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GOAL AND TARGET ADDRESSED

Goal 6. Combat HIV/AIDS, malaria and other diseases
Target 6.C. Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

DEFINITION AND METHOD OF COMPUTATION

Definition
The proportion of children under 5 with fever who are treated with anti-malarial drugs is defined as the percentage of children aged 0–59 months who were ill with a fever in the two weeks before the survey and who received any anti-malarial drugs during that time.

Concepts
Anti-malarial drugs are drugs that are used to treat malaria. Anti-malarial drugs are prescribed according to the type of malaria that the patient has. Artemisinin-based combination therapy (ACT) is recommended for the treatment of confirmed, uncomplicated malaria caused by Plasmodium falciparum. Chloroquine remains effective for most cases of Plasmodium vivax.

Malaria is an infectious disease caused by the parasite Plasmodium and transmitted via the bites of infected mosquitoes. Symptoms usually appear between 10 and 15 days after the mosquito bite and include fever, headache, and vomiting. If not treated, this disease can become life-threatening by disrupting the blood supply to vital organs.

Fever: Presumptive malaria diagnosis (based on fever) used to be the standard, especially for young children, in areas with Plasmodium falciparum. In 2010, however, WHO recommended universal use of diagnostic testing to confirm malaria infection before treatment.

Method of computation
The indicator is calculated by dividing the number of children aged 0–59 months with a fever during the two weeks prior to the survey who received any anti-malarial medicine during that time by the total number of children aged 0–59 months with a fever during the two weeks prior to the survey.

RATIONALE AND INTERPRETATION

Prompt diagnosis and effective treatment of malaria within 24 hours of the onset of symptoms is necessary to prevent life-threatening complications. This indicator, however, is based on all children with fever and not children with confirmed malaria. Thus, as the use of diagnostics has scaled up, this indicator has become difficult to interpret. If parasitological confirmation is available to determine that some fever cases are not malaria, these children will be excluded from treatment and thus, from the numerators, although they will still be included in the denominator due to their non-malarious fevers. This will result in an underestimate of the true levels of antimalarial treatment.

SOURCES AND DATA COLLECTION

Information on the proportion of fever cases seeking care are obtained from nationally representative household surveys which are generally conducted by national statistical offices within malaria endemic countries. The most common sources are the Demographic and Health Survey (DHS) or the Multiple Indicator Cluster Survey (MICS), which are typically conducted every three to five years. The lag between the reference year and the actual production of data series differs between surveys. For household surveys, such as DHS and MICS, the results are usually published within a year of field data collection. Malaria Indicator Surveys (MIS) are often conducted in interim years between DHS and MICS in order to increase the frequency of malaria data collection. Since data on this indicator are compiled in sample surveys, data are subject to sampling errors.

DISAGGREGATION

Disparities by sex, mother’s education, area of residence (urban/rural) and wealth index quintiles should be assessed. Estimates should also be disaggregated by sub-national populations living in areas with malaria transmission.

COMMENTS AND LIMITATIONS

Interpretation of levels and trends in malaria treatment coverage among all febrile children is limited as fevers are not always the result of malaria infection. In countries that are scaling up the use of diagnostics, measuring treatment rates among all children with fever cannot be used for monitoring the progress of programmes targeted toward treating confirmed malaria cases.

This indicator has other limitations as well. Many children with fever are still treated with less effective traditional monotherapies, such as chloroquine. Therefore, the proportion of children treated with any antimalarial will be significantly higher than the proportion of children treated with effective anti-malarial medicines. In addition, information is not collected on whether the anti-malarial treatment was administered correctly.

Because of difficulty recalling past events, respondents may not provide reliable information on episodes of fever within the previous two weeks or on the identity of prescribed drugs. Data may also be biased by the seasonality of survey data collection, which is most often carried out during the dry season for logistical reasons.

In some countries, significant proportions of the population live in areas with no malaria transmission. Therefore, estimates of intervention coverage at the national level may underestimate the level of coverage among sub-populations living in areas of malaria transmission. For many countries, it is difficult to accurately define at-risk areas within countries and to identify households surveyed within those areas since surveys do not always geocode survey households or villages. In addition, survey sample sizes are not always large enough to offer meaningful results for sub-national areas.

GENDER EQUALITY ISSUES

Access to health care services for malaria can be affected by gender issues. When health care is too expensive for families or communities, boys and men may receive priority for access to household finances for treatment.

DATA FOR GLOBAL AND REGIONAL MONITORING

The United Nations Children’s Fund (UNICEF) is the agency responsible for compiling the data for this indicator and for reporting on this MDG indicator at the international level. Data are derived from national-level household surveys, including MICS, DHS and MIS. No adjustments are made to the data compiled from DHS, MICS, MIS or other surveys that are statistically sound and nationally representative.

The data are reviewed in collaboration with the Roll Back Malaria (RBM) partnership, launched in 1998 by the World Health Organization (WHO), UNICEF, the United Nations Development Programme (UNDP) and the World Bank (WB).

Regional and global estimates are based on population-weighted averages weighted by the total number of children under five years of age. These estimates are presented only if available data cover at least 50 per cent of total children under five years of age in the regional or global groupings.

Because all nationally-representative data on anti-malarial use are collected only through large-scale household surveys, and these figures are not modified, there would normally not be any discrepancies between global and national figures. However, there can be discrepancies if national figures are calculated based on only those geographic areas with malaria transmission, or if national figures do not fit the current standard indicator definition used for global reporting.

SUPPLEMENTARY INFORMATION



EXAMPLES



REFERENCES

See “REFERENCES” in Indicator 6.7.

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