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 Cam bodia Benin Uganda DRC 5 year, 7 country project Funded by the BMGF Objective Provide policy m akers w ith evidence on trends in Zam bia availability, price, and use of Madagascar antim alarials Partnership PSI , LSHTM and MoHs w w w .ACTw atch.info 2 2
Household questionnaire 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 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 3
Data Collection Photo: ACTw atch Household Survey Data Collection, Uganda 2 0 1 2 4
Dates of Data Collection Country Baseline Endline Uganda Mar-Apr, 2009 Apr-May, 2012 Madagascar Dec-Jan, 2009 Apr-Jun, 2012 Aug-Sep, 2009 Jun-Jul, 2012 Nigeria Sam ple Country Baseline ( n) Endline ( n) Eligible Num ber of Eligible Num ber of households children < 5 households 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 w w w .ACTw atch.info 5
RESULTS Photo: ACTw atch Data Managem ent, Nairobi, 2 0 1 2 6
Success m etrics: Sum m ary Madagascar m ainland Tanzania Zanzibar Uganda Nigeria Ghana Kenya Niger Benchm ark 1. 20 percentage point 52 35 4.6 10 26 44 46 39 (p< 0. (p< 0. (p= 0. (p= 0. (p= 0. (p< 0. (p< 0. increase in QAACT availability 01) 01) 99) 99) 14) 01) 01) 3.0 1.0 1.6 2.5 3.1 1.0 3.3 1.5 2. Median price of QAACTs (p= 0. (p< 0. (p< 0. (p< 0. (p= 0. (p< 0. (p= 0. with AMFm logo is < 3 times 81) 01) 01) 01) 99) 01) 99) the median price of the most popular antimalarial in tablet form that is not a QAACT (ratio) -0.94 -1.17 -6.3 3. Median price of QAACTs (p< 0. (p< 0. with AMFm logo is less than 01) 01) the median price of AMT tablets (difference, QAACT – AMT) 40 31 8.6 -8.8 18 16 17 48 5. 10 percentage point (p< 0. (p= 0. (p= 0. (p= 0. (p< 0. (p= 0. (p= 0. increase in market share of 01) 01) 61) 99) 01) 23) 08) QAACTs 6. Decrease in market share -3.9 -12 (p= 0. of oral AMTs (percentage 03) point change) Note that the outlet survey was not powered to detect a 10% change in market share in Madagascar, Tanzania mainland and Uganda
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 w w w .ACTw atch.info 8
Treatm ent of children w ith fever, Uganda 100 90 80 70 53.5 50.3 60 44.2 50 % 35.6 40 20.2 30 17.0 17.8 20 10.0 10 0 2009 2012 N= 1752 N= 2273 Diagnostic test Antimalarial ACT Prompt ACT w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 Source: ACTwatch Household Survey Trends 2008/2009- 2012,: Preliminary Findings. 9
Treatm ent of children w ith fever: ACTw atch alongside DHS* and MI S* findings: Uganda 100 Antimalarial ACT Prompt ACT 90 80 70 64.5 59.6 60 53.5 50.3 % 50 44.2 44.2 40 35.6 29.9 30 23.3 20.2 17 20 13.7 10 0 ACTwatch UMI S UDHS ACTwatch Apr-May 2009 Nov-Dec 2009 Jun-Dec 2011 Apr-May 2012 N= 1752 N= 1667 N= 3042 N= 2273 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) w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 MI S/ DHS/ ACTw atch Household Survey Results 1 0
Proportion of children that received an ACT, across household w ealth quintiles, Uganda 100 90 80 70 60 50 % 40 30 20 10 0 2009 2012 Poorest Second Middle Fourth Richest w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 Household Prelim inary Survey Results 1 1
Treatm ent of children w ith fever w ith an ACT, by strata and am ong the poorest, Uganda 100 90 80 70 48.5 60 46.6 % 50 33.2 21.6 40 20.3 30 16.2 20 10 0 Urban Rural n= 170; 1102 n= 1582; 1171 n= 707; 916 Strata Poorest 2009 2012 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report. 1 2
I nitial source of advice/ treatm ent 100% Uganda 42.1 60.6 At home 50% 14.8 13.3 Public/ Not for Profit 37.7 Sector 26.1 Private Sector 0% 2009 2012 N= 1674 N= 2212 Total Source of antim alarials Source of ACTs 100 100 90 90 80 80 70 70 50.6 44.4 47.3 60 60 41.6 36.0 38.6 50 50 % 28.5 25.8 24.0 40 40 23.3 21.4 20.4 30 30 20 20 10 10 0 0 2009 2012 2009 2012 N= 899 N= 1177 N= 358 N= 948 Total Total w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report. 1 3
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 w w w .ACTw atch.info 1 4
Treatm ent of children w ith fever, Nigeria 100 90 80 70 60 50 % 36.6 31.8 40 30 11.1 20 8.0 4.4 6.8 6.0 3.3 10 0 2009 2012 N= 3274 N= 1551 Diagnostic test Antimalarial ACT Prompt ACT w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 Source: ACTwatch Household Survey Trends 2008/2009- 2012,: Preliminary Findings. 1 5
Treatm ent of children w ith fever: ACTw atch alongside DHS* and MI S* findings: Nigeria 100 Antimalarial ACT Prompt ACT 90 80 70 60 % 49.1 50 40 36.2 33.2 32.8 30 20 10.0 10 6.6 5.9 4.5 3.4 3.2 2.4 1.1 0 DHS ACTwatch MI S ACTwatch June-Oct 2008 Aug-Sept 2009 Oct-Dec 2010 July-Aug 2012 N= 3968 N= 3274 N= 1956 N= 1548 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) w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 MI S/ DHS/ ACTw atch Household Survey Results 1 6
Proportion of children that received an ACT, across household w ealth quintiles, Nigeria 100 90 80 70 60 50 % 40 30 20 10 0 2009 2012 Poorest Second Middle Fourth Richest w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 Household Prelim inary Survey Results 1 7
Treatm ent of children w ith fever w ith an ACT, by urban and rural strata; poorest, Nigeria 100 90 80 70 60 % 50 40 30 12.0 10.2 1.5 6.6 20 3.1 6.5 10 0 Urban Rural n= 1160; 852 n= 2114; 699 n= 1269; 610 Strata Poorest 2009 2012 w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report. 1 8
I nitial source of advice/ treatm ent 100% 1.2 Nigeria 28.6 47.8 At home 50% 13.3 69.6 Public/ Not for Profit 38.9 Sector Private Sector 0% 2009 2012 N= 1960 N= 1525 Total Source of antim alarials Source of ACTs 100 100 90 90 66.7 80 80 70 70 49.9 48.0 43.5 60 60 40.6 30.7 50 50 % 25.2 40 40 21.9 30 30 12.7 9.5 20 20 0.7 1.1 10 10 0 0 2009 2012 2009 2012 N= 1060 N= 565 N= 164 N= 157 Total Total w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 Source: ACTwatch Household Survey Trends 2008/2009- 2012, Draft Report. 1 9
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 w w w .ACTw atch.info 2 0
Treatm ent of children w ith fever, Madagascar 100 90 80 70 60 47.7 50 % 40 30 19.0 12.0 20 8.4 7.0 6.9 3.4 3.2 10 0 2009 2012 N= 2120 N= 2388 Diagnostic test Antimalarial ACT Prompt ACT w w w .ACTw atch.info 1 1 / 5 / 2 0 1 2 Source: ACTwatch Household Survey Trends 2008/2009- 2012,: Preliminary Findings. 2 1
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