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

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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)

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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

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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

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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

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