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Malaria Treatment (ACT)

The recommended treatment by the World Health Organization for uncomplicated P. falciparum malaria is a combination of two or more antimalarial medicines with different mechanisms of action. PSI distributes artemisinin-based combination therapy (ACT) 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, ACTs are 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 intervention1 pre-packaged treatment course of ACT

FormulationACT formulation and dosage dependent on national treatment guidelines and child’s weight/age

Target populationChildren under five with malaria

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

Model Overview

PSI’s ACT impact model is based on the Lives Saved Tool (LiST). LiST is used to estimate the number of deaths averted by increasing coverage of ACT for treatment of malaria 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 of ACT, using parameters such as baseline coverage of ACT, under-five population size, and malaria incidence rates. Once we have deaths averted per treatment course of ACT, 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 ACT treatment courses in Myanmar in 2015 Statement of modeled results, examples:

In 2015, an estimated 11 deaths and 1,070 DALYs would be averted if 10,000 treatment courses of ACT were distributed in Myanmar.

For more details about how PSI models ACT 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 ACT is increased from the current, country-specific baseline to 100% among children under five. LiST then estimates the number of additional deaths averted by this increased level of coverage.

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

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

PSI estimates the number of ACT treatment courses needed to reach 100% coverage using a number of parameters, including baseline coverage of ACT, under-five population size, and malaria incidence rates. Each case of malaria is assumed to require one full treatment course of ACT. We include a 15% adjustment factor, to take into account that not all ACT treatment courses will go to malaria cases. We also account for wastage of ACT 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 unit of ACT (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 ACT, 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. Age specific life expectancy is taken from the 2010 Global Burden of Disease (GBD 2010). The number of years of life lost per malaria death is then multiplied by the number of deaths averted per treatment course of ACT (deaths averted coefficient), calculated in step 2 above for a selected country. This gives us the YLLs averted per unit of ACT.

To estimate YLDs averted per unit of ACT, 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 children under five in a selected country. We apply this ratio to the number of YLLs averted per treatment course of ACT to estimate the number of YLDs averted per treatment course. Because ACT treats malaria, 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 of ACT.

Step 3 Output:
DALYs averted coefficient