Impact and evaluation studies
MULTIPLY will carry out a before-after evaluation of the impact of PMC delivered through the project. PMC will be delivered at health facilities and mobile-outreach EPI clinics to all children living in the project districts. The number of PMC doses a child will receive will be based on the EPI schedule of the country, with a maximum of 6 doses given in the first two years of life. In order to assess the impact of the intervention a number of baseline / pre-intervention studies will be conducted to measure malaria incidence, malaria hospitalisation, and other indicators in this population.
These studies include:
Household surveys to collect information about PMC uptake in children in Sierra Leone (the only country which currently implements PMC), information on socio-economic and demographic characteristics of the households, the use of insecticide treated bednets, and the prevalence of malaria parasites in children under two years of age in all the project countries. A pre and post MULTIPLY PMC implementation household survey will be conducted.
- Pre-Implementation Household survey in Sierra Leone (November to December 2021)
- Pre-Implementation Household survey in Togo (January to February 2022)
- Pre-Implementation Household survey in Mozambique (October to November 2022)
- Post-Implementation Household survey in Sierra Leone (March to May 2024)
- Post-Implementation Household survey in Togo (September to October 2024)
- Post-Implementation Household survey in Mozambique (March to June 2025)
Cohort studies to assess the impact of PMC delivered through MULTIPLY on the incidence of malaria in children under 2 years of age. We will follow 2 cohorts of 250 children per country. The first cohort is set up before the MULTIPLY intervention is implemented, and the second after the MULTIPLY intervention is implemented. Each cohort of children will be followed up until 2 years of age. Following these 2 cohorts of children we will be able to see the impact of the invention on malaria incidence, morbidity and mortality, as well as health services integration and quality of care, including the uptake of EPI immunisations and vitamin A supplementation.
- Sierra Leone has completed the follow of the 2 cohorts
- Togo has completed the follow up of the 2 cohorts (January 2022 to January 2024)
Studies to measure molecular markers of malaria parasite resistance to the drug used for PMC; sulfadoxine-pyrimethamine (SP). This study investigates whether the use of SP for PMC causes the development of parasite resistance to the drug in the community. The prevalence of molecular markers associated with resistance to SP will be assessed before and after PMC is delivered through MULTIPLY.
- Sierra Leone baseline survey (June to August 2021)
- Togo baseline survey (November 2021 to March 2022)
- Mozambique baseline survey (June to July 2022)
- Sierra Leone endline survey (July to August 2023)
- Togo endline survey (January to June 2024)
- Mozambique endline survey (June to November 2024)
Studies on the operational feasibility and acceptability of PMC will be conducted to assess the acceptability (satisfaction, barriers and facilitators) of PMC and its operational feasibility. This is to be assessed through questionnaires, focus group discussions and in-depth interviews with all levels of the health system, the caregivers of the children, the healthcare professionals and the healthcare managers.
- Sierra Leone pre-intervention acceptability and feasibility studies conducted from January to March 2022
- Togo pre-intervention acceptability and feasibility studies conducted from November 2021 to February 2022
- Mozambique pre-intervention acceptability and feasibility studies conducted from May to July 2022
- Togo month-6 study conducted from November to December 2022
- Sierra Leone per-intervention acceptability studies conducted in January 2023
- Togo month-15 acceptability studies conducted in October 2023
- Mozambique per-intervention acceptability studies conducted in July 2023
- Sierra Leone post-implementation studies conducted from May to June 2024
- Togo post-implementation studies conducted from September to October 2024
- Mozambique post-implementation studies conducted from November to December 2024
Studies on the cost-effectiveness of PMC will be conducted, measuring the costs of PMC delivered through MULTIPLY, taking into consideration the known impact of PMC on health outcomes. Direct costs such as medical expenses and transportation costs to the health facility; and indirect costs i.e. opportunity costs of the time lost due to illness, household costs, and provider (health system) costs, will be measured. PMC is highly cost-effective but it is important to gather this information for PMC delivered through MULTIPLY i.e. with increased doses of PMC in the first 2 years of life and delivered through the EPI mobile outreach clinics.
- Sierra Leone cost-effectiveness study conducted from July to August 2024
- Togo cost-effectiveness study conducted from December 2024 to January 2025
- Mozambique cost-effectiveness study conducted from March to May 2025
Implementation of PMC delivered through MULTIPLY
Implementation of PMC delivered through MULTIPLYstarted in 2022 and will be implemented for 2 years. MULTIPLY PMC implementation started in Sierra Leone in February 2022 in Togo in May 2022 and in Mozambique in December 2022.
