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Using Malaria Tools for Elimination Scenario Planning
1. Getting Started
Start the Malaria Tools software, then click on the New icon in the bottom left-
hand corner to open a new scenario. Use the Countries panel on the left to first
select your country and then the region/province you are considering within that
country.
2. Estimating the malaria baseline
The software can be used to estimate the malaria baseline from current prevalence
and interventions as explained in Part III of the Elimination Scenario Planning
manual (page 13-16) and in step 4 in Box 2 (page 17). The following steps should
be undertaken.
a) Click on the Current Transmission tab. Enter the most recent prevalence
data available for the region in the top panel of this screen. Four boxes
should be completed: prevalence (the measured prevalence), year (in which
the survey was conducted), lower age (of the population surveyed) and
upper age (of the population surveyed). If there is specific data on the
distribution of Anopheles vector species (An.funestus, An.arabiensis and
An.gambiae s.s.), this can also be entered. All prevalence measures are
given as percentages.
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b) Click on the Past ITN Use tab. This contains the country-level estimates of
percent ITN usage as reported in the World Malaria Report 2013. Slide the
bars for each year to adjust these to any region/province level data if these
are available, otherwise leave these at the pre-set values.
c) Click on the Current Drug Use tab. This contains estimates of current
percent treatment coverage levels estimated in Cohen et al. (2012). Change
the percentage of cases treated to values you have available – note that this
proportion represents those that seek treatment and receive an anti-malarial
across both the public and private sectors. Next change the proportion of all
those treated receiving either an ACT (selecting AL or DHA-PQ as
appropriate) or a non-ACT. These three values should sum to 100%. If AS
is first-line treatment, please select AL to represent this drug.
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d) Return to the Transmission Settings tab.
e) Now run the scenario by clicking on the Run icon in the bottom left-hand
corner. Once the simulation has completed, the new estimated malaria
baseline prevalence is shown in the top panel.
f) Save this scenario to ensure that these settings can be used for the next
steps .
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3. Making Predictions about Technical and Operational
Feasibility of Malaria Reduction
3.1 Introduction
Parts IV and V can be combined in the Malaria Tools software by exploring explicit
scenarios about the impact of interventions either alone or in combination. In
particular, the actions in Box 6 (page 30) can be undertaken in more detail for each
region/province. Selecting the Intervention Options tab allows the following
interventions and operational constraints on coverage to be adjusted:
a) Vector Control: For both ITNs (A) and IRS (B), decaying efficacy is
implemented automatically to capture wear-and-tear and decay of the
insecticide. Vector behaviour (including outdoor biting) and sleeping behaviour
is also captured in the software. Thus the coverage levels entered should be the
proportion of the population protected (i.e. those using bed nets or those
residing in sprayed houses) – see Figure 13 and Figure 14 on page 15 of the
Elimination Scenario Planning manual.
b) IPT/SMC (C) and Mass treatment (D): Options are available to specify the
target coverage which represents the proportion of the at-risk population
receiving the full intervention. Mass Treatment can be combined with an RDT
to implement a Mass Screen and Treat program.
A
B
C
D
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c) Vaccination: A hypothetical vaccine (such as RTS,S) can be considered at a
specified target coverage. This can be delivered through the Expanded Program
for Immunisation, EPI (E) or to the whole population via Mass Vaccination
(F).
d) First-line treatment (G): The software distinguishes between symptomatic
and asymptomatic infection. The coverage levels should therefore represent the
proportion of malarial fevers treated with an anti-malarial (adjusting for
treatment-seeking, diagnosis, supply chain and adherence). See Figure 18 on
page 25 of the Elimination Scenario Planning manual.
E
F
G
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3.2 An Example
As an example, we demonstrate a scenario for Houet province in Burkina Faso in
which bed net coverage is increased to 90% and SMC is introduced with a coverage
of 80%.
a) Baseline scenario
As detailed in section 2 above, start Malaria Tools, click New to create a new
scenario, then select Burkina Faso as the country, then Houet as the province.
Then click Run to run the model for the default settings for that province.
Note that by default, the software assumes no interventions (including bed nets) after
2013. Hence the output graph shows an increase in prevalence over time.
To keep bed nets at their 2013 level go to the Intervention Options tab and tick
Insecticide Treated Nets. Next highlight this option and make sure that the coverage
is as at 2013 levels. In this case our default settings are 39%. Click the Run icon again
to generate the new baseline scenario. The output graph now shows constant
prevalence over time.
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b) Increasing bed net coverage to 90%
To generate a second scenario, click New. This will create a new scenario with
the same settings as the previous scenario.
Now increase the coverage of ITNs to 90%. Click Run. The output window
will now show results for both scenarios. You will notice an initial decrease in
prevalence over time for the second scenario.
Other outputs (clinical incidence, severe disease incidence, mortality and EIR)
can be viewed by selecting different tabs in the output pane. The icons on the
right side of the graph allow you to switch between smoothed and seasonal
output, and between line and bar graphs.
c) Increasing SMC to 80% coverage
Generate a third scenario by clicking New. Tick the IPT/SMC intervention option
and highlight it, then tick the SMC sub-option and change SMC coverage to 80%.
Click Run again.
A third line will appear in the output graph showing the additional predicted impact
of adding SMC in the presence of high bed net coverage.
Output from these runs can be saved to a text file (which can be opened in Microsoft
Excel) by clicking the “save” icon. Further details of the columns in this file are given
in the Malaria Tools manual.