Indicators of malaria control

A short primer on the various indicators used for evaluating malaria control in India

1. Epidemiological exercises: Malaria indices Dr. Rizwan S A Asst. Professor (Community Medicine) VMCH & RI, Madurai 1

2. Three major types Rates and proportions Measures of association Diagnostic test validity 2

3. Rate and Proportions 3

4. Rate and Proportions Demographic indices (CBR, CDR, MYP) MCH indicators Disease related indices (AR, SAR) Filarial indices Malarial indices TB indices Fertility indices (TFR, GFR, GMFR) 4

5. Intro to malaria burden 5

6. World 6

7. 7

8. Global disease burden in 2015 New cases: 214 million (149–303) Africa (88 %), South-East Asia ( 10%) Deaths: 438 000 (236  000–635 000 ) Between 2000 and 2015, malaria incidence fell by 37% globally malaria mortality fell by 60% globally  Global Technical Strategy for Malaria 2016-2030 r educing incidence by 90 %; reducing mortality 90 %; eliminating malaria in at least 35 countries; 8

9. Countries with malaria 9

10. Trends in incidence and deaths 10

11. india 11

12. Malaria endemic areas in India (API 2004) 12

13. P . falciparum  distribution in India 13

14. High risk towns for malaria in India 14

15. Pf%, API and Deaths (1995-2014) 15

16. ABER, API, SPR, SFR, Deaths (2001-14) 16

17. Trends in incidence 17

18. Trends in cases and deaths (2001-14) 18

19. Controversies in malaria burden India’s true malaria burden is a matter of intense debate Different estimates of malaria deaths WHO : 15,000 Million Deaths Study : 1.2-2.7 lakh ICMR committee : 40,297 19

20. Malaria indices 20

21. Learning objectives To assess the burden of disease in a community in terms of morbidity and mortality wrt malaria To calculate indices to monitor and evaluate national health programs wrt malaria 21

22. Malarial indices – 1/3 Annual blood examination rate = X 100 Annual parasite incidence = X 1000   22

23. Malarial indices – 2/3 Annual falciparum incidence = X 1000 Slide positivity rate = X 100   23

24. Malarial indices – 3/3 Slide falciparum rate = X 100 Percentage of falciparum = X 100   24

25. Malaria control in India 25

26. Objective and indicators To achieve API <1 by 2017 At least 80% of those suffering from malaria get complete treatment within 24 hours At least 10% of the population in high-risk areas is surveyed annually ( ABER >10 % ) At least 50% reduction in mortality by 2017 (2010 baseline ) 26

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28. Example problems 28

29. Ex. Problem 1 1. In a Community health centre , with a population of 1,00,000, the health workers collected 3725 blood smears from fever cases during their home visits. In the same year, 3275 blood smears were collected from Outpatient departments. On examination 185 slides were positive for P . vivax and 15 slides were positive for P . falciparum . Calculate the all-possible malarial indices. 29

30. Ex. Problem 1 Given: Population = 100000 Blood smears collected from fever cases home visits = 3725 Blood smears collected from Outpatient departments = 3275 Slides positive for P. vivax = 185 Slides positive for P. falciparum = 15 Annual blood examination rate = (3725+3275)/100000 X 100 = 7% Annual parasite incidence = (185+15)/100000 X 1000 = 2 per 1000 population Annual falciparum incidence = 15/100000 X 1000 = 0.15 per 1000 population Slide positivity rate = 200/7000 X 100 = 2.8% Slide falciparum rate = 15/7000 X 100 = 0.2% Percentage of falciparum = 15/200 X 100 = 7.5% 30

31. Ex. Problem 2 2. Population of a PHC is 25000. A total of 200 peripheral blood smears were made. 38 of them tested positive for P.vivax , 40 for P.Falciparum and 10 showed both. Calculate the indices for malaria control in the area. 31

32. Ex. Problem 2 API= 88/25000*1000= 3.5 per 1000 population ABER= 200/25000*100= 0.8% SPR = 88/ 200*100= 44% SFR= 40/200 *100= 20 % 32

33. Work out on your own 1 The following are the data available for Madurai district with population 10,00,000 regarding Anti malaria activities during the year 2010. Blood smear examined = 80000 positive cases detected PV = 2592, PF = 308. Calculate ABER, API, AFI, SPR and Percentage of falciparum. Interpret the results and mention remedial measures . 33

34. Work out on your own 2 The following are the data from a Primary Health Centre for the year 2015 Total population = 30,000 Blood slides collected by active surveillance = 260 Blood slides positive for parasite in above = 80 Blood slide collected by passive surveillance = 140 Blood slides positive for parasite in above = 40 Among the positive slides, falciparum was seen in 9 Calculate the malaria indices and comment on them 34