Demographic and health community-based surveys to inform a malaria elimination project in Magude district, southern Mozambique

Abstract

ObjectivesA Demographic and Health Platform was established in Magude in 2015, prior to the deployment of a project aiming to evaluate the feasibility of malaria elimination in southern Mozambique, named the Magude project. This platform aimed to inform the design, implementation and evaluation of the Magude project, through the identification of households and population; and the collection of demographic, health and malaria information.SettingMagude is a rural district of southern Mozambique which borders South Africa. It has nine peripheral health facilities and one referral health centre with an inpatient ward.InterventionA baseline census enumerated and geolocated all the households, and their resident and non-resident members, collecting demographic and socio-economic information, and data on the coverage and usage of malaria control tools. Inpatient and outpatient data during the 5 years (2010 to 2014) before the survey were obtained from the district health authorities. The demographic platform was updated in 2016.ResultsThe baseline census conducted in 2015 reported 48 448 (92.1%) residents and 4133 (7.9%) non-residents, and 10 965 households. Magude’s population is predominantly young, half of the population has no formal education and the main economic activities are agriculture and fishing. Houses are mainly built with traditional non-durable materials and have poor sanitation facilities. Between 2010 and 2014, malaria was the most common cause of all-age inpatient discharges (representing 20% to 40% of all discharges), followed by HIV (12% to 22%) and anaemia (12% to 15%). In early 2015, all-age bed-net usage was between 21.8% and 27.1% and the reported coverage of indoor residual spraying varied across the district between 30.7% and 79%.ConclusionThis study revealed that Magude has limited socio-economic conditions, poor access to healthcare services and low coverage of malaria vector control interventions. Thus, Magude represented an area where it is most pressing to demonstrate the feasibility of malaria elimination.Trial registration numberNCT02914145; Pre-results.

A multiphase program for malaria elimination in southern Mozambique (the Magude project): A before-after study

“…Artemether-lumefantrine, the national first-line antimalarial treatment, remains fully efficacious [14].The district has 27 community health workers (CHWs), nine rural health facilities (HFs), one referral health center with an inpatient ward in Magude Sede (main town), although the more severe cases are sometimes referred to the neighboring hospitals of Xinavane or Manhiça (Manhiça District). Magude's baseline sociodemographic characteristics and health systems have been described elsewhere [15].…”

“…Overall, this suggests that conducting more than one round of MDA per year is needed to increase the population coverage of the intervention. It also reveals that the majority of the population that participated in the annual MDA campaigns only received one of the two rounds and was thus under chemoprevention with DHAp for 1-2 months instead of 2-4 months [34], thus increasing the potential for exposure to local or imported infections [15,35,36].…”

Field performance of ultrasensitive and conventional malaria rapid diagnostic tests in southern Mozambique

“…In both surveys, a simple random sample of participants was selected per age group from the census databases available from Manhiça and Magude, collected and updated through the demographic surveillance platforms established in both districts [ 38 , 39 ]. The age groups used to stratify the sample differed according to the district.…”

Moving towards malaria elimination in southern Mozambique: Cost and cost-effectiveness of mass drug administration combined with intensified malaria control

“…The district has year-round malaria transmission, with seasonal peaks in the rainy season (November-April). Further epidemiological and socio-demographic characteristics of the district have been described elsewhere [22,25].…”

“…Cost data associated with routine malaria vector control interventions as part of the counterfactual scenario were gathered from the Global Fund's Price and Quality Reporting database (for LLIN,) and the President's Malaria Initiative country evidence (for IRS) [32]. IRS coverage rates (52.2%) registered in the Magude demographic census in 2015 were used to estimate the costs of routine IRS [25].…”