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Needs Assessment Tool 10

VIEWS: 13 PAGES: 38

									                  RBM-HWG Needs Assessment Calculation Tool

                                           User Guide




General remarks




Principal approach to estimations and output
Data entry sections




1. Demography




2. Endemicity
                                   Malaria rates in <5
                     % reduction   high          low
                               0      2.50         1.00
                              10      2.25         0.90
                              20      2.00         0.80
                              30      1.75         0.70



3. Health Services




4. Prevention
5. Treatment




Troubleshooting




Acknowledgement
                     RBM-HWG Needs Assessment Calculation Tool

                                                 User Guide

This tool was developed for consultants involved in the Roll Back Malaria Harmonization Working Group Needs
Assessment to assist in the primary objective, i.e. to assess whether or not a country's current planning and
resources are sufficient to reach and sustain the 2010 RBM and country specific targets and if not what is the
order of magnitude of required inputs.
It is not meant nor able to replace detailed costing of activities as needed for implementation plans and budgets.
In order to be generally applicable to countries in sub-Sahara Africa as well as easy to use some common
assumptions are necessary and results should be seen as approximate figures.
General remarks
The tool has one principal data input page although some selection of options are also possible on the ITN and
IRS output page. The major output tables provide annual need and cost for the major commodities for treatment
and prevention of malaria. Additional pages provide data and graphs on the estimated number of fever cases, 1st
line treatments, malaria cases etc as well as the population at risk for malaria by various age groups
The file is "read only" and in order to save any country settings it must be saved under a new name. No changes
can be made by the user on the output pages but you can copy/paste the information into a new spreadsheet
(best use paste-special> values and number formats only) for further use.
Two options exist if you want to reset the values of the data entry page: you can either press the "reset" button on
the top of the page (macros must be enabled). This will return the input to the default settings except for those
fields with pull-down menues or select boxes. Or you just close the file without saving and re-open. This way all
fields including pull-down menues and selection boxes will be reset.

Principal approach to estimations and output
This section briefly summarizes the approach that has been used for the estimations. More detailed notes
regarding the used assumptions for the ITN and treatment need calculations are given on the "Notes" page at the
end.
Starting point for all calculations is the population estimated for each year based on country data (population and
growth rate) stored in the sheet or provided by the user. The population is then "split" into different age groups
and target groups such as pregnant women. Source for the preset country data are given at the bottom of the
"Population" page.
The mosquito net section only deals with ITNs and ignores untreated nets. Assuming that in the future only
LLINs will be used in public sector distributions no scenarios for re-treatment campaigns have been included
since - if targets for 2010 are met - the vast majority of nets will be LLIN and the number of untreated nets
negligible. If a country is planning such a campaign they have to be calculated separately.
The starting point of calculations for the LLIN needs to achieve RBM target is the net crop (number of nets) at the
end of 2007 which is calculated from past survey data supplemented by an estimate of the input since the survey
or by an "informed guess" by the consultants for the 2007 situation. Percent coverage with ITN is converted to
number of nets based on the number households and the mean number of nets per household derived from
empirical data (see Notes). Nets are lost over time at rates that are based on detailed loss estimates for different
net types assuming a mix of polyethylene and polyester nets (see Notes).
Two major outputs are provided to allow a judgement whether or not targets are likely to be reached:
1. An estimate of the LLIN needed to reach the 2010 target of either 80% or 100% of households with sufficient
nets (number of nets per households varies with size of households) and then sustain that level to 2013. A range
of values is given where the low value assumes that previously distributed nets (not yet lost) are considered while
the high estimate ignores them (for 2010) or uses only 50% of them (2013). The targets refer to all households. If
a country target is only defined as "households with a child under 5 or pregnant woman" this lower target can only
be estimated by reducing the "proportion targeted for ITN" (F45).
2. A calculation of LLINs to be distributed based on planned activities (campaign and different types of routine
distributions). These can be varied by year and approach separately for the period 2008-2010 and 2011-2013 on
the ITN output page.
Please note that these are two totally independent calculations. The first calculates backwards from the
households in 2010 and 2013 respectively how many nets will have to be distributed in the previous years to
cover 80% or 100% of households with the number of nets associated with these coverage levels (see Notes for
the exact figure) and makes some assumptions about loss of nets in the previous years. The second is based
only on the population figures and calculates how many nets are needed if each child under 5, each woman
attending ANC at least once etc. is to be given a net in a given year. This then allows an assessment whether the
planned distribution activities will be sufficient to reach the targets or whether additional activities (e.g. doing a
general campaign rather than only to under 5s) should be recommended.

Calculation of fever and malaria cases, treatment needs and diagnostics is a special challenge as most
variables such as proportion with access to health services, choice of provider, compliance with treatment
guidelines etc will change over time. To take this dynamic into account is clearly beyond this tool and must be
done in more complex models. However, the tool is able to give a reasonable estimate of the number first line
ACTs and RDTs needed in the next 3 years. It is probably less accurate for the 2011-2013 period if the real
situations deviates significantly from the assumption made in the calculation.
Need for second line drug and severe malaria cases have not been included. The major reason is that most
of the factors that drive these cost are either not constant over time or poorly understood (e.g. severe cases in a
situation with decreasing transmission). In addition their cost is marginal compared to first line ACT and RDTs
and. In most cases a 5% cost compared to first line is a reasonable estimate. Also, no cost for microscopy have
been calculated as these are part of the health system cost that have to be estimated separately.

From recent data it is evident that consequent implementation of malaria prevention and treatment will lead to
dramatic reductions in actual malaria cases. This will lead to reductions in the "true" malaria cases but only
translates into savings for ACTs if the number of diagnostic tests is dramatically increased. In order to allow
calculation of such reduced need for ACTs the calculations assume that the RBM targets actually will be met and
therefore apply a reduction of maraia incidence of 25% by 2010, 75% by 2011 and 80% thereafter. Further details
of assumptions for fever episodes per person per year are given in the Notes.

Data entry sections
The data entry page is structured into 5 sections. All these must be carefully filled before any useful output
can be obtained.
Most fields where country specific information is needed are set to 0 as default. In some cases, however, some
commonly used values have been entered. If better information is available in country these should be
overwritten.
Some comments and clarifications for input needs are given directly on the input page. Below are some additional
points for specific sections:
1. Demography
The easiest way is to load the country data set from the pull down menu. The figures may vary from what the
country uses as most population fugures are based on census data many years old. Population figures can be
entered manually but it should be kept in mind that differences of a few %-points up and down (or decimal points
for rates) hardly make a difference in the outcome given the rather rough assumptions that have to be made.
Since at the time of the development of this tool the list of countries for needs assessments was still changing not
all countries have preset data.
2. Endemicity
This section is crucial for the results. It first allows the definition of that part of the population that is living in areas
with no malaria risk. This part of the population will then be excluded from all calculations.
In the next step the proportion of the total population in areas of two different levels of endemicity needs to be
defined. These two settings are "high to very high" and "medium to low". In many countries the terms "high" and
"low" are used with very differing underlying actual transmission and may only refer to the relative level within the
country. For these calculation a high level of endemicity means on average 2.5 malaria episodes per child under
5 per year at baseline and 0.8 episodes for persons 5 years and older. The rates for "low" areas are 1.0 and 0.4
respectively.Therefore, some areas that are considered "high" by NMCP relative to the country may actually be
"low"last these in this section can provide an estimate of what level of malaria reduction has been achieved
The by entry standards.
already. This is meant to allow an initial reduction of malaria cases from the "intrinsic" endemicity in countries
where high levels of ITN coverage or ACT treatments have been reached. The maximum level allowed is
30%.However, this variable (F 27 in data input) can also be used to modify the baseline settings of the malaria
incidence for "high" and "low" endemicity areas as follows:
                                                           Malaria rates in <5
                                         % reduction           high           low
                                                       0          2.50          1.00
                                                     10           2.25          0.90
                                                     20           2.00          0.80
                                                     30           1.75          0.70



3. Health Services
There are two entries for "access" to health services. One for the reach of public health services in general (but
should include outreach activities and will in some countries also include NGO-run facilities). The other refers to
treatment access in children. This is needed to allow for a scenario where community based treatment is
implemented and hence access to public treatment is higher for under5s than for the general population. If no
home-based management of malria (HMM) is planned, the two rates should be the same. Those not accessing
the public sector are then automatically defined as "private sector".
ANC attendance figures can usually be obtained from the most recent DHS, MICS or MIS.

4. Prevention
The first and most important step is to define that part of the population at risk of malaria that is targeted for ITNs
and IRS. It should be noted that the targets for ITN and IRS are independent so that a simultaneous coverage of
both ITN and IRS can be included.
A clarification on different campaigns: a "general" campaign is any time of limited distribution (integrated or stand
alone) that is not giving nets to children under five and/or pregnant women. Calculations for these general
campaigns are based on the households and the number of nets given (on average) per household. In contrast,
the under five and pregnant women campaigns are calculated based on the estimated population of these
categories.
As explained in the previous section the ITN output table regarding the need to achieve targets by 2010 and 2013
respectively (left top) is independent from the number of nets needed for specific delivery approaches but both
relate to (and therefore are modified by) the proportion of the population targeted for ITN defined in field F45. The
routine distribution figures are also influenced by the health service settings (proportion attending health services
and ANC). Field F60 allows an additional modification (i.e. reduction of nets) but only applies to general
campaigns. It is meant to adjust for situations where not every household within the population targeted for ITN
will receive the specified number of nets defined in F59. It is recommended to use this feature cautiously and
generally leave it at 100% if a "universal access" campaign is planned. However, it can be used if certain
geographically limited campaigns (i.e. not covering the whole population who are in principal targeted for ITN) are
planned or if the campaign only plans to cover certain households (e.g. any household with children under 10
receives x nets).
Table 12 of the report template requests the number of LLIN delivered by delivery approach. These are obtained
from the two lower tables on the ITN output page (for campaign choose the respective year). They can be added
up in the table on the top right of that page according to country plans using the pull-down menus and be
compared with the "needs estimates". The resulting number of nets may exceed the target estimates if e.g. a
campaign is undertaken where every child under 5 receives a net irrespective of whether the household already
has a net or not. However, the resulting number from the top right table should not be significantly below the
estimate or the delivery strategy must be adjusted (one exception may be that significant input is also expected
from the commercial sector which is not considered in this tool).
The cost of the nets entered in field F61 is meant to cover the cost of the commodity (CIF) but not delivery to the
recipient. The reason for this is that delivery cost may differ significantly by delivery mechanism. However, Table
12 in the report template requests the average cost per LLIN delivered by delivery mechanism. This can be
obtained either by adding the cost for delivery manually or by modifying the cost in the data input page (F61). In
the latter case care must be taken that only figures of needed LLIN for that particular delivery approach to which
the modified cost applies are copied.
5. Treatment
For the calculation of IPT the proportion of population covered with this intervention has first to be entered. This is
necessary as in some countries the IPT area is not identical with the total area at risk. Note that the proportion
here refers to the total population, not the population at risk.
Next the proportion of non-falciparum malaria among malaria cases has to be entered. This is meant to allow a
separate calculation for vivax/ovale cases where these are significant and are not treated with an ACT. Note,
however, that this rate should refer only to mono-infections as mixed infections have to be treated with ACTs.
In most cases this rate should be set to 0%.
The ACT regimens differ in age/weight cut-off between AL and other ACTs. Selecting the 1st line ACT in the box
will then bring up the corresponding age categories.
The diagnostic section is very important as it will determine the need for ACTs in the future. Since in most
countries the situation outlined in the policy or planned for implementation is not yet achieved, a current (2008) as
well as future scenario is allowed. Calculations will then assume that 2009 will be a transition year and full
scenario reached in 2010.
The figures needed to fill Table 17 of the report template then can be obtained from the ACT & RDT output page.
Additional information is also provided on the "cases" page which has two sections, the upper table presents
figures for the total population at risk while the lower lable shows only the figures for the public sector. The two
graphs are based on these two tables.

Troubleshooting
The tool has been test run to ensure that all calculations and options work properly. However, some bug or error
cannot be excluded (this is version 1.2!). Nonetheless, if you encounter some "weird" results please first carefully
check your data entry and ensure that all are what you wanted them to be as this is the most likely cause.
If you encounter unsolvable problems, need a "special solution" or simply have suggestions for improvements in
the future please contact Albert Kilian at <a.kilian@malariaconsortium.org>.

Acknowledgement
While most of the calculations are based on previous work done in Uganda for the GFATM proposals it builds on
significant inputs also from Elizabeth Streat (Malaria Consortium) and Bruno Moonen (Clinton Foundation).
RBM-HWG Needs Assessment Calculation Tool

Data entry areas and variables

1. Demographic data
                                           Select country profile
                                           other

Entered data                               Preset estimates
Year                                       Year                              2007
Population                                 Population                            0
Annual growth (%)                          Annual growth                     2.5%
Persons/household                          Persons/household                   5.0
% age 0-4                                  % age 0-4                        16.5%
% pregnant women                           % pregnant women                  4.5%



2. Malaria endemicity

                 Proportion of population not at risk of malaria (%)          0.0%

   Proportion of population at high to very high risk of malaria (%)         0.0%
     Proportion of population at medium to low risk of malaria (%)         100.0%


                              Current level of malaria reduction (%)          0.0%




3. Health services

               Population with access to public health services (%)           0.0%
              Fever cases in under 5s treated in public sector (%)            0.0%
            Proportion of women attending ANC at least once (%)               0.0%
            Proportion of women attending ANC at least twice (%)              0.0%




4. Prevention

NMCP targets for 2010 for malarious areas
             Proportion of at risk population targeted for ITN (%)            0.0%
             Proportion of at risk population targeted for IRS (%)            0.0%

ITN                                                                    FALSE

                                        Survey data (2005 or later)    available
                                              Year of last national survey

                                                       At least ITN must be filled!
                 Proportion of households with at least one net (%)          0.0%
                 Proportion of households with at least one ITN (%)          0.0%
                Proportion of households with at least one LLIN (%)          0.0%

                 Total number of ITN/LLIN distributed since survey
   Number of nets calculated per household for general campaign                    2
  Proportion of targeted population reached by general campaign              100.0%
                                                Cost per LLIN in $             $6.00

IRS

  Proportion of households to be covered within targeted area (%)                0.0%
              Average # of structures to be sprayed per household                    2
                                  Proportion of structures "formal"              0.0%
                        Average surface for formal structure in m²                200
                      Average surface for informal structure in m²                  90
                                 Number of spray rounds per year                     1
                         Average cost per household sprayed in $                 $8.00




5. Treatment and diagnosis

IPT

                 Proportion of population where IPT is implemented             0.0%
                                 Price per tin (1,000 tabs) of SP in $        $24.00

Treatment & diagnosis

             Proportion malaria cases being non-falciparum (%)                   0.0%
  Average treatment cost per case of non-falciparum malaria in $                 $0.10

                             First line ACT
                               Artemether/Lumefantrine
                                                                             1
                               Other ACT e.g. AS+SP or AS+AQ


                        Cost of 1st line ACT per dose in $
                                               Age groups in years
                                                                <3               $0.90
                                                               3-8               $1.00
                                                              9-14               $1.20
                                                               15+               $1.80

      Proportion of all fever cases in public sector to be diagnosed
             current               children under 5 yrs                      planned
                  0%                     Microscopy                               0%
                  0%                        RDT                                   0%
                  0%       Total proportion of under 5 diagnosed                  0%
             current                  5 yrs and above                        planned
    0%                   Microscopy                         0%
    0%                       RDT                            0%
    0%    Total proportion of 5 and older diagnosed         0%

 Estimated proportion diagnosed in the private sector
current                                                 planned
    0%                   Microscopy                          0%
    0%                      RDT                              0%
    0%           Total proportion diagnosed                  0%

                                   Cost for RDT in $      $0.80
Comments




Select the preloaded country data and change only if they
significantly deviate from estimate normally used
                                                                0   0
If you choose to enter different data you must fill at least the
first 2 fields




This part of the population will not be included in the
calculations
Please carefully read user guide before filling in!
This field is calculated from the previous two


See user guide for explanations how to use this field




Including outreach activities
Including HMM, should be the same as total population if no
HMM




Excludes the population not at risk
ITN and IRS areas may overlap


If data from 2005 or later available tick box and enter year
Mention the type of survey (DHS, MIS, MICS) in the report
                  If no recent survey data leave blank

must be filled!

                  If no recent survey use "informed guess" for 2007


                  If no exact data use "informed guess"

                  This rate does not apply to other campaigns (children under 5 & PW)
                  Basic unit cost should be CIF and not delivery to recipient.
                  Delivery cost must be calculated separately. (see also user
                  guide)

                  formal =non-porous surface, i.e. any structure with four walls
                  and a roof with smooth, not absorbant plaster or painted wall
                  informal =porous surface, i.e. any structure with four walls
                  and a roof with porus walls (e.g. unfinished brick, cement
                  block, reeds, stone, mud plastered or earth)

                  Include non-insecticide commodity, training cost and
                  implementation cost




                  Proportion refers to total population of country!
                  In order to allow exclusion of IPT in low malarious areas



                  refers to natinal average and only non-pf mono-infections!




                  Age groups are proxies for weight categories which may vary           <3
                  slightly between countries                                            3-8
                                                                                        9-14
                                                                                        15+

                                                                                        <1
                                                                                        1-6
                  See explanation in user guide                                         7-13
                                                                                        14+
Informed guess
If no estimate possible all cases will be treated clinically
other
Burkina Faso
Burundi
Cameroon
CAR
Comoros
Congo
Cote d'Ivoire
DRC
Eq. Guinea
Ethiopia
Gabon
Ghana
Kenya
Mali
Mozambique
Nigeria
Tanzania
Togo
Zanzibar
Zimbabwe
Prevention with Insecticde Treated Nets (LLIN)

 Approximate need for LLIN to reach and maintain 2010 targets
            for population at risk targetd for ITN                                 Planned distributio
                                  Time period
                    2008-2010                     2011-2013
Target           80%         100%           80%            100%
LLIN
 low estimate            0           0               0             0
high estimate            0           0               0             0            LLIN
         mean            0           0               0             0                 Routine
Cost                                                                              Campaign
  low estimate          $0          $0              $0            $0                   Total
 high estimate          $0          $0              $0            $0            Cost
         mean           $0          $0              $0            $0                   Total



 Estimated annual need for routine LLIN distribution in various scenarios for populations
                                 at risk targeted for ITN
                     2008         2009            2010        2011       2012          2013
LLIN
ANC                      0           0               0             0        0               0
EPI                      0           0               0             0        0               0
ANC & EPI                0           0               0             0        0               0
None
Cost
ANC                     $0          $0              $0            $0       $0             $0
EPI                     $0          $0              $0            $0       $0             $0
ANC & EPI               $0          $0              $0            $0       $0             $0


Approximate need for campaign LLIN in a given year in various scenarios for populations
                               at risk targeted for ITN
                     2008         2009            2010        2011       2012          2013
LLIN
Under 5                  0           0               0             0        0               0
Under 5 & PW             0           0               0             0        0               0
General                  0           0               0             0        0               0
None
Cost
Under 5                 $0          $0              $0            $0       $0             $0
Under 5 & PW            $0          $0              $0            $0       $0             $0
General                 $0          $0              $0            $0       $0             $0
Planned distribution activities
                                                                                ANC
                                          select campaign year                  EPI
        None             None             select campaign type                  ANC & EPI
        None             None             select type of routine distribution   None
                 Time period
               2008-10       2011-13                                            Under 5
                     0                0                                         Under 5 & PW
                     0                0                                         General
                     0                0                                         None

                    $0               $0




                    Period
               2008-10          2011-13

                     0                0
                     0                0
                     0                0


                    $0               $0
                    $0               $0
                    $0               $0



                    Period
               2008-10          2011-13

                     0                0
                     0                0
                     0                0


                    $0               $0
                    $0               $0
                    $0               $0
Indoor Residual Spraying
                               0% population targeted with IRS                                   0%

                                      Annual targets and approximate cost for Indoor Residual Spraying
                                                2008           2009              2010            2011
             Households targeted                   0              0                  0              0
               Population covered                  0              0                  0              0
        Formal structures to spray                 0              0                  0              0
       Informal structures to spray                0              0                  0              0
                 Approximate cost                 $0             $0                $0              $0



                                                Some insecticides commonly used for IRS
           Insecticide                Brand           Formulation     dose (mg/m²)     gram/sachet
           DDT                                                   75%            2,000             670
           Lambda-cyhalothrin         ICON                       10%                25           62.5
           Alpha-cypermethrin         Fendona                      5%               25            125
           Deltamethrin               K-Othrine                    5%               25             80
           Bendiocarb                                            80%               400            125

Insecticide calculator

                                                              Number of sachets of selected insecticide needed
Structure Selected Insecticide                  2008           2009             2010            2011
Formal    Lambda-cyhalothrin                       0              0                 0               0
Informal  Lambda-cyhalothrin                       0              0                 0               0
           targeted households within IRS area

ual Spraying
                        2012             2013
                           0                0
                           0                0
                           0                0
                           0                0
                          $0               $0




           m²/sachet
                       251.25                    DDT
                       250.00                    Lambda-cyhalothrin
                       250.00                    Alpha-cypermethrin
                       160.00                    Deltamethrin
                       250.00                    Bendiocarb




d insecticide needed
                        2012             2013
                           0                0
                           0                0
Intermittent Preventive Treatment in Pregnancy

                                                        0.0% of total population targeted for IPT

Number of women targeted for IPT
                                                         2008          2009          2010
             Women currently attending ANC                  0             0             0
  Women currently attending ANC at least twice              0             0             0
                   80% of all pregnant women                0             0             0
                     100% of pregnant women                 0             0             0

Annual SP treatments (2 doses per woman)
                                                         2008          2009          2010
             Women currently attending ANC                  0             0             0
  Women currently attending ANC at least twice              0             0             0
                   80% of all pregnant women                0             0             0
                     100% of pregnant women                 0             0             0

Approximate need for SP*
                                                         2008          2009          2010
Tins of 1,000 tabs
                Women currently attending ANC               0              0             0
  Women currently attending ANC at least twice              0              0             0
                   80% of all pregnant women                0              0             0
                     100% of pregnant women                 0              0             0
Cost in $
                Women currently attending ANC              $0             $0            $0
  Women currently attending ANC at least twice             $0             $0            $0
                   80% of all pregnant women               $0             $0            $0
                     100% of pregnant women                $0             $0            $0

* adding 15% for women receiving more than 2 doses and 10% for logistic add-on
opulation targeted for IPT


                             2011   2012   2013
                                0      0      0
                                0      0      0
                                0      0      0
                                0      0      0


                             2011   2012   2013
                                0      0      0
                                0      0      0
                                0      0      0
                                0      0      0


                             2011   2012   2013

                               0       0     0
                               0       0     0
                               0       0     0
                               0       0     0

                              $0      $0    $0
                              $0      $0    $0
                              $0      $0    $0
                              $0      $0    $0
Treatment & Diagnostics

                                                        Needed treatments for 1st line ACT, non-falcuparum m
                                                                                         in public sector
                             ACT                          2008            2009              2010
                    P. falciparum malaria
                                 Age group in yrs
                                               <3   #DIV/0!        #DIV/0!         #DIV/0!
                                              3-8   #DIV/0!        #DIV/0!         #DIV/0!
                                             9-14   #DIV/0!        #DIV/0!         #DIV/0!
                                              15+   #DIV/0!        #DIV/0!         #DIV/0!
                                            Total   #DIV/0!        #DIV/0!         #DIV/0!
                                Cost for ACT in $   #DIV/0!        #DIV/0!         #DIV/0!
                   Non-falciparum malaria
                 # of non-falciparum treatments     #DIV/0!        #DIV/0!         #DIV/0!
                    Cost for non-falciparum in $    #DIV/0!        #DIV/0!         #DIV/0!
                          Diagnostics
                           # of microscopy tests               0              0               0
                                       # of RDTs               0              0               0
                                Cost of RDT in $              $0             $0              $0
e ACT, non-falcuparum malaria and diagnostic tests
    in public sector
                     2011            2012            2013


               #DIV/0!         #DIV/0!         #DIV/0!
               #DIV/0!         #DIV/0!         #DIV/0!
               #DIV/0!         #DIV/0!         #DIV/0!
               #DIV/0!         #DIV/0!         #DIV/0!
               #DIV/0!         #DIV/0!         #DIV/0!
               #DIV/0!         #DIV/0!         #DIV/0!

               #DIV/0!         #DIV/0!         #DIV/0!
               #DIV/0!         #DIV/0!         #DIV/0!

                          0               0               0
                          0               0               0
                         $0              $0              $0
Cases, diagnosis and treatments

                                                                                  Total population
                                        Age group             2008         2009
                                        under 5 yrs              0            0
                        Fever cases     5 yrs & above            0            0
                                        Total                    0            0
                                        under 5 yrs              0            0
                    Diagnostic tests
                                        5 yrs & above            0            0
                     (micro or RDT)
                                        Total                    0            0
                                        under 5 yrs     #DIV/0!      #DIV/0!
            % fever cases diagnosed
                                        5 yrs & above   #DIV/0!      #DIV/0!
                      (micro or RDT)
                                        Total           #DIV/0!      #DIV/0!
                                        under 5 yrs     #DIV/0!      #DIV/0!
             Cases treated with ACT
                                        5 yrs & above   #DIV/0!      #DIV/0!
                                        Total           #DIV/0!      #DIV/0!
                                        under 5 yrs              0            0
                  True malaria cases    5 yrs & above            0            0
                                        Total                    0            0
                                        under 5 yrs              0            0
                  True malaria cases
                                        5 yrs & above            0            0
                      (P. falciparum)
                                        Total                    0            0
                                        under 5 yrs              0            0
                  True malaria cases
                                        5 yrs & above            0            0
                 (non P. falciparum )
                                        Total                    0            0
                                        under 5 yrs     #DIV/0!      #DIV/0!
            % of fever cases treated    5 yrs & above   #DIV/0!      #DIV/0!
                                        Total           #DIV/0!      #DIV/0!
                                        under 5 yrs     #DIV/0!      #DIV/0!
  % of fever cases being true malaria   5 yrs & above   #DIV/0!      #DIV/0!
                                        Total           #DIV/0!      #DIV/0!
                                        under 5 yrs     #DIV/0!      #DIV/0!
     Ratio treated ACT/true pf cases    5 yrs & above   #DIV/0!      #DIV/0!
                                        Total           #DIV/0!      #DIV/0!

                                                                                  Public sector onl
                                        Age group             2008         2009
                                        under 5 yrs              0            0
                        Fever cases     5 yrs & above            0            0
                                        Total                    0            0
                                        under 5 yrs              0            0
                    Diagnostic tests
                                        5 yrs & above            0            0
                     (micro or RDT)
                                        Total                    0            0
                                        under 5 yrs     #DIV/0!      #DIV/0!
            % fever cases diagnosed
                                        5 yrs & above   #DIV/0!      #DIV/0!
                      (micro or RDT)
                                        Total           #DIV/0!      #DIV/0!
                                        under 5 yrs     #DIV/0!      #DIV/0!
             Cases treated with ACT     5 yrs & above   #DIV/0!      #DIV/0!
                                        Total           #DIV/0!      #DIV/0!
                                        under 5 yrs     #DIV/0!      #DIV/0!
                  True malaria cases
             True malaria cases 5 yrs & above    #DIV/0!   #DIV/0!
                                 Total           #DIV/0!   #DIV/0!
                                 under 5 yrs     #DIV/0!   #DIV/0!
             True malaria cases
                                 5 yrs & above   #DIV/0!   #DIV/0!
                 (P. falciparum)
                                 Total           #DIV/0!   #DIV/0!
                                 under 5 yrs     #DIV/0!   #DIV/0!
             True malaria cases
                                 5 yrs & above   #DIV/0!   #DIV/0!
            (non P. falciparum )
                                 Total           #DIV/0!   #DIV/0!
                                 under 5 yrs     #DIV/0!   #DIV/0!
        % of fever cases treated 5 yrs & above   #DIV/0!   #DIV/0!
                                 Total           #DIV/0!   #DIV/0!
                                 under 5 yrs     #DIV/0!   #DIV/0!
Ratio treated ACT/true pf cases 5 yrs & above    #DIV/0!   #DIV/0!
                                 Total           #DIV/0!   #DIV/0!
Total population
      2010        2011        2012         2013
         0           0           0            0
         0           0           0            0
         0           0           0            0
         0           0           0            0
         0           0           0            0
         0           0           0            0
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
         0           0           0            0
         0           0           0            0
         0           0           0            0
         0           0           0            0
         0           0           0            0
         0           0           0            0
         0           0           0            0
         0           0           0            0
         0           0           0            0
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!

Public sector only
      2010        2011        2012         2013
         0           0           0            0
         0           0           0            0
         0           0           0            0
         0           0           0            0
         0           0           0            0
         0           0           0            0
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
#DIV/0!      #DIV/0!     #DIV/0!     #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!
    #DIV/0!   #DIV/0!   #DIV/0!   #DIV/0!

`
                  Total Population at Risk for Malaria

1

1

1

1

1                                                               Fever cases
                                                                Diagnostic tests
                                                                ACT treatments
1                                                               Malaria Cases
                                                                pf cases
0                                                               non-pf cases



0

0

0

0
    2008   2009     2010         2011         2012       2013
                         Public Sector Only

1

1

1

1

1                                                           Fever cases
                                                            Diagnostic tests
                                                            ACT treatments
1                                                           Malaria Cases
                                                            pf cases
0                                                           non-pf cases



0

0

0

0
    2008   2009   2010         2011           2012   2013
                            Population estimates
country       other
pop07                   0   Country                      2007             2008            2009
growth rate**        2.5%   Population*                     0                0               0
pers/hh***              5   Households                      0                0               0
%U5                 16.5%
%PW                  4.5%   Children 0-4                     0               0               0
%pop/yr 0-4          3.2%   Persons 5+                       0               0               0
%pop/yr 5-9          2.8%   Infants                          0               0               0
%pop/yr 10-14        2.5%
%>14                57.5%   Pregnant Women                   0               0               0


                            At risk for malaria
                            Population                       0               0               0
                            Households                       0               0               0

                            Children 0-4                     0               0               0
                            Persons 5+                       0               0               0
                            Infants                          0               0               0

                            Pregnant Women                   0               0               0


                            * from US Census Bureau estimates unless entered manually
                            ** from 2007 Population Data Sheet, Population Reference Bureau unless entered manuall
                            *** from Globalhealth.org website unless entered manually
                     2010        2011   2012   2013
                        0           0      0      0
                        0           0      0      0

                        0          0      0      0
                        0          0      0      0
                        0          0      0      0

                        0          0      0      0



                        0          0      0      0
                        0          0      0      0

                        0          0      0      0
                        0          0      0      0
                        0          0      0      0

                        0          0      0      0



Bureau unless entered manually
1. Treatment

                                                      Mean Episodes/Person/Year
                                                     by endemicity level at baseline*
                                                            Fever                  Malaria
                                               Age     High        Low        High        Low
                                                 <5     4.5        3.0         2.5         1.0
                                                 5+     1.8        1.4         0.8         0.4
                                        * they are then reduced to a max of 85% by interventions

                                        Figure1 : Detailed fever incidence rates

                             7.00
Fever episodes/person/year




                             6.00

                             5.00

                             4.00                                                                  high
                             3.00                                                                  low

                             2.00

                             1.00
                             0.00                                                          +
                                                                          10
                                                                          11


                                                                                   13
                                                                                         14
                                    0
                                         1
                                             2
                                                 3
                                                     4
                                                         5
                                                             6
                                                                  7
                                                                      8
                                                                           9



                                                                                   12



                                                                                        15



                                                                 Age in years




2. ITN



                                          Mean number of ITN per household as a
                                        function of household size and ITN coverage
                                           ITN          Household size (persons)
                                         coverage      <4.5      4.5-5.5     >5.5
                                              4.5%      1.3        1.5        1.7
                                            13.8%       1.4        1.6        1.8
                                            22.0%       1.5        1.7        1.9
                                            32.0%       1.6        1.8         2
                                            40.5%       1.7        1.9        2.1
                                            49.0%       1.8         2         2.2
                                            57.0%       1.9        2.1        2.3
                                            66.0%        2         2.2        2.4
                                            75.0%       2.1        2.3        2.5
                                            83.0%       2.2        2.4        2.6
                                            91.0%       2.3        2.5        2.7
                                           100.0%       2.4        2.6        2.8




                              100%
   Figure 2: Loss function by net type over time (years)


100%
90%
                                              Polyethylene
80%                                           Polyester
70%
60%
50%
40%
30%
20%
10%
 0%
       0   2    4      6     8    10     12    14     16     18

								
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