Surveillance and Data for Management (SDM) Project Final Report Submission Date: May 8th, 2020 Revised document submission date: July 31st, 2020 Revised document submission date: December 15th, 2020 Grant No. AID-687-G-13-00003 Submitted by: Institut Pasteur de Madagascar (IPM) BP 1274 Ambatofotsikely, 101 Antananarivo, Madagascar Tel: +261 20 22 412 72 Email: [email protected] This document was produced for review by the Institut Pasteur de Madagascar. This report is made possible by the generous support of the American people through the United States Agency for International Development (USAID). The contents are the responsibility of the Institut Pasteur de Madagascar and do not necessarily reflect the views of USAID or the United States Government. Surveillance and Data for Management (SDM) Project Page 1 of 68 Grant No. AID-687-G-13-00003 Institut Pasteur de Madagascar TABLE OF CONTENTS ACRONYMS AND ABBREVIATIONS 4 PROJECT OVERVIEW/SUMMARY 6 Introduction 7 WP1. MALARIA SURVEILLANCE AND CONTROL MEASURES 8 Subproject SP1: Fever sentinel surveIllance network 8 Subproject SP2: RDT qualIty assurance 10 Subproject SP3: Evaluative research of the fever surveIllance network system 11 Subproject SP4: Fever etiology assessment 12 Subproject SP5: Mathematical models of surveIllance data to detect epIdemIc thresholds 13 Subproject SP6: GIS technology to vIsualIze trends In malarIa IncIdence 15 Subproject SP7 GIS and vector control program to Identify prIorIty areas for Indoor resIdual sprayIng 16 Subproject SP8: AnophelIne mosquIto monItorIng In the dIstrIcts of Farafangana, MiandrIvazo, and Morondava, Madagascar, 2014-2017: evaluation of the malarIa transmIssIon rIsk and ImplIcations for vector control 18 Subproject SP9: InsecticIde resIstance testing, approaches, and methodologIes developed to lInk entomologIcal measurements and malarIa control 20 Subproject SP10: AnophelIne mosquIto monItorIng In the Central Highlands of Madagascar, 2014-2017: evaluation of the malarIa transmIssIon rIsk and ImplIcations for vector control 20 Subproject SP11: Quarterly malarIa bulletin to summarIze key fIndIngs and IndIcators from the sentinel system 23 Subproject SP12: EpIdemIologIcal study and monItorIng/evaluation to Improve malarIa control Interventions and strategIes 24 Subproject SP13: Use of malarIa serology to valIdate healthcare facIlIty- based data for prIorItiZIng IRS In the Central Highlands of Madagascar 25 Subproject SP14: MonItorIng the therapeutic effIcacy of artesunate and amodIaquIne for treating uncomplIcated malarIa In Madagascar 26 Subproject SP18: A comparIson of reactive case detection and focal mass drug admInIstration strategIes to provIde Information to the national malarIa control strategy towards elImInation 27 Subproject SP21: BIo-effIcacy monItorIng of long-lasting InsecticIdal nets In Madagascar 29 Surveillance and Data for Management (SDM) Project Page 2 of 68 Grant No. AID-687-G-13-00003 Institut Pasteur de Madagascar Subproject SP30: The role of Anopheles coustani In malarIa transmIssIon In Madagascar 31 WP2. INCREASED EFFECTIVENESS OF NUTRITION AND MATERNAL, NEWBORN, AND CHILD HEALTH INTERVENTIONS (MCH) 33 Subproject SP15: QualItative research to Identify the prImary two or three socIocultural/behavIoral determInants of stunting and develop strategIes to address these determInants and recommendations for Implementation In USAID project sItes 33 Subproject SP16: Research on malnutrItion and opportunIstic Infections to develop therapeutic guIdelInes on malnutrItion complIcated by opportunIstic Infection(s) 34 Subproject SP17: Research and/or fIeld-testing on new cost-effective Innovations or potential Interventions that support Improvements In maternal, newborn, and chIld survIval to clandestine abortions 36 Subproject SP19: QualItative study In malarIa: ownershIp and use of long- lasting InsecticIde-treated bed nets In Madagascar 40 Subproject SP20: A cluster randomIzed trIal to assess the effIcacy of fortnIghtly malarIa RDT testing at the communIty level In hIgh-transmIssIon areas 42 Subproject SP22: CommunIty survey on healthcare-seekIng determInants In pregnant women and chIldren under fIve to better understand related behavIor to propose strategy Improvements 44 Subproject SP26: AssessIng the etiologIes of dIarrheal and respIratory Infections In chIldren below fIve years of age 49 Subproject SP31: QualItative assessment of prematurIty and the Kangaroo Mother Care method In Madagascar 51 WP3. PLAGUE 53 Subproject SP23: Support of the 2017 plague epIdemic response 53 Subproject SP24: Support of the Central Laboratory - 2017 plague epIdemic response 55 Subproject SP25: Assessment of the rIsk of drug adverse events, knowledge of the dIsease, and the perception of transmIssIon rIsk durIng the plague epIdemIc 59 Subproject SP27: Sentinel surveIllance of plague rIsk IndIcators (rodents and fleas) In Madagascar 61 Subproject SP28: Lab processIng of human samples durIng the 2018-2019 plague season (October 3rd, 2018 to September 30th, 2019) 63 Subproject SP29: Plague: strengthenIng communIty health education and epIdemIologIcal surveIllance 67 Surveillance and Data for Management (SDM) Project Page 3 of 68 Grant No. AID-687-G-13-00003 Institut Pasteur de Madagascar ACRONYMS AND ABBREVIATIONS ACT Artemisinin-based Combination Therapy AFP Acute flaccid paralysis AL Fixed combination artemether + lumefantrine API Annual Parasite Incidence ASAQ Fixed combination artesunate + amodiaquine CB-CD Community-Based Continuous Distribution CFR Case Fatality Rate CHM Central Highlands of Madagascar CHW Community Healthcare Workers CLP Central Laboratory for Plague CPN Consultation Prénatale (prenatal consultation) CRA Clinical Research Associate CSB Centre de Santé de Base CSB_R Centres de Surveillance Biologique Référents Direction de la Veille Sanitaire, de la Surveillance Epidémiologique et de DVSSER Riposte EIR Entomological Inoculation Rate EV Enterovirus EWS Early Warning System fMDA focal Mass Drug Administration GIS Geographical Information System HBR Human Biting Rate HLC Human Landing Catch ILI Influenza Like Illness IPM Institut Pasteur de Madagascar IPTp Intermittent Preventive Treatment of pregnant women IRS Indoor Residual Spraying ITN Insecticide-Treated Nets KMC Kangaroo Mother Care LLIN Long-Lasting Insecticidal Nets m/p/n mosquitoes collected by HLC per person per night MCE Multi-Criteria Evaluation MCI Malaria Control Interventions MDC Mass Distribution Campaign mEWS Malaria Early Warning System MOP Malaria Operational Plan MoPH Ministry of Public Health mRDT Malaria Rapid Diagnostic Test MTP Muirhead-Thomson Pit MTPC Muirhead-Thomson Pit Collection Surveillance and Data for Management (SDM) Project Page 4 of 68 Grant No. AID-687-G-13-00003 Institut Pasteur de Madagascar NMCP National Malaria Control Program PMI President’s Malaria Initiative RCD Reactive Case Detection RDT Rapid Diagnostic Test SARI Severe Acute Respiratory Infection SBS School-Based Malaria Serology Survey SDM Surveillance and Data for Management SI Sporozoite Index SSDS Système de Surveillance Démographique et de Santé VDPV Vaccine-derived poliovirus WHO World Health Organization Surveillance and Data for Management (SDM) Project Page 5 of 68 Grant No. AID-687-G-13-00003 Institut Pasteur de Madagascar PROJECT OVERVIEW/SUMMARY SurveIllance and Data for Management (SDM) Project Name Project Activity Start Date October 1st, 2013 to September 30th, 2019 and End Date Name of Prime Implementing Institut Pasteur de Madagascar (IPM) Partner Cooperative Grant No. AID-687-G-13-00003 Agreement Number Name of Subcontractors/Sub None awardees Major Counterpart None Organizations Geographic Coverage (cities and or Madagascar countries) Reporting Period October 1st, 2013 to September 30th, 2019 Surveillance and Data for Management (SDM) Project Page 6 of 68 Grant No. AID-687-G-13-00003 Institut Pasteur de Madagascar Introduction The Surveillance and Data Management (SDM) project (Grant USAID No. AID-687-G-13-00003) was implemented by the Institut Pasteur de Madagascar (IPM) from October 1st, 2013 to September 30th, 2019 in close collaboration with national health authorities and with the support of other USAID partners. This project was designed to support three fundamental purposes: research, training, and health promotion. The SDM project initially included two work-packages (WPs): WP1 for malaria control, aligned with the President’s Malaria Initiative (PMI) and Malaria Operational Plan, and WP2, which focused on mother and child health activities, in line with the health, population, nutrition (HPN) lifecycle of USAID. A third WP was added to support the plague epidemic response of 2017. In total, 32 subprojects (SP) were conducted. They included qualitative and quantitative approaches, encompassing some of the most urgent health issues in Madagascar. The key results of this project included but were not limited to strengthening the epidemiological surveillance and response system; validation of the current control measures used to fight malaria in Madagascar and the development of new tools to aid the surveillance of malaria outbreaks; determining the etiologies associated with fever, respiratory and diarrhea illnesses in children under the age of 5; identification of certain determinants for the stunting of child growth in Madagascar; and strengthening of the epidemiological surveillance and response to plague. Consequently, the SDM project has not only successfully contributed to new knowledge but has also raised important questions that will shape