Evaluating Malaria Interventions in Africa: A Review and Assessment of Recent Research.
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Author(s): Eisele T, Macintyre K, Eckert E, Beier J, Killeen G
This paper reviews the literature of malaria intervention studies in Africa over the last ten years, and specifically assesses the state of the art of evaluation of those interventions. Five primary types of malaria intervention studies were found: (1) vector control evaluation studies, (2) vaccine trial evaluation studies, (3) case management evaluation studies (includes chemoprophylaxis and malaria treatment trials), (4) diagnostic evaluation studies (trials of new quick and easy methods of diagnosing malaria) and, (5) cost-effectiveness evaluation studies. Methodological criteria used to identify the evaluation studies included outcomes measured at the community level, use of a rigorous design - experimental, quasi-experimental or pre/post intervention evaluation, and a minimum sample size of 100. The bulk of the literature (ten studies) focused on vector control evaluation studies. In addition, three vaccine trial evaluation studies, three case management evaluation studies, three diagnostic evaluation studies and three cost-effectiveness studies are included. There are several studies that did not stand up to the methodological criteria, but that we considered important from a methodological point of view and were included in our discussion. This review presents four major findings. First, the usefulness of existing studies is limited by their methodological shortcomings, particularly by the lack of standardized indicators. Second, due to the lack of standardized outcome indicators, between-study comparisons are extremely limited which essentially affects everything we can do in terms of evaluating malaria programs or interventions. Third, there is a paucity of evaluation studies on the (possible) synergistic effect of using more than one type of intervention to combat malaria. Fourth, due to the nature of malaria transmission, which can vary seasonally and spatially, it is difficult to generalize study results to other areas and years. In terms of the evaluation designs used, the randomized controlled clinical trial (RCT) is clearly the preferred gold standard in malaria intervention studies. However, because of the nature of malaria transmission and disease, and because of the lack of standard indicators, the majority of results from the studies have severely limited generalizability. Given the human and financial toll malaria is taking on societies throughout the world, continued research on ways to prevent and treat malaria is essential. In order for health professionals to be able to implement effective, large-scale programs to control malaria, at the national or sub-national level, more systematic evaluation protocols are needed. These evaluations should focus on essential program elements using standardized indicators in a wide variety of locations.
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