Monitoring and Evaluation (M&E)

MCDI has developed and is currently implementing a rigorous and extensive M&E program to track results and document the impact of the BIMCP and EGMCI projects. This includes monitoring any changes in mosquito populations and sporozoite rates as IRS is implemented, testing and documenting the continuing effectiveness of insecticides chosen for IRS, establishing and following any changes in malaria parasitemia and anemia rates in children and pregnant women associated with the IRS campaign, and tracking reported malaria cases though government health facilities as noted above. This comprehensive M&E system was set up with Ministry of Health participation to include periodic annual household surveys to track results and measure impact, improve supervision of health facility staff, and improve data entry. It includes data management and feedback to facilities through the routine MOH health information system, and a complete drug management system that includes purchasing, logistics, and monitoring for proper prescribing practices and use. In addition, through its extensive work implementing child survival programs in a number of countries, MCDI has experience gathering information, designing programs, and developing M&E systems based on a proven methodology of community knowledge, practice, and coverage (KPC) surveys that are used to establish baselines and monitor progress over time.

Behavior Change Communications (BCC)

MCDI developed comprehensive BCC approaches in a number of countries that include radio spots and short programs, pictorial job aids (flipcharts, posters), pictorial reminder materials for caretakers (on ACT doses and schedules), information, education and communication (IEC) materials promoting IRS, and educational games and scripts for use in community drama presentations. Materials were improved with feedback from focus groups of users and health providers. In Benin, Madagascar and Equatorial Guinea, MCDI developed IEC materials, training curricula, and supervisory systems to improve the recognition of malaria signs and symptoms at household level, promote better and timelier care-seeking behavior, and improving the quality of treatment at facility and community levels. In BIMCP, sprayers, reaching all communities and most homes, were trained to provide face-to-face education to mothers to increase awareness on prevention, early detection and care seeking behavior, and better household care practices for treatment of fever.

Case Management

Under BIMCP, MCDI managed the production of drug management protocols, training materials to support timely and proper treatment of malaria at all levels, inventory management systems, storage and distribution protocols, logistics management plans, and supervisory protocols for quality control of case management at health facility level. In addition, MCDI worked with the National Malaria Control Program (NMCP) and other partners to successfully introduce the use of artemisinin combination therapy (ACT) to replace chloroquine as the first line anti-malarial on Bioko Island. Data from sentinel survey sites in 2006 showed a reduction of 63% in malaria incidence among oil workers and a 69% reduction in malaria reported among children under the age of five. Health facility surveys demonstrated that over 90% of health providers were dispensing an effective anti-malarial at the correct dosage following the materials development and training. Finally, with support from the EGMCI project, MCDI provided technical assistance to the NMCP to plan for a roll out of a new ACT for first-line treatment throughout the country.

Under the President’s Malaria Initiative (PMI), in late 2007, MCDI was awarded a Cooperative Agreement as leader of a consortium to implement the Improving Malaria Diagnostics (IMaD) project. IMaD is a 5-year, $20 million program funded by USAID to cooperate with 15 Sub-Saharan African countries to improve laboratory-based diagnosis of malaria at primarily Ministry of Health facilities, and increase understanding, acceptance and use of rapid diagnostic tests (RDTs) by laboratory staff and health care practitioners providing direct care to patients. Regional activities in the Amazon basin and the Mekong delta may be included as well, if requested. Malaria treatment that is based on quality malaria diagnostics reduces mortality as well as costs, and minimizes the risk of developing drug resistance. Work began in ten PMI countries in 2008, and will expand into five more in future years.

Specific activities supported under IMaD include: 1) develop detailed plans for implementing, expanding, and improving laboratory-based diagnosis of malaria in Ministry of Health facilities; 2) assist with importation and in-country logistics of PMI commodities in selected countries; 3) develop training materials and train health workers in malaria diagnosis using microscopy/RDTs; 4) train health care providers and laboratory staff to implement national policies for diagnosis and treatment of malaria; 5) monitor stocks of supplies and develop a reporting and procurement system for their replacement; 6) develop a quality assurance plan for maintaining diagnostic quality over time; and 7) develop surge capacity to meet increased demand for diagnostic capabilities during malaria epidemics.

Distribution of Long Lasting Insecticide Treated Bed-nets (LLINs)

MCDI has managed the procurement and distribution of LLINs at the community level in Madagascar and Benin working with partners on social marketing and free distribution. Under the EGMCI project, MCDI purchased 164,000 nets, and to date has distributed approximately 146,608 nets on the EG mainland, with plans to distribute the rest during the next distribution round in 2010. In addition, MCDI has purchased and distributed close to 116,594 LLINs on Bioko Island under the BIMCP Project thereby exceeding the coverage rate achieved by all other African countries for which data are available. Emphasis in all these programs was to work through community distributors in both urban and rural areas. In rural areas specifically, coverage and accessibility to health facilities is limited. At the same time, a health facility-based distribution of approximately 2,000 nets will be targeted toward pregnant women and children under five on Bioko Island to ensure that as new children are born, they will also be covered. MCDI coordinated with the International Federation of Red Cross and Red Crescent Societies (IFRC), national chapters of the Spanish and Canadian Red Cross, as well as the local Red Cross Chapter in Equatorial Guinea to develop and implement an effective distribution plan and post-distribution monitoring strategy. Monitoring coverage with LQAS after the campaign proved that the campaign had achieved satisfactory coverage in all supervision areas under both the BIMCP and EGMCI projects. The BIMCP project has documented an additive, synergistic effect of the combined use of LLINs and IRS together.

MCDI Malaria Capabilities - Indoor Residual Spraying (IRS)

MCDI’s experience from 2004 to date includes planning and managing a comprehensive indoor residual spraying program as part of the Bioko Island Malaria Control Project (BIMCP) in Equatorial Guinea (EG) with funding from Marathon Oil Company. The BIMCP completed eleven rounds of spraying by the end of 2009, covering more than 205,076 structures. Recent results in BIMCP from regular household surveys in sentinel sites of children under the age of 15 showed a continued reduction in the prevalence of parasitemia from 23% in 2007 to 18% in 2009. MCDI monitoring reveals that one malaria vector was reduced to 7% of pre-spray numbers after four rounds of spraying, and another vector was not found after the third round. MCDI worked with government and international partners on the appropriate choice of insecticide for IRS, including fulfilling environmental requirements, and establishing a system to monitor and respond to the development of insecticide resistance. Careful entomological monitoring organized by MCDI revealed emerging insecticide resistance to the first product, leading to a change in insecticide between the second and third rounds. The BIMCP recruits and trains spraying teams, and develops behavior change strategies and materials supportive of IRS. MCDI has procured all IRS-related equipment and commodities, including insecticides, spraying equipment, and survey-related materials and supplies for BIMCP. In addition, beginning in 2007, MCDI was designated as the Principal Recipient (PR) of a Global Fund grant under the Equatorial Guinea Malaria Control Initiative (EGMCI). The EGMCI project began spraying in one province on the EG mainland in 2007, and expanded to an additional province in 2008. If the Social Development Fund grant is approved, MCDI will expand spraying activities to all four provinces on the mainland.

MCDI Malaria Blog - Topics and Technical Updates

MCDI has many years of experience assisting governments and working at community level in Equatorial Guinea (EG), Madagascar, Benin, Mozambique, and Belize to develop and implement comprehensive malaria control programs. This includes working through government systems and using community outreach to incorporate malaria control into existing child survival programs (the Integrated Management of Childhood Illness – IMCI approach), as well as more direct malaria control interventions. In addition, MCDI chairs the malaria working group of CORE (a consortium of non-governmental organizations working in child survival) that coordinates the adoption of appropriate policies and development of state-of-the-art technical approaches to malaria control by its member organizations. To date, the CORE malaria working group has developed reference materials and guidelines to provide advice on areas such as behavior change, community case management, and prevention approaches. Finally, MCDI participates in the periodic planning discussions of the measles/malaria working group that works to coordinate combined programs of ITN distribution and measles vaccination in many countries.