TITLE: Scoping Review: Analytical Approaches to Estimating Malaria Intervention Effectiveness and Impact
AUTHORS: Jessica Craig, Donal Bisanzio, Richard Reithinger

[DESCRIPTION]
Context: Ministries of Health and National Malaria Control
Programs need simple approaches to be able to regularly estimate the
effectiveness and impact of malaria interventions. Traditionally, this has been
done by analyzing data from post-intervention campaign surveys or periodic
nationally-representative surveys, or estimated by complex mathematical
modelling. As health management information systems collecting routine
programmatic data are maturing, there increasingly is an opportunity to use
these data to measure effectiveness and impact of interventions more
continuously and readily. The objective of this scoping review is to map and
summarize the different analytical approaches for estimating the 
effectiveness and impact of malaria interventions using routine surveillance and health
management information system data. 

Methods: We will follow the PRISMA-ScR (Preferred Reporting
Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews)
to conduct and report this scoping review.

[STEPS]
SECTION: Rationale
1. Malaria is an acute febrile illness caused by a parasitic
infection transmitted by Anopheles mosquitoes. Human malaria is caused by five
different Plasmodium parasites, with P. falciparum being the predominant
species in sub-Saharan Africa (SSA) [1]. In the past 15–20 years, the combined
efforts of Ministries of Health (MOHs) and National Malaria Control Programs
(NMCPs), and their partners, including PMI, have made tremendous progress
against malaria. This progress resulted from the massive scale-up of various
malaria prevention and control interventions, including facility and
community-based confirmatory testing and treatment of malaria cases,
intermittent preventive treatment in pregnancy (IPTp), and seasonal malaria
chemoprevention (SMC), along with indoor residual spraying (IRS) and
insecticide-treated nets (ITNs). 
MOH / NMCPs use programmatic intervention coverage and
effectiveness data to regularly monitor impact of interventions; modify
intervention implementation approaches (e.g., if coverage estimates are
sub-par) or switch interventions altogether (e.g., if effectiveness is observed
to be lower than expected). Intervention coverage and effectiveness has
traditionally been assessed by post-intervention campaign surveys or periodic
nationally-representative surveys (e.g., Demographic and Health Surveys [DHS],
Malaria Indicator Surveys [MIS], Multiple Indicator Cluster Surveys [MICS]), or
estimated by complex mathematical modelling. The limitations of surveys are
that—while generally robust—they only occur every 2–5 years; take time; require
significant human, logistical and financial resources and capabilities; and may
not be powered sufficiently enough to provide sub-national intervention
estimates. Similarly, mathematical modelling may be limited by the available
data and the significant technical expertise needed to develop and run the
models, let alone run them continuously. Additionally, neither surveys or
modeling may avail necessary estimates at key strategic moments in the malaria
programming planning, implementation and monitoring cycle, such as the
development of national strategies or design of necessary donor documents
(e.g., Global Fund Concept Notes or PMI Malaria Operational Plans). 
Countries health
management information systems (HMIS) have been dramatically strengthened in
the past few years, with countries being able to consistently and fully report
on outpatient, inpatient and other programmatic data—much of this progress has
been made by adopting, piloting and rolling out the district health management
information system 2 (DHIS2), an open-source data-system software specifically
developed to capture health data in lower-and-middle income countries. Because
of their sheer volume across space and time, data collected and reported through
HMIS like DHIS2 complement and even offer an alternative to nationally
representative and other ad hoc surveys to assess health intervention coverage
and effectiveness, and ultimately impact on health outcomes. [2–4]
SECTION: Information Sources
3. A systematic search of PubMed was conducted on January 2,
2024, to identify studies and analyses that had used routine surveillance and
health management information systems data to assess the effectiveness of
malaria interventions. A detailed search strategy was designed and piloted to
identify the optimal combination of keywords used.
SECTION: Objectives
2. The objective of this scoping review is to map and summarize different
analytical approaches for estimating the impact and effectiveness of malaria
interventions using routine surveillance and health management information
system data. To our knowledge, such review has not been conducted. A
preliminary search for existing scoping and systematic reviews on the topic was
conducted on December 15, 2023, using PubMed and no similar reviews were found.
We will follow the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews
and Meta-Analysis extension for Scoping Reviews) to conduct and report this
scoping review [5].
SECTION: Search Strategy
4. We examined the available electronic databases using
combination searches of the following Boolean terms: “Malaria” AND
“Intervention” AND “effect*” OR “impact*” AND “System” OR “Surveillance.” Other
key terms for such as "routine” or “information systems” control were not
included in the search strategy to have a more comprehensive search and will be
used during abstract and full text screening. 
SECTION: Study Records
5. All identified studies will be imported into Rayyan, a systematic review
management software, to screen (title, abstract, and full text) and manage the
results of the search. Two reviewers will independently assess the titles and
abstracts of the included articles based on the inclusion criteria. In the
event of discordance between the two reviewers, a third reviewer will review
the titles and abstracts and will come to a final decision. From the included
articles, the two reviewers will identify relevant publications by reviewing
the full text. Any discordance will again be resolved by a third reviewer. A
PRISMA flow diagram will be used to report final numbers of articles that are
included and excluded at each stage.
SECTION: Eligibility Criteria
6. We limited inclusion to studies and analyses that were
conducted in the past decade (i.e., 2014), which we purposefully chose as a
time point when countries’ routine health management information systems had
begun to substantially mature, with data reported by these systems
progressively becoming more robust. 
SECTION: Data Items
7. From the included articles, each reviewer will work
independently to extract data from the articles following a pre-specified
extraction sheet. The following data will be extracted from each paper into an
MS Excel spreadsheet: (1) author; (2) year of publication; (3) geography; (4)
study design; (5) study period / time period covered; (6) intervention(s) for
which effectiveness and impact was measured; (7) approach to measure
effectiveness and impact; (8) health information system platform used for
analyses; (9) indicator variables included in the analyses; (10) target
population; (11) key findings; and (12) items from the Template for
Intervention Description and Replication (TIDieR) checklist. TIDieR is a
12-item checklist that includes the brief name, why, what (materials), what
(procedure), who provided, how, where, when and how much, tailoring,
modifications, how well (planned), how well (actual) of a program.
SECTION: Data Synthesis
8. The proposed scoping review will outline the approaches to
estimate the effectiveness of malaria interventions using routine surveillance
and health management information systems data. The scoping review does not
involve data on human subjects and ethical approval is not required.