Use of Routine Health Information System Data to Evaluate Impact of Malaria Control Interventions in Zanzibar, Tanzania from 2000 to 2015
Background: Impact evaluations allow countries to assess public health gains achieved through malaria investments. This study uses routine health management information system (HMIS) data from Zanzibar to describe changes in confirmed malaria incidence and impact of case management and vector contro...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-07-01
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| Series: | EClinicalMedicine |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537019300896 |
| _version_ | 1819154947262906368 |
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| author | Ruth A. Ashton Adam Bennett Abdul-Wahid Al-Mafazy Ali K. Abass Mwinyi I. Msellem Peter McElroy S. Patrick Kachur Abdullah S. Ali Joshua Yukich Thomas P. Eisele Achuyt Bhattarai |
| author_facet | Ruth A. Ashton Adam Bennett Abdul-Wahid Al-Mafazy Ali K. Abass Mwinyi I. Msellem Peter McElroy S. Patrick Kachur Abdullah S. Ali Joshua Yukich Thomas P. Eisele Achuyt Bhattarai |
| author_sort | Ruth A. Ashton |
| collection | DOAJ |
| description | Background: Impact evaluations allow countries to assess public health gains achieved through malaria investments. This study uses routine health management information system (HMIS) data from Zanzibar to describe changes in confirmed malaria incidence and impact of case management and vector control interventions during 2000–2015. Methods: HMIS data from 129 (82%) public outpatient facilities were analyzed using interrupted time series models to estimate the impact of artemisinin-based combination therapy (ACT), indoor residual spray, and long-lasting insecticidal nets. Evaluation periods were defined as pre-intervention (January 2000 to August 2003), ACT-only (September 2003 to December 2005) and ACT plus vector control (2006–2015). Findings: After accounting for climate, seasonality, diagnostic testing rates, and outpatient attendance, average monthly incidence of confirmed malaria showed no trend over the pre-intervention period 2000–2003 (incidence rate ratio (IRR) 0.998, 95% CI 0.995–1.000). During the ACT-only period (2003–2005), the average monthly malaria incidence rate declined compared to the pre-intervention period, showing an overall declining trend during the ACT-only period (IRR 0.984, 95% CI 0.978–0.990). There was no intercept change at the start of the ACT-only period (IRR 1.081, 95% CI 0.968–1.208), but a drop in intercept was identified at the start of the ACT plus vector control period (IRR 0.683, 95% CI 0.597–0.780). During the ACT plus vector control period (2006–2015), the rate of decline in average monthly malaria incidence slowed compared to the ACT-only period, but the incidence rate continued to show an overall slight declining trend during 2006–2015 (IRR 0.993, 95% CI 0.992–0.994). Interpretation: This study presents a rigorous approach to the use of HMIS data in evaluating the impact of malaria control interventions. Evidence is presented for a rapid decline in malaria incidence during the period of ACT roll out compared to pre-intervention, with a rapid drop in malaria incidence following introduction of vector control and a slower declining incidence trend thereafter. Keywords: Malaria, Impact evaluation, Zanzibar, Health management information systems (HMIS) |
| first_indexed | 2024-12-22T15:29:10Z |
| format | Article |
| id | doaj.art-ad1dd1720ddc4f64a101cfeb9c840170 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-12-22T15:29:10Z |
| publishDate | 2019-07-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-ad1dd1720ddc4f64a101cfeb9c8401702022-12-21T18:21:24ZengElsevierEClinicalMedicine2589-53702019-07-01121119Use of Routine Health Information System Data to Evaluate Impact of Malaria Control Interventions in Zanzibar, Tanzania from 2000 to 2015Ruth A. Ashton0Adam Bennett1Abdul-Wahid Al-Mafazy2Ali K. Abass3Mwinyi I. Msellem4Peter McElroy5S. Patrick Kachur6Abdullah S. Ali7Joshua Yukich8Thomas P. Eisele9Achuyt Bhattarai10Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Corresponding author at: School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, Suite 2300, New Orleans, LA, USA.Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA; Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, CA, USAZanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, United Republic of TanzaniaZanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, United Republic of TanzaniaMnazi Mmoja Hospital, Zanzibar, United Republic of TanzaniaU.S. President's Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USAMalaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA; Mailman School of Public Health, Columbia University, NY, New York, USAZanzibar Malaria Elimination Programme, Ministry of Health, Zanzibar, United Republic of TanzaniaCenter for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USACenter for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USAU.S. President's Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USABackground: Impact evaluations allow countries to assess public health gains achieved through malaria investments. This study uses routine health management information system (HMIS) data from Zanzibar to describe changes in confirmed malaria incidence and impact of case management and vector control interventions during 2000–2015. Methods: HMIS data from 129 (82%) public outpatient facilities were analyzed using interrupted time series models to estimate the impact of artemisinin-based combination therapy (ACT), indoor residual spray, and long-lasting insecticidal nets. Evaluation periods were defined as pre-intervention (January 2000 to August 2003), ACT-only (September 2003 to December 2005) and ACT plus vector control (2006–2015). Findings: After accounting for climate, seasonality, diagnostic testing rates, and outpatient attendance, average monthly incidence of confirmed malaria showed no trend over the pre-intervention period 2000–2003 (incidence rate ratio (IRR) 0.998, 95% CI 0.995–1.000). During the ACT-only period (2003–2005), the average monthly malaria incidence rate declined compared to the pre-intervention period, showing an overall declining trend during the ACT-only period (IRR 0.984, 95% CI 0.978–0.990). There was no intercept change at the start of the ACT-only period (IRR 1.081, 95% CI 0.968–1.208), but a drop in intercept was identified at the start of the ACT plus vector control period (IRR 0.683, 95% CI 0.597–0.780). During the ACT plus vector control period (2006–2015), the rate of decline in average monthly malaria incidence slowed compared to the ACT-only period, but the incidence rate continued to show an overall slight declining trend during 2006–2015 (IRR 0.993, 95% CI 0.992–0.994). Interpretation: This study presents a rigorous approach to the use of HMIS data in evaluating the impact of malaria control interventions. Evidence is presented for a rapid decline in malaria incidence during the period of ACT roll out compared to pre-intervention, with a rapid drop in malaria incidence following introduction of vector control and a slower declining incidence trend thereafter. Keywords: Malaria, Impact evaluation, Zanzibar, Health management information systems (HMIS)http://www.sciencedirect.com/science/article/pii/S2589537019300896 |
| spellingShingle | Ruth A. Ashton Adam Bennett Abdul-Wahid Al-Mafazy Ali K. Abass Mwinyi I. Msellem Peter McElroy S. Patrick Kachur Abdullah S. Ali Joshua Yukich Thomas P. Eisele Achuyt Bhattarai Use of Routine Health Information System Data to Evaluate Impact of Malaria Control Interventions in Zanzibar, Tanzania from 2000 to 2015 EClinicalMedicine |
| title | Use of Routine Health Information System Data to Evaluate Impact of Malaria Control Interventions in Zanzibar, Tanzania from 2000 to 2015 |
| title_full | Use of Routine Health Information System Data to Evaluate Impact of Malaria Control Interventions in Zanzibar, Tanzania from 2000 to 2015 |
| title_fullStr | Use of Routine Health Information System Data to Evaluate Impact of Malaria Control Interventions in Zanzibar, Tanzania from 2000 to 2015 |
| title_full_unstemmed | Use of Routine Health Information System Data to Evaluate Impact of Malaria Control Interventions in Zanzibar, Tanzania from 2000 to 2015 |
| title_short | Use of Routine Health Information System Data to Evaluate Impact of Malaria Control Interventions in Zanzibar, Tanzania from 2000 to 2015 |
| title_sort | use of routine health information system data to evaluate impact of malaria control interventions in zanzibar tanzania from 2000 to 2015 |
| url | http://www.sciencedirect.com/science/article/pii/S2589537019300896 |
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