Selection of Priority Geographic Areas
description
Transcript of Selection of Priority Geographic Areas
Selection of Priority Geographic Areas
Integrated Prevention Campaigns: Evidence for Impact and Efficiency, Global Potential, and Sustainability
07/25/2012
PANEL 2:
Judd L Walson, MD, MPHUniversity of Washington
Depts of Global Health, Internal Medicine (Infectious Disease), Pediatrics and Epidemiology
OBJECTIVE
Assess country opportunity and feasibility for implementation of an HIV, malaria and diarrhea IPC
Opportunity Index (OI)
Designed to: Summarize large amount of data from
disparate sources Summarize burden of diseases that may be
impacted by the IPC Reflect existing relevant interventions that
may affect diarrhea, malaria, or HIV burden Facilitate identification of countries where
opportunity for IPC implementation is greatest
3
OI: At a GlanceDiarrhea Malaria HIV
CountryTotal DALY
burdenDALYs per
capitaPopulation
Under-5 mortality rate
Overall mortality
rate
Life expectancy
Diarrhea burden
Annual deaths
DALYsImproved
drinking water coverage
Malaria burden (WHO)
Childhood malaria burden (IHME)
Annual deaths
DALYsTotal PAR
(WHO)ITN coverage HIV burden
Annual deaths
DALYs
Pregnant women tested,
coverage
ART coverage (CD4<350)
Botswana 146,889 0.0732 2,006,945 46.4 13.1 53 7.0 101 3,086 96 0.4 12.5 15 458 65 21 24.8 5,800 143,346 >95 83
Malaysia 144,598 0.0051 28,401,017 4.7 4.7 74 1.0 35 1,069 100 0.1 0.0 6 183 Unknown 65 0.5 5,800 143,346 77 23
Peru 144,195 0.0050 29,076,512 24.3 5.4 74 4.5 658 20,102 85 0.0 0.0 17 519 47 0 0.4 5,000 123,574 78 37
Iran, Islamic Rep. 136,895 0.0019 73,973,630 24.2 5.4 73 9.8 4,480 136,864 96 Unknown 0.0 1 31 Unknown 1 0.2 Unknown Unknown Unknown 4
Algeria 133,241 0.0038 35,468,208 19.2 4.9 73 12.8 3,876 118,412 83 Unknown Unknown 0 0 0 100* 0.1 600 14,829 Unknown 25
Mauritania 124,229 0.0359 3,459,773 78.2 9.7 58 15.7 1,936 59,145 50 6.1 144.3 1,645 50,255 90 64 0.7 600 14,829 3 25
Morocco 118,772 0.0037 31,951,412 33.1 5.8 72 12.4 2,917 89,115 83 0.0 Unknown 0 0 0 Unknown 0.1 1,200 29,658 <1 27
Eritrea 109,745 0.0209 5,253,676 70.4 7.7 61 21.4 2,188 66,844 Unknown 0.5 169.3 29 886 100 17 0.8 1,700 42,015 27 37
Brazil 109,400 0.0006 194,946,470 20.9 6.4 73 5.3 3,543 108,239 98 0.0 0.1 38 1,161 26 0 0.45 Unknown Unknown 79 60
Gabon 91,943 0.0611 1,505,463 67.0 8.9 62 5.9 180 5,499 87 12.0 146.3 888 27,128 100 0 5.2 2,400 59,315 55 47
Papua New Guinea 85,470 0.0125 6,858,266 65.7 7.6 62 5.2 728 22,240 40 9.0 24.0 1,018 31,100 100 26 0.9 1,300 32,129 24 52
Uzbekistan 85,287 0.0030 28,562,400 41.0 4.7 68 12.0 2,549 77,872 87 0.0 0.0 0 0 Unknown 100* 0.1 300 7,414 88 Unknown
Bolivia 80,848 0.0081 9,929,849 54.1 7.3 66 15.2 2,158 65,927 Unknown Unknown 0.5 3 92 Unknown Unknown 0.2 600 14,829 Unknown 19
Honduras 80,331 0.0106 7,600,524 21.8 4.9 73 9.8 605 18,483 87 0.0 0.0 2 61 42 0 0.8 2,500 61,787 62 33
Tajikistan 77,802 0.0113 6,878,637 43.7 6.2 67 19.2 2,304 70,387 64 0.0 0.3 0 0 Unknown 5 0.2 300 7,414 62 11
Dominican Republic 77,649 0.0078 9,927,320 27.6 5.9 73 9.2 677 20,682 86 0.1 0.0 4 122 80 0 0.9 2,300 56,844 41 47
Argentina 74,545 0.0018 40,412,376 14.2 7.7 76 0.9 94 2,872 Unknown 0.0 0.0 0 0 9 100* 0.5 2,900 71,673 >95 70
Korea, Dem. Rep. 67,271 0.0028 24,346,229 23.0 9.9 69 12.1 2,202 67,271 Unknown Unknown 0.0 0 0 Unknown 1 Unknown Unknown Unknown Unknown 0
Ecuador 66,226 0.0046 14,464,739 19.4 5.0 75 5.5 388 11,853 94 0.0 0.1 0 0 52 5 0.4 2,200 54,372 92 30
Mexico 61,161 0.0005 113,423,047 18.1 4.7 77 5.5 2,002 61,161 96 0.0 0.0 0 0 5 100* 0.3 Unknown Unknown 34 54
OI: Top 10 DALY Burden Countries
Diarrhea Malaria HIV
CountryTotal DALY
burdenDALYs per
capitaDiarrhea burden
Annual deaths DALYs
Improved drinking water
coverage
Malaria burden (WHO)
Annual deaths DALYs ITN coverage HIV burden
Annual deaths DALYs
Pregnant women tested,
coverage
Nigeria 18,229,334 0.1151 18.7 201,368 6,151,810 58 2.7 217,357 6,640,275 49 3.6 220,000 5,437,250 14
India 11,648,828 0.0095 13.0 237,482 7,255,095 92 0.1 6,292 192,221 1 0.3 170,000 4,201,511 23
South Africa 7,855,389 0.1571 8.7 6,293 192,252 91 0.2 51 1,558 100* 17.8 310,000 7,661,579 >95
DRC 6,014,548 0.0912 18.5 102,679 3,136,852 45 35.5 94,196 2,877,696 69 Unknown Unknown Unknown 11
Uganda 3,810,069 0.1140 16.0 30,391 928,448 72 25.1 42,549 1,299,876 57 6.5 64,000 1,581,745 63
Kenya 3,793,934 0.0936 20.5 38,802 1,185,404 59 64.0 20,666 631,348 37 6.3 80,000 1,977,182 83
Tanzania 3,621,080 0.0808 11.6 20,211 617,448 53 35.3 28,745 878,162 100* 5.6 86,000 2,125,470 86
Ethiopia 2,906,138 0.0350 22.8 73,341 2,240,574 44 1.9 21,786 665,564 62 Unknown Unknown Unknown 26
Afghanistan 2,742,023 0.0797 28.9 89,709 2,740,618 50 0.1 46 1,405 13 Unknown Unknown Unknown Unknown
Mozambique 2,650,507 0.1133 11.9 13,105 400,359 47 14.3 13,789 421,255 38 11.5 74,000 1,828,893 87
5*PEPFAR countries
Top 10 countries based on total DALY burden (diarrhea, malaria, HIV):
OI – A Closer Look
Diarrhea Malaria HIV
Country Total DALY burden
DALYs per capita Population
Under-5 mortality
rate
Overall mortality
rate
Life expectancy
Diarrhea burden
Annual deaths DALYs
Improved drinking
water coverage
Malaria burden (WHO)
Childhood malaria burden (IHME)
Annual deaths DALYs Total PAR
(WHO)ITN
coverageHIV
burdenAnnual deaths DALYs
Pregnant women tested,
coverage
ART coverage
(CD4<350)
6
Diarrhea
Country Total DALY burden
DALYs per capita Population
Under-5 mortality
rate
Overall mortality
rateLife
expectancyDiarrhea burden
Annual deaths DALYs
Improved drinking
water coverage
Malaria HIV
Malaria burden (WHO)
Childhood malaria burden (IHME)
Annual deaths DALYs Total PAR
(WHO)ITN
coverageHIV
burdenAnnual deaths DALYs
Pregnant women tested,
coverage
ART coverage (CD4<350
)
OI: Identifying the OpportunityDiarrhea
Country Total DALY burden
DALYs per capita
Diarrhea burden
Annual deaths DALYs Improved drinking
water coverage
Malaria HIVMalaria burden
(WHO)Annual deaths DALYs ITN
coverageHIV
burdenAnnual deaths DALYs
Pregnant women tested,
coverage
Diarrhea
Country Total DALY burden
DALYs per capita
Diarrhea burden
Annual deaths DALYs Improved drinking
water coverage Nigeria 18,229,334 0.1151 18.7 201,368 6,151,810 58India 11,648,828 0.0095 13.0 237,482 7,255,095 92South Africa 7,855,389 0.1571 8.7 6,293 192,252 91DRC 6,014,548 0.0912 18.5 102,679 3,136,852 45Uganda 3,810,069 0.1140 16.0 30,391 928,448 72Kenya 3,793,934 0.0936 20.5 38,802 1,185,404 59Tanzania 3,621,080 0.0808 11.6 20,211 617,448 53Ethiopia 2,906,138 0.0350 22.8 73,341 2,240,574 44Afghanistan 2,742,023 0.0797 28.9 89,709 2,740,618 50Mozambique 2,650,507 0.1133 11.9 13,105 400,359 47
Malaria HIVMalaria burden
(WHO)Annual deaths DALYs ITN
coverageHIV
burdenAnnual deaths DALYs
Pregnant women tested,
coverage2.7 217,357 6,640,275 49 3.6 220,000 5,437,250 140.1 6,292 192,221 1 0.3 170,000 4,201,511 230.2 51 1,558 100* 17.8 310,000 7,661,579 >95
35.5 94,196 2,877,696 69 Unknown Unknown Unknown 1125.1 42,549 1,299,876 57 6.5 64,000 1,581,745 6364.0 20,666 631,348 37 6.3 80,000 1,977,182 8335.3 28,745 878,162 100* 5.6 86,000 2,125,470 861.9 21,786 665,564 62 Unknown Unknown Unknown 260.1 46 1,405 13 Unknown Unknown Unknown Unknown
14.3 13,789 421,255 38 11.5 74,000 1,828,893 87
DALYs per Capita
Opportunity Exists
Grouped into high, medium and low feasibility
Feasibility Index
Identify key characteristics of successful programs
10
Feasibility Indicator Source
Economic Risk Rating Euler Hermes Economic Country Risk Rating
Violent conflict State Department country profile pages
Corruption Transparency International
Govt. investment in health Government health expenditure as % of total government expenditure (WHO data)
Feasibility Index
11
Country Economic Stability Violent conflict Corruption Health
Expenditure
Nigeria D YES: Ongoing civil/rebel conflict in Niger River Delta 2.4 6.4
India BYES: Minor regional ongoing
civil/rebel conflict in northeast India and on western border
3.1 4.1
South Africa BB YES: 4.1 9.3 DRC D YES: Ongoing civil/rebel conflict 2.0 1.7
Uganda C YES: Minor ongoing rebel conflict in the north 2.4 11.6
Kenya D YES: 2.2 5.4 Tanzania C NO 3.0 18.1
Ethiopia D YES: Minor conflict on border with Somalia 2.7 11.4
Afghanistan D YES: Ongoing civil/rebel conflict 1.5 3.7 Mozambique C NO 2.7 14.2
Country Profile
Expands on and provides context for information in the Opportunity and Feasibility Indices
Provides subnational information where possible
Provides detailed information for planning and implementation of campaigns, including country specific cost data
12