts for M&E visits
Alert | Definition |
---|---|
Late report | More than 21 days for SMS reports, more than 28 days for paper reports from start of reporting week |
Missing report | No report for this week |
Report 0 RDT | Reported 0 stock for RDTs |
Report 0 ACT | Reported 0 stock for ACT medicines |
Correct RDT use | Each febrile patient at MP has been tested using RDT; measured as weekly total consultations = weekly total number of valid RDT |
Correct treatment use | Each febrile patient with a positive RDT diagnosis is treated; measured as weekly total malaria positive RDT = weekly total number of febrile patients treateda |
Invalid RDTs repeated | All invalid RDT results are repeated; measured as total number of valid RDTs < than the total number of consultations and an invalid RDT reported |
Monitoring and evaluation data
Definitions of MP functionality
Variables and data sources
Weekly data
Individual consultation data
RDT quality control
Statistical methods
Results
Monitoring and evaluation visits
Indicator | Severity of dysfunction | Proportion | Percentage (%) |
---|---|---|---|
MP operated by at least 1 trained MP worker | Minor | 487/547 | 89.03 |
Supervisor visit frequency in past 2 months | Minor | ||
0 | 141/534 | 26.40 | |
1 | 87/534 | 16.29 | |
2–3 | 121/534 | 22.66 | |
> 4 | 185/534 | 34.64 | |
Forms on site | Minor | 541/547 | 98.90 |
Manual on site | Minor | 531/548 | 96.90 |
Regular salary received | Minor | 534/547 | 97.62 |
Another MP in village | N/A | 112/547 | 20.48 |
Observed stockouts | Major | ||
ACT or RDT | 44/551 | 7.99 | |
ACT and RDT | 3/551 | 0.54 | |
Reported stockouts for > 2 days in the past month | Major | 37/541 | 6.84 |
MP closure for > 24 h in the past 2 months | Major | 144/549 | 26.23 |
Functionality category | |||
Major dysfunction | 194/552 | 35.14 | |
Minor dysfunction | 186/552 | 33.70 | |
No dysfunction | 256/552 | 46.38 | |
Insufficient data collected | 23/552 | 4.17 |
MP worker treatment knowledge
Quality control of rapid diagnostic tests
Access to MP by population
Weekly reporting system and data completion
Alert of MP dysfunction through weekly reporting
Discussion
Malaria post worker performance
Treatment quiz question | MP worker | MP supervisors, zone and assistant zone coordinators | ||
---|---|---|---|---|
Proportion | Percentage (%) | Proportion | Percentage (%) | |
1. Treatment for 1st trimester pregnancy P. f | 533/635 | 83.94 | 74/87 | 85.06 |
2. Response to vomiting > 1 h after taking drug | 270/635 | 42.52 | 49/87 | 56.32 |
3. Treatment for 2nd or 3rd trimester pregnancy P. f | 301/635 | 47.40 | 44/87 | 50.57 |
4. Exclusion criteria for single low dose primaquine | 441/635 | 69.45 | 72/87 | 82.76 |
5. Treatment for P. f if AL allergy | 268/635 | 42.20 | 60/87 | 68.97 |
6. Variable used for drug dosage calculation | 585/635 | 92.13 | 84/87 | 96.55 |
7. Correct treatment for mix infection (non-pregnant, aged > 5 months) | 326/635 | 51.34 | 55/87 | 63.22 |
8. Correct treatment for breast-feeding mother P. f | 318/635 | 50.08 | 49/87 | 56.32 |
9. Treatment for 6-month to 5-year old child P. f | 330/635 | 51.97 | 47/87 | 54.02 |
10. Treatment for non-pregnant adult with P. f positive RDT and no fever | 484/635 | 76.22 | 76/87 | 87.36 |
11. Treatment/conduct for patient with P. f who cannot eat or drinka | 271/635 | 42.68 | 35/87 | 40.23 |
12. Treatment for P. f in child with fever, just woken from convulsion | 383/635 | 60.31 | 53/87 | 60.92 |
13. Treatment of patient with P. f positive RDT, 1 week after complete malaria treatment | 257/635 | 40.47 | 37/87 | 42.53 |
14. Treatment for P. v in child treated 1 month ago for P. v | 467/635 | 73.54 | 60/87 | 68.97 |
15. Reason for treating P. f within 48 h of fever | 367/635 | 57.80 | 70/87 | 80.46 |
16. Conduct if patient vomits drug < 30 min after taking it | 479/635 | 75.43 | 67/87 | 77.01 |
17. Product to administer with AL to facilitate absorption | 526/635 | 82.83 | 76/87 | 87.36 |
18. Treatment for patient 1st trimester pregnancy with P. v | 383/635 | 60.31 | 60/87 | 68.97 |
19. Treatment of P. f in adult | 494/635 | 77.80 | 73/87 | 83.91 |
20. Treatment for pregnant patient 1st trimester pregnancy with mixed infection (P. f + P. v) | 428/635 | 67.40 | 67/87 | 77.01 |
Alert | Proportion | Percentage (%) |
---|---|---|
Late report | 8281/140905 | 5.88 |
Missing report | 560/140905 | 0.40 |
No RDT stock | 1474/140905 | 1.05 |
No ACT stock | 1371/140905 | 0.97 |
Incorrect RDT use | 1239/140905 | 0.88 |
Incorrect treatment use | 1340/140905 | 0.95 |
Invalid RDTs not repeated | 188/140905 | 0.13 |
Availability of testing and treatment
M&E observed variable | Weekly alert | Odds ratio | 95% CI | P-value |
---|---|---|---|---|
ACT not in stock | Report 0 ACT | 6.33 | 3.40, 11.79 | < 0.001 |
ACT not in stock | Late report | 2.12 | 1.27, 3.53 | 0.004 |
Manual not on site | Report 0 ACT | 5.49 | 2.42, 12.45 | < 0.001 |
Manual not on site | Report 0 RDT | 9.64 | 4.08, 22.79 | < 0.001 |
Regular salary not received | Report 0 ACT | 4.94 | 1.92, 12.72 | 0.001 |
Regular salary not received | Late report | 3.90 | 2.03, 7.46 | < 0.001 |
MPW not trained by METF | Report 0 RDT | 10.99 | 5.30, 22.77 | < 0.001 |