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Malaria Treatment (non-ACT)

In Haiti, where P. falciparum resistance to chloroquine has not yet developed, PSI distributes cholorquine (plus primaquine) for the treatment of malaria, following the national treatment guidelines. This treatment is packaged in strength and dosage suitable different age groups of children with instructions provided in local languages and reinforced by simple illustrations. For optimum effect, treatment is given within 24-48 hours of the onset of symptoms and continued for at least three days or until the elimination of the parasite.

Unit of interventionper pre-packaged treatment course

Treatment coursedosage dependent on national treatment guidelines and child’s weight/age

Target populationChildren under five with malaria

For more information about how PSI is improving access to malaria treatment to improve health and save lives, , visit our website at:
http://www.psi.org/health-area/malaria/

Model Overview

PSI’s non-ACT malaria treatment impact model is based on the Lives Saved Tool (LiST). LiST is used to estimate the number of deaths averted by increasing coverage of malaria treatment among children under age five in a country. This number of deaths averted at the population level is translated to deaths averted per treatment course, using parameters such as baseline coverage, under-five population size, and malaria incidence rates. Once we have deaths averted per treatment course, we apply data from the 2010 Global Burden of Disease study to estimate the corresponding number of DALYs averted.

Model Outputs (impact metrics)

Estimates of DALYs averted, deaths averted, CYPs provided, and unintended pregnancies averted represent the projected health impact of the intervention. It is projected because it has not been directly measured.

Examples based on distribution of malaria treatment in Haiti in 2015 Statement of modeled results, examples:

In 2015, an estimated 9 deaths and 845 DALYs would be averted if 10,000 malaria treatment courses were distributed in Haiti.

For more details about how PSI models malaria treatment impact, see below.

Model Details

Step 1: Running a projection in the Lives Saved Tool (LiST)LiST is a multi-cause mortality model developed by Johns Hopkins Bloomberg School of Public Health that estimates the number of deaths averted (or lives saved) through the scale up of maternal and child health interventions.

PSI begins by running a projection in LiST for a selected country. In this projection, coverage of malaria treatment is increased from the current, country-specific baseline to 100% among children under five. LiST then projects the number of deaths averted by this increased level of coverage.

Step 1 Output:
Number of deaths averted (or lives saved) if coverage of malaria treatment is increased to 100% among the children under age five years in a given country

Step 2: Estimating deaths averted per malaria treatment course (deaths averted coefficient)PSI uses the step 1 output (deaths averted at 100% coverage) to estimate the number of deaths averted by a single treatment course. To do this, we divide the number of deaths averted at 100% coverage by the number of treatment courses needed to reach 100% coverage.

PSI estimates the number of treatment courses needed to reach 100% coverage using a number of parameters, including baseline coverage, under-five population size, and malaria incidence rates. Each case of malaria is assumed to require one full treatment course. We include a 15% adjustment factor, to take into account that not all treatment courses will actually go to malaria cases. We also account for wastage in the supply chain after leaving PSI’s warehouse, which we assume to be 10% across all interventions.

Step 2 Output:
Deaths averted coefficient

Step 3: Estimating DALYs averted per malaria treatment course (DALYs averted coefficient)A DALY (or disability adjusted life year) includes two components: years of life lost due to premature death (YLL) and years lived with disability (YLD). DALYs averted are in turn comprised of YLLs averted and YLDs averted or, put simply: death and disability that is prevented by PSI interventions.

To estimate YLLs averted per unit of malaria treatment, PSI first estimates the number of years of life lost per malaria death among children under five in a selected country. This is equal to the life expectancy at the average age of death from malaria for children under five. Age specific life expectancy is taken from the 2010 Global Burden of Disease study (GBD 2010). The number of years of life lost per malaria death is then multiplied by the number of deaths averted per treatment course (deaths averted coefficient), calculated in step 2 above for a selected country. This gives us the YLLs averted per treatment course.

To estimate YLDs averted per treatment course, we use a YLD/YLL ratio, based on GBD 2010. This ratio represents the relative number of years lived with disability for every year lost due to death from malaria in a selected country. We apply this ratio to the number of YLLs averted per treatment course to estimate the number of YLDs averted per treatment course. Because this is a malaria treatment intervention, not prevention, we assume that individuals will still suffer some disability before and during treatment. Therefore, we only include half of the total YLD averted in our estimate. This is a standard assumption in all of our treatment models.

Finally, YLLs averted and YLDs averted are added together to estimate the number of DALYs averted per treatment course.

Step 3 Output:
DALYs averted coefficient