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IPTi Implementation Experiences in Africa
A de Sousa Operational Research Coordinator
UNICEF
D Schellenberg Prof of Malaria & International Health
LSHTM
WHO SAGE October 2009
Overview
• Approach to implementation • Coverage and acceptability • Safety • Financial costs • Applicability tool • Summary
“Prepare for Action”
Enable prompt program-based application of IPTi if a policy recommendation is made
Development Implementation
Evaluation of IPTi strategy
Pilot implementation
• IPTi-SP administered simultaneously with:
- DTP + Hib + Hep + OPV doses 2 & 3
- Measles +/- YF at 9 months
• 25 districts in seven countries
• Tanzania (southern Tanzanian collaboration)
• Benin, Ghana, Mali, Senegal, Madagascar
and Malawi (UNICEF)
• ~260,000 infants per year since 2005/2007
Health workers training evaluation
(n = 734 HWs)
At 1 year of implementation, informally and formally trained have similarly high understanding of IPTi
Overview
• Approach to implementation • Coverage and acceptability • Safety • Financial costs • Applicability tool • Summary
IPTi coverage in 1st year
Madagascar
0 20 40 60 80
100
Ghana
0 20 40 60 80
100
Benin
0 20 40 60 80
100
Jan
Mar
s
May
Jul
Sep
t
% o
f cov
erag
e (IP
Ti/E
PI) IPTi1/ DTP2
IPTi2/ DTP3
IPTi3/ Measles
Malawi
0 20
40 60
80 100
Dec
Feb
Apr
Jun
Mali
0
20
40
60
80
100
Dec Feb Apr Jun
Senegal
0
20
40 60
80
100
IPTi is a well accepted intervention
- Increased time at health clinics was well accepted by both caregivers and health workers
- Coupling of IPTi with EPI was welcomed by caregivers and health workers, and easily integrated
- Some confused it with anti-pyretic, brought in to prevent post-vaccination fever
- IPTi often used by health workers as mechanism to increase adherence to EPI
UNICEF Type your title in this FOOTER area and in CAPS
UNICEF Type your title in this FOOTER area and in CAPS
0% 10% 20% 30% 40% 50% 60% 70% 80% 90%
100%
Benin Ghana Madagascar Malawi Mali Senegal Average
Distribution of time in immunization clinics
IPTi time (11%)
EPI time (64%)
% o
f tim
e pe
r ses
sion
Takes 5 min to administer one dose of IPTi
60% of workers time is used preparing a drinkable solution for infants
Drinkable solution
Other
“free” time (25%)
Overview
• Approach to implementation • Coverage and acceptability • Safety • Financial costs • Applicability tool • Summary
Adverse Events after IPTi
53%
29%%
9%
Events reported are the same reported when EPI vaccines are given alone, except for crying and diarrhea
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
SP/ DTP1
SP/ DTP2
SP/ Measles
Not possible to attribute AEs to the specific administration of SP
Overview
• Approach to implementation • Coverage and acceptability • Safety • Financial costs • Applicability tool • Web tool • Summary
Start up years : 2.3 USD (range 4.15 to 0.77 USD)
Incremental financial costs / infant
Routine years : 30 cents (range 48 to 14 cents)
If one takes into account supervision strengthening
Routine years : 80 cents (range 171 to 25 cents)
Start up years : 3 USD (range 5.71 to 0.91 USD)
IPTi - highly Cost Effective Hutton G et al Bull WHO in press
Conteh L et al Submitted
UNICEF Operational research
Based on Ifakara & Manhica trials
Based on all 6 RCTs of IPTi-SP
Based on data from all 6 countries
Cost/episode averted
1.57 – 4.73 1.36 – 4.03 (0.68 – 2.27*)
0.66
Cost/DALY averted
3.7 – 11.2 2.90
* Based on IPTi efficacy estimates from pooled analysis
Overview
• Approach to implementation • Coverage and acceptability • Safety • Financial costs • Applicability tool • Summary
• Inputs – Country – 1st administrative level – Transmission intensity (EIR or prevalence) – Seasonality – DTP immunization schedule – DTP3 coverage
IPTi Decision-Making Tool www.iptiwebtool.org
Overview
• Approach to implementation • Coverage and acceptability • Safety • Financial costs • Applicability tool • Summary
• IPTi can be delivered by existing EPI/health systems
• High coverage can be achieved rapidly
• IPTi is well accepted by communities & health workers
• IPTi has a reassuring safety profile
• IPTi is highly cost-effective & affordable
• A paediatric formulation is desirable
Summary
Acknowledgements Southern Tanzania • Community
• District, regional and national authorities
• Health facility staff
• Ifakara Health Research & Development Centre
• Centre for International Health, Hospital Clinic, Barcelona, Spain
• Swiss Tropical Institute, Basle, Switzerland
• London School of Hygiene & Tropical Medicine, UK
• The IPTi Consortium - www.ipti-malaria.org
• Bill & Melinda Gates Foundation
GHANA • Dr. Ebenezer Inkoom • Dr. Philippe Adongo • Mr. Komla Abotsi Anselm • Dr. Alex Dodoo • Dr. Ofori Tenkorang • Dr. Jerry Nee Wang
MADAGASCAR • Dr. Leon Rabarijaona • Dr. Issa Coulibaly • Ms. Mialy Rabarison • Dr. Hanta Ravelomanantena • Dr. Didier Menard • Dr. Jean Rene Randriasamimanana • Dr. Sabrina Lock
MALAWI • Dr. Donald Mathanga • Dr. Kelias Msyamboza • Dr. Prestor Kubalalika • Dr. Ketema Bizuneh • Dr. Jobiba Chimkhumba • Pr. Charles Mwasambo • Dr. Edson Dembo
MALI • Dr. Alassane Dicko • Dr. Issaka Sagara • Dr. Mariam Sy • Dr. Sidi Toure • Mr. Idrissa Camara
SENEGAL • Dr. Jean Louis Ndiaye • Pr. Omar Gaye • Dr. Dodoo Sow • Dr. Mouhamed Ndiaye • Dr. Sylvain Laundry • Mr. Abdou Diop • Dr. Babacar Faye
BENIN • Dr. Jacques Hassan • Dr. Gninoussa Akadiri • Dr. Emile Akowanou • Mr. Paul Adovohekpe • Mr. Vincent Capo-Chichi • Dr. Alphonse Apho
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