Among children under age 5 years with fever in the 2 weeks preceding the survey who took any antimalarial medication, percentage who took specific antimalarial drugs:
1) Any Artemisinin-based Combination Therapy (ACT)
2) SP/Fansidar
3) Chloroquine
4) Amodiaquine
5) Quinine pills
6) Quinine injection or intravenous (IV)
7) Artesunate rectal
8) Artesunate injection or intravenous (IV)
9) Other antimalarial
The purpose of this indicator is to measure the proportion of anti-malarial treatments that are in accordance with national treatment policy, an important component of access to effective treatment for uncomplicated malaria.
Coverage:
Population base: Children under age 5 (KR file)
Time period: Two weeks preceding the interview
Numerator:
Number of children under age 5 with fever, at any time during the 2 weeks preceding the interview, who took specific antimalarial drugs (b5 = 1 & b19 < 60 & h22 = 1):
1) Any Artemisinin-based Combination Therapy (ACT) (ml13e = 1)
2) SP/Fansidar (ml13a = 1)
3) Chloroquine (ml13b = 1)
4) Amodiaquine (ml13c = 1)
5) Quinine pills (ml13d = 1)
6) Quinine injection or intravenous (IV) (ml13da = 1)
7) Artesunate rectal (ml13aa = 1)
8) Artesunate injection or intravenous (IV) (ml13ab = 1)
9) Other antimalarial (ml13h = 1)
Note that other survey-specific antimalarials may also be included using ml13f and ml13g.
Denominator: Number of children under age 5 who were ill with a fever in the 2 weeks preceding the interview who were given any anti-malarial drugs (b5 = 1 & b19 < 60 & h22 = 1 and any of ml13a – ml13h = 1)
Variables: IR file.
|
b19 |
Current age of child in months |
|
h22 |
Had fever in last two weeks |
|
ml13a |
Fansidar taken for fever |
|
ml13aa |
Artesunate rectal taken for fever |
|
ml13ab |
Artesunate injection/IV taken for fever |
|
ml13b |
Chloroquine taken for fever |
|
ml13c |
Amodiaquine taken for fever |
|
ml13d |
Quinine taken for fever |
|
ml13da |
Quinine injection/IV taken for fever |
|
ml13e |
Combination with artemisinin taken for fever |
|
ml13f |
CS antimalarial taken for fever |
|
ml13g |
CS antimalarial taken for fever |
|
ml13h |
Other antimalarial taken for fever |
|
v005 |
Women’s individual sample weight |
Numerator divided by denominator, multiplied by 100.
Children with missing values for fever status will be excluded from this indicator. Missing values are assumed to be “no” responses and are thus Included in both numerator and denominator (assumes no ACT taken, or no anti-malarial drugs taken).
When a DHS includes a malaria module and for MIS survey, the specific drugs given are included as variables ml13. In DHS surveys without a malaria module, the specific drugs may be included in variables h37.
The current guidelines in most countries with predominantly Plasmodium falciparum malaria are for Artemisinin-based Combination Therapy (ACT) to be given as a first-line treatment.
Due to the challenges of measuring confirmed malaria cases among children under age 5 years through household surveys, this indicator is considered an interim measure of access to effective treatment for malaria. The limitations of the indicator are that it is based on mother’s or caregiver’s information, which may not provide reliable estimates of fever episodes in the previous 2 weeks and may miss fostered children or others living in a household without a parent/caregiver. Additionally, a fever may not have been the result of a malaria infection.
In previous surveys before ACT was the recommended first line antimalarial for uncomplicated malaria these indicators were not calculated. Previously, the denominator was specified as all children under age 5 with recent fever. As WHO now recommends testing before treating, the denominator has been changed.
Bennett, A., D. Bisanzio, J.O. Yukich, B. Mappin, C.A. Fergus, M. Lynch, R.E. Cibulskis, S. Bhatt, D.J. Weiss, E. Cameron, and P.W. Gething. 2017. “Population coverage of artemisinin-based combination treatment in children younger than 5 years with fever and Plasmodium falciparum infection in Africa, 2003–2015: a modelling study using data from national surveys.” The Lancet Global Health, 5(4), pp.e418-e427. https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(17)30076-1/fulltext
Flegg, J.A., C.J. Metcalf, M. Gharbi, M. Venkatesan, T. Shewchuk, C.H. Sibley, and P.J. Guerin. 2013. “Trends in antimalarial drug use in Africa.” The American journal of tropical medicine and hygiene, 89(5), pp.857-865. http://www.ajtmh.org/content/journals/10.4269/ajtmh.13-0129
DHS-8 Tabulation plan: Table 12.12
API Indicator IDs:
ML_AMLD_C_ACT, ML_AMLD_C_SPF, ML_AMLD_C_CHL, ML_AMLD_C_AMQ, ML_AMLD_C_QNN, ML_AMLD_C_ART, ML_AMLD_C_OAM
Household Survey Indicators for Malaria Control Indicator 11: Proportion receiving first-line treatment, among children under five years old with fever in the last two weeks who received any antimalarial drugs
MICS6 Indicator TC.29: Treatment with Artemisinin-based Combination therapy (ACT) among children who received anti-malarial treatment