Geoffrey Manda

PhD summary

General objective

To provide additional required information to translate the evidence gathered on ‘intermittent preventive treatment in school aged children’ in various studies into policy.

Specific objectives

1. What is the relative and absolute contribution of schoolchildren (6-12 years) on malaria transmission depending in different malaria endemic settings taking into account (the effectiveness) of other interventions?
   
   Rationale: next to the burden of disease, school aged children may contribute significantly to the transmission of Malaria in malaria endemic setting. To convince policy makers globally that school aged children are a missed opportunity essential to either control or eliminate the disease, their relative contribution the malaria endemicity must be assessed in various endemic settings. We hypothesise that school aged children, who represent 26.8% of the population though over 40% of both the malaria reservoir and burden, are a main driver of malaria transmission. Methods on selection of compartmental conformist transmission models and how they are impacted by IPTsc will be shown on this publication.
   
   
2. Impact of intermittent preventive treatment of malaria on mathematical modelling of malaria transmission and immunity and malaria burden (at population level) among school aged children
   
   Recommended control interventions as early diagnosis and treatment, use of repellents, chemoprophylaxis or bed nets are either not recommended or have a sub-optimal impact, effectiveness in this age group. The evidence that IPTsc is an efficacious, effective, acceptable and feasible intervention tool in this target group is accumulating. This study will assess via mathematical models selected developed in objective 1 the impact of IPTsc on malaria transmission and immunity (considering the effectiveness of actual existing interventions) at population level. A sensitivity analysis will be performed considering drug resistance, adherence, immunity, etc. Via the impact on transmission, IPTsc will not only affect the burden of disease in this specific age group but equally be an important key population for controlling (and eliminating) malaria at population health level. These results will an additional element to convince policy makers (and funders) locally and globally that malaria control in school aged children is essential to control (or eliminate) the disease
   
   
3. How cost effective is an IPTsc program in relation the malaria endemicity? Cost-effectiveness study. Cost effectiveness analysis (CEA) has become increasingly important for evidence-based decision-making in health care in resource-constrained settings. There is consensus among economists about the main points of CEA methodology, although there continues to be important advances in techniques related to CEA such as modelling uncertainty. Little work has been done on the cost-effectiveness of IPTsc and this has not considered the potential savings in health care costs or productivity of workers. However, CEA of malaria interventions, even when based on careful costing, have generally not considered either the transmission effects or the dynamics of the long-term impact. An adequate model for CEA of malaria vaccines needs to consider these elements. This objective yields several assessments on cost-effectiveness. Study aims to determine cost effectiveness of IPTsc for malaria in school children across different levels of exposure and transmission dynamics and taking into drug resistance, school attendance, etc . Direct cost-effectiveness i.e., will be estimated taking into account the protective efficacy (i.e. costs per life year gained, Number needed to treat, etc…) However, the models developed in objective 2 and 3 will be used to assess overall cost effectiveness at population level. The impact of integrating other school health related activities and helminth control, bed nets, … will be incorporated. Health economic studies provide information to decision makers for efficient use of available resources for maximizing health benefits. This study will situate the cost-effectiveness of IPTsc in terms of gains in DALY, QUALY’s gained (cost-utility evaluation) compared to other malaria control interventions, and other health interventions taking several tangible examples.
   
   
4. Institutional Acceptability and feasibility of large IPTsc operational impact bed net program and IPTsc on malaria related burden of disease. Health systems analysis.
   
   Health systems analysis (HSA) seeks to understand the determinants of health system performance and to develop better policies and strategies for reform that improve that performance. HSA involves gathering data on health system inputs, processes, and outputs; and analyzing how these combine to produce the outcomes. It also examines other important dimensions of the health system environment such as politics, history, and institutional arrangements. HSA seeks to form hypotheses about the causes of poor health system performance and about how reform policies and strategies can improve performance. It includes proposals on implementing reforms and analyzes their possible effects might be. Everyone is interested in innovation in healthcare. Innovation promises better ways of organizing and delivering treatment, improvements in the clinical and cost-effectiveness of services, and reductions in the burdens of illness. Most research on healthcare innovation focuses on the outcomes of innovations - measuring their impact and exploring their effects - but this doesn't always tell us the things that we need to know. Researchers try to help healthcare providers by quantifying outcomes and comparing the effects of these innovations. But it is also understood that outcomes evaluations are not enough, and that we need to perform process evaluations that help us to understand how these effects come about. Identifying and adopting an innovative health intervention, or a new way of organizing professional work, is the beginning of the story, not the end. Down the line, policymakers, managers, professionals, and patients all face two important problems as they try to get innovations into practice process and structural problems. We will assess process and structural challenges about the integration of IPTsc into existing the organizational and professional settings. In this objective we will assess the impact, feasibility and acceptability of IPTsc in school health package at institutional level. This assessment will go beyond the accessibility assessments done at field level. The latter focussed on stakeholders directly involved (i.e., teachers, parents, children) but will more from a health system and school system perspective to assess who and how IPTsc can be implemented (supply chain, Human resources, reporting etc.) considering and integrate related topics as health education, health seeking behaviour, etc). We will incorporate many relevant dimensions of health system performance and characteristics of health systems inputs and process. The result reform will be significant because it involves a more strategic, comprehensive view of the health system, and purposeful because it is based on a foundation of logic and evidence and an explicit analytical framework.