Alternative approaches to coverage surveys (Malawi)
Compare coverage evaluation methods to identify a method that is statistically rigorous and feasible for programs. This study will focus on assessing MDA coverage for lymphatic filariasis by comparing the cost, time and feasibility of the EPI approach (n=1768), LQAS design (n=95) and probability sampling alternatives (n=1768).
Primary Findings and Lessons Learned
Coverage surveys are an important tool for programs to evaluate their reporting systems and to determine whether effective MDA coverage has been achieved. However, for various reasons coverage surveys are seldom implemented. Some key challenges are: perceived technical difficulty, lack of resources, and lack of standardized guidance on how to conduct coverage surveys. This protocol seeks to address the 1st and 3rd points by comparing the feasibility of three different coverage survey methods (EPI approach, LQAS, and segmentation). This study was completed in 3 districts in Burkina Faso. All 3 districts found that their survey coverage was above the WHO target threshold (65% for LF). Furthermore, in all 3 cases the survey coverage validated (or nearly validated) the reported coverage. Taken together this suggests that the Burkina Faso program is working well. The feasibility results found all 3 methods to be very similar with regards to time, cost and perceived difficulty. Because only the segmentation approach results in a probability sample, this method was recommended by the M&E Working Group and ultimately approved by the STAG. Since the approval, significant work has been underway to create guidelines for conducting coverage surveys for preventive chemotherapy. An excel tool was created to improve the usability of the tool and online learning modules are currently in the works.
Regional study site, Malawi
The data resulting from this study are available here.