Treatm ent seeking for fever: Uganda, Nigeria, Madagascar Data - - PowerPoint PPT Presentation

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Treatm ent seeking for fever: Uganda, Nigeria, Madagascar Data - - PowerPoint PPT Presentation

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Treatm ent seeking for fever: Uganda, Nigeria, Madagascar Data sourced from : ACTwatch Household Survey Trends 2008/2009- 2012 (Draft report). Washington DC: Population Services International; 2012. ACTw atch: the original countries Nigeria

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Treatm ent seeking for fever: Uganda, Nigeria, Madagascar

Data sourced from : ACTwatch Household Survey Trends 2008/2009- 2012 (Draft report). Washington DC: Population Services International; 2012.

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w w w .ACTw atch.info 2

Benin DRC Zam bia Nigeria Uganda Madagascar Cam bodia

ACTw atch: the original countries

2

Objective

Provide policy m akers w ith evidence on trends in availability, price, and use of antim alarials

Partnership

PSI , LSHTM and MoHs

5 year, 7 country project

Funded by the BMGF

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1 ) Screening m odule: to identify households that were eligible for the survey; 2 ) Household listing: to list all the usual members in the selected households. 3 ) Household questionnaire m odule: modelled after the Demographic and Health Survey (DHS) 4 ) Treatm ent seeking m odule: which included questions documenting the type, timing, source and cost of treatments acquired for the child’s fever. 5 ) [ AT endline] AMFM aw areness section: which included questions on caregiver exposure and awareness of the AMFm interventions and activities.

* Full questionnaire available at: http: / / www.actwatch.info/ research/ study_designs.php

3 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

Household questionnaire

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Data Collection

Photo: ACTw atch Household Survey Data Collection, Uganda 2 0 1 2 4

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Sam ple

w w w .ACTw atch.info 5

Country Baseline ( n) Endline ( n) Eligible households Num ber of children < 5 Eligible households Num ber of children < 5 Uganda 1,528 1,752 1,832 2,273 Madagascar 1,961 2,120 2,176 2,388 Nigeria 2,860 3,273 1,312 1,551 Country Baseline Endline Uganda Mar-Apr, 2009 Apr-May, 2012 Madagascar Dec-Jan, 2009 Apr-Jun, 2012 Nigeria Aug-Sep, 2009 Jun-Jul, 2012

Dates of Data Collection

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RESULTS

6 Photo: ACTw atch Data Managem ent, Nairobi, 2 0 1 2

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Benchm ark

Ghana Kenya Madagascar Niger Nigeria Tanzania m ainland Uganda Zanzibar

  • 1. 20 percentage point

increase in QAACT availability

52 (p< 0. 01) 35 (p< 0. 01) 4.6 (p= 0. 99) 10 (p= 0. 99) 26 (p= 0. 14) 44 (p< 0. 01) 46 (p< 0. 01) 39

  • 2. Median price of QAACTs

with AMFm logo is < 3 times the median price of the most popular antimalarial in tablet form that is not a QAACT (ratio)

3.0 (p= 0. 81) 1.0 (p< 0. 01) 1.6 (p< 0. 01) 2.5 (p< 0. 01) 3.1 (p= 0. 99) 1.0 (p< 0. 01) 3.3 (p= 0. 99) 1.5

  • 3. Median price of QAACTs

with AMFm logo is less than the median price of AMT tablets (difference, QAACT – AMT)

  • 0.94

(p< 0. 01)

  • 1.17

(p< 0. 01)

  • 6.3
  • 5. 10 percentage point

increase in market share of QAACTs

40 (p< 0. 01) 31 (p= 0. 01) 8.6 (p= 0. 61)

  • 8.8

(p= 0. 99) 18 (p< 0. 01) 16 (p= 0. 23) 17 (p= 0. 08) 48

  • 6. Decrease in market share
  • f oral AMTs (percentage

point change)

  • 3.9

(p= 0. 03)

  • 12

Success m etrics: Sum m ary

Note that the outlet survey was not powered to detect a 10% change in market share in Madagascar, Tanzania mainland and Uganda

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w w w .ACTw atch.info 8

Uganda - Context

  • LLIN distribution - national (7.2million, 2010/2011)
  • Net use from 11% (MIS, 2009) to 43% (DHS, 2011)
  • IRS continuous in four high-transmission districts
  • ACTs - stocks from AMFm, PMI and DfID
  • AL subsidy to private sector in four districts (CAPSS,

2008-2010)

  • distribution through ICM by community medicine distributors

in rural areas

  • Signed AMFm grant in Feb 2011; first order delivered in April (FLB;

private for-profit sector) and July (NMS; public sector) 2011

  • SI for promotion of AMFm drugs not begun as of August 2012
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9 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

10.0 17.8 50.3 53.5 20.2 44.2 17.0 35.6

10 20 30 40 50 60 70 80 90 100

2009 N= 1752 2012 N= 2273 % Diagnostic test Antimalarial ACT Prompt ACT

Treatm ent of children w ith fever, Uganda

Source: ACTwatch Household Survey Trends 2008/2009- 2012,: Preliminary Findings.

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1 0 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

50.3 59.6 64.5 53.5 20.2 23.3 44.2 44.2 17 13.7 29.9 35.6 10 20 30 40 50 60 70 80 90 100

ACTwatch Apr-May 2009 N= 1752 UMI S Nov-Dec 2009 N= 1667 UDHS Jun-Dec 2011 N= 3042 ACTwatch Apr-May 2012 N= 2273

% Antimalarial ACT Prompt ACT

MI S/ DHS/ ACTw atch Household Survey Results

Treatm ent of children w ith fever: ACTw atch alongside DHS* and MI S* findings: Uganda

Of children w ith fever in the tw o w eeks prior to the survey, the percentage that received: an antim alarial, an ACT, an ACT w ithin < 4 8 hours *Source: www.measuredhs.com ICF Macro (2012) ICF Macro (2009)

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1 1 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 Household Prelim inary Survey Results

Proportion of children that received an ACT, across household w ealth quintiles, Uganda

10 20 30 40 50 60 70 80 90 100

2009 2012 % Poorest Second Middle Fourth Richest

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16.2 20.3 21.6 33.2 46.6 48.5

10 20 30 40 50 60 70 80 90 100

Urban n= 170; 1102 Rural n= 1582; 1171 n= 707; 916 Strata Poorest

%

2009 2012

1 2 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

Treatm ent of children w ith fever w ith an ACT, by strata and am ong the poorest, Uganda

Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report.

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1 3 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

25.8 36.0 50.6 47.3 20.4 23.3

10 20 30 40 50 60 70 80 90 100

2009 N= 899 2012 N= 1177 Total

%

Source of antim alarials

Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report.

Source of ACTs

44.4 38.6 28.5 41.6 21.4 24.0

10 20 30 40 50 60 70 80 90 100

2009 N= 358 2012 N= 948 Total

37.7 26.1 14.8 13.3 42.1 60.6

0% 50% 100% 2009 N= 1674 2012 N= 2212 Total

At home Public/ Not for Profit Sector Private Sector

I nitial source of advice/ treatm ent Uganda

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w w w .ACTw atch.info 1 4

Nigeria - Context

  • LLIN distribution – mass campaign in 22 states (34million, 2011)
  • Net use from 6% (DHS, 2008) to 29% (MIS, 2010)
  • Targeted IRS in 7 states – 15% (250,000 HHs)
  • ACTs - stocks from World Bank , PMI and Global Fund
  • abundant local pharmaceutical manufacturing – not eligible

for the subsidy

  • Signed AMFm grant in Sep 2010; first order delivered in Jan (private

sector) and May (public sector) 2011

  • Successful advocacy and promotion efforts in 2011
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1 5 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

6.0 6.8 31.8 36.6 4.4 11.1 3.3 8.0

10 20 30 40 50 60 70 80 90 100

2009 N= 3274 2012 N= 1551

% Diagnostic test Antimalarial ACT Prompt ACT

Treatm ent of children w ith fever, Nigeria

Source: ACTwatch Household Survey Trends 2008/2009- 2012,: Preliminary Findings.

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1 6 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

33.2 32.8 49.1 36.2 2.4 4.5 5.9 10.0 1.1 3.4 3.2 6.6 10 20 30 40 50 60 70 80 90 100

DHS June-Oct 2008 N= 3968 ACTwatch Aug-Sept 2009 N= 3274 MI S Oct-Dec 2010 N= 1956 ACTwatch July-Aug 2012 N= 1548

% Antimalarial ACT Prompt ACT

MI S/ DHS/ ACTw atch Household Survey Results

Treatm ent of children w ith fever: ACTw atch alongside DHS* and MI S* findings: Nigeria

Of children w ith fever in the tw o w eeks prior to the survey, the percentage that received: an antim alarial, an ACT, an ACT w ithin < 4 8 hours *Source: www.measuredhs.com ICF Macro (2012) ICF Macro (2009)

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1 7 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 Household Prelim inary Survey Results

Proportion of children that received an ACT, across household w ealth quintiles, Nigeria

10 20 30 40 50 60 70 80 90 100

2009 2012 % Poorest Second Middle Fourth Richest

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6.5 3.1 1.5 12.0 10.2 6.6

10 20 30 40 50 60 70 80 90 100

Urban n= 1160; 852 Rural n= 2114; 699 n= 1269; 610 Strata Poorest

%

2009 2012

1 8 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

Treatm ent of children w ith fever w ith an ACT, by urban and rural strata; poorest, Nigeria

Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report.

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1 9 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

25.2 21.9 48.0 66.7 1.1 12.7

10 20 30 40 50 60 70 80 90 100

2009 N= 1060 2012 N= 565 Total

%

Source of antim alarials

Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report.

Source of ACTs

30.7 40.6 43.5 49.9 0.7 9.5

10 20 30 40 50 60 70 80 90 100

2009 N= 164 2012 N= 157 Total

69.6 38.9 28.6 13.3 1.2 47.8

0% 50% 100% 2009 N= 1960 2012 N= 1525 Total

At home Public/ Not for Profit Sector Private Sector

I nitial source of advice/ treatm ent Nigeria

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w w w .ACTw atch.info 2 0

Madagascar - Context

  • Prevention strategies - LLIN distribution & targeted IRS
  • Net use from 58% (DHS, 2008/ 09) to 94% (MIS, 2011)
  • ACTs - stocks from PMI
  • ASAQ (ACTipal) subsidy through CHWs, pharmacies & drug

stores since 2008

  • distribution by CHWs since 2008; RDTs permitted at

community level in 2010

  • First order for copaid ACTs delivered in Oct 2010 (FLB, private

sector) and Feb (public sector) 2011

  • AMFm SI limited by enforcement of national regulations on drug

advertising

  • Political instability and economic challenges
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2 1 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

6.9 12.0 47.7 19.0 3.4 8.4 3.2 7.0

10 20 30 40 50 60 70 80 90 100

2009 N= 2120 2012 N= 2388

% Diagnostic test Antimalarial ACT Prompt ACT

Treatm ent of children w ith fever, Madagascar

Source: ACTwatch Household Survey Trends 2008/2009- 2012,: Preliminary Findings.

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2 2 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

40.1 13.9 7.2 82.6 30.3 44.5

10 20 30 40 50 60 70 80 90 100

N= 899; 1177 N= 1060; 565 N= 972; 427 Uganda Nigeria Madagascar

% 2009 2012

ACT treatm ent am ong those w ho received an antim alarial

Source: ACTwatch Household Survey Trends 2008/2009- 2012,: Preliminary Findings.

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2 4 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 Household Prelim inary Survey Results

Proportion of children that received an ACT, across household w ealth quintiles, Madagascar

10 20 30 40 50 60 70 80 90 100

2009 2012 % Poorest Second Middle Fourth Richest

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4.2 3.3 2.3 6.2 8.7 8.9

10 20 30 40 50 60 70 80 90 100

Urban n= 1061; 1326 Rural n= 1059; 1062 n= 851; 964 Strata Poorest

%

2009 2012

2 5 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

Treatm ent of children w ith fever w ith an ACT, by urban and rural strata; poorest, Madagascar

Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report.

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2 6 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

26.8 46.1 61.0 38.7 12.3 17.7

10 20 30 40 50 60 70 80 90 100

2009 N= 972 2012 N= 427 Total

%

Source of antim alarials

Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report.

Source of ACTs

49.3 62.4 47.8 29.2 2.9 10.0

10 20 30 40 50 60 70 80 90 100

2009 N= 80 2012 N= 167 Total

58.5 34.8 23.8 21.5 17.7 43.7

0% 50% 100% 2009 N= 1957 2012 N= 2215 Total

At home Public/ Not for Profit Sector Private Sector

I nitial source of advice/ treatm ent Madagascar

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w w w .ACTw atch.info 2 7

Sum m ary – source of ACTs

44.4 38.6 28.5 41.6 21.4 24.0

10 20 30 40 50 60 70 80 90 100

2009 N= 358 2012 N= 948

Uganda

30.7 40.6 43.5 49.9 0.7 9.5

10 20 30 40 50 60 70 80 90 100

2009 N= 164 2012 N= 157

Nigeria

49.3 62.4 47.8 29.2 2.9 10.0

10 20 30 40 50 60 70 80 90 100

2009 N= 80 2012 N= 167

Madagascar

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2 8 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2

10 20 30 40 50 60 70 80 90 100

Uganda N= 1752; 2273 Madagascar N= 2120; 2388 Nigeria N= 3274; 1551

% ACT 2009 ACT 2012 Diagnosis 2009 Diagnosis 2012

Sum m ary - Treatm ent of children w ith fever

Source: ACTwatch Household Survey Trends 2008/2009- 2012,: Preliminary Findings.

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Aw areness of the AMFm

AMFm Antim alarial found during data collection in Benin 2 9

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3 0 w w w .ACTw atch.info

39.2 20.1 13.4 18.3 9.2 15.7 48.0 25.7 25.9

10 20 30 40 50 60 70 80 90 100

Uganda N= 3,193 Nigeria N= 3,681 Madagascar N= 6,781 % Seen or heard of the AMFm logo Heard of initiative to reduce the price of ACTs Either seen/ heard of the AMFm logo or initiative

Caregiver aw areness and exposure to the AMFm

Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report.

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3 1 w w w .ACTw atch.info

36.8 3.2 30.8 38.9 16.8 49.7 13.2 3.9 20.9 3.2 27.4 15.3 27.7 23 2.7

20 40 60 80 100

Medicine packaging TV Radio Public Health Facility Private Facility % Madagascar N= 1,289 Nigeria N= 728 Uganda N= 1,281

Com m on sources of exposure to the AMFm logo

Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report.

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3 2 w w w .ACTw atch.info

2.8 6.5 74.7 20.0 7.0 6.0 20.8 39.8 26.1 3.3 6.7 14.8 63.1 16.3 1.2

20 40 60 80 100

Medicine packaging TV Radio Public Health Facility Private Facility

% Madagascar N= 1,216 Nigeria N= 728 Uganda N= 579

Com m on sources of exposure to the AMFm initiative

Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report.

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Meaning of the AMFm logo ( n= 1 2 8 9 )

20 40 60 80 100 Medicine Antimalarial Effective antimalarial Cheap antimalarial Health Don't know Madagascar N= 1,289 Nigeria N= 730 Uganda N= 1,280

w w w .ACTw atch.info 3 3 Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report.

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3 4 w w w .ACTw atch.info

9.9 8.8 11.9 6.8 11.5 8.0

20 40 60 80 100

Uganda Nigeria % Urban Rural Total

Know ledge of the Recom m ended Price*

Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report.

* There was no recommended retail price for the AMFm medicine in Madagascar

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3 5 w w w .ACTw atch.info

  • Mr. Suprotik Basu
  • Mr. Rik Bosman
  • Ms Renia Coghlan
  • Dr. Thom Eisele
  • Mr. Louis Da Gama
  • Dr. Paul Lalvani
  • Dr. Ramanan

Laxminaravan

  • Dr. Matthew Lynch
  • Dr. Bernard Nahlen
  • Dr. Jayesh M. Pandit
  • Dr. Melanie Renshaw
  • Mr. Oliver Sabot
  • Ms Rima Shretta
  • Dr. Rick Steketee
  • Dr. Warren Stevens
  • Dr. Gladys Tetteh
  • Dr. Nick White
  • Dr. Prashant Yadav
  • Dr. Shunmay Yeung

Bill & Melinda Gates Foundation

Acknow ledgem ents

ACTw atch Advisory Com m ittee