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Thawer SG, Golumbeanu M, Lazaro S, Chacky F, Munisi K, Aaron S, Molteni F, Lengeler C, Pothin E, Snow RW, Alegana VA. Spatio-temporal modelling of routine health facility data for malaria risk micro-stratification in mainland Tanzania. Sci Rep 2023; 13:10600. [PMID: 37391538 PMCID: PMC10313820 DOI: 10.1038/s41598-023-37669-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 06/26/2023] [Indexed: 07/02/2023] Open
Abstract
As malaria transmission declines, the need to monitor the heterogeneity of malaria risk at finer scales becomes critical to guide community-based targeted interventions. Although routine health facility (HF) data can provide epidemiological evidence at high spatial and temporal resolution, its incomplete nature of information can result in lower administrative units without empirical data. To overcome geographic sparsity of data and its representativeness, geo-spatial models can leverage routine information to predict risk in un-represented areas as well as estimate uncertainty of predictions. Here, a Bayesian spatio-temporal model was applied on malaria test positivity rate (TPR) data for the period 2017-2019 to predict risks at the ward level, the lowest decision-making unit in mainland Tanzania. To quantify the associated uncertainty, the probability of malaria TPR exceeding programmatic threshold was estimated. Results showed a marked spatial heterogeneity in malaria TPR across wards. 17.7 million people resided in areas where malaria TPR was high (≥ 30; 90% certainty) in the North-West and South-East parts of Tanzania. Approximately 11.7 million people lived in areas where malaria TPR was very low (< 5%; 90% certainty). HF data can be used to identify different epidemiological strata and guide malaria interventions at micro-planning units in Tanzania. These data, however, are imperfect in many settings in Africa and often require application of geo-spatial modelling techniques for estimation.
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Affiliation(s)
- Sumaiyya G Thawer
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Monica Golumbeanu
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Samwel Lazaro
- Ministry of Health, Dodoma, Tanzania
- National Malaria Control Programme, Dodoma, Tanzania
| | - Frank Chacky
- Ministry of Health, Dodoma, Tanzania
- National Malaria Control Programme, Dodoma, Tanzania
| | - Khalifa Munisi
- Ministry of Health, Dodoma, Tanzania
- National Malaria Control Programme, Dodoma, Tanzania
| | - Sijenunu Aaron
- Ministry of Health, Dodoma, Tanzania
- National Malaria Control Programme, Dodoma, Tanzania
| | - Fabrizio Molteni
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- National Malaria Control Programme, Dodoma, Tanzania
| | - Christian Lengeler
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Emilie Pothin
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Clinton Health Access Initiative, New York, USA
| | - Robert W Snow
- Population Health Unit, KEMRI-Welcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Victor A Alegana
- World Health Organization, Regional Office for Africa, Brazzaville, Republic of Congo
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Women attending antenatal care as a sentinel surveillance population for malaria in Geita region, Tanzania: feasibility and acceptability to women and providers. Malar J 2023; 22:66. [PMID: 36829200 PMCID: PMC9951145 DOI: 10.1186/s12936-023-04480-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/02/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Measurement of malaria prevalence is conventionally estimated through infrequent cross-sectional household surveys that do not provide continuous information regarding malaria parasitaemia. Recent studies have suggested that malaria parasitaemia prevalence among women attending antenatal care (ANC) correlates with prevalence among children under 5 years old and that pregnant women could be a sentinel population for tracking malaria prevalence. In mainland Tanzania, 97% of women are tested for malaria parasitaemia during first ANC visits. However, acceptability among pregnant women and healthcare providers of collecting malaria risk factor data during ANC visits is limited. METHODS A tablet-based questionnaire including 15 questions on insecticide-treated net ownership and use and care-seeking for febrile children was introduced at 40 healthcare facilities in Geita Region, Tanzania. Facilities were randomly selected from among those with 15-120 first ANC visits per month. To assess perspectives regarding introduction of the questionnaire, 21 semi-structured interviews were held with providers and facility in-charges at 12 facilities. Thirty pregnant and recently delivered women participated in focus group discussions at seven facilities to assess the acceptability of spending additional time answering questions about malaria risk. RESULTS All pregnant women reported that introduction of ANC surveillance and spending 10 more minutes with providers answering questions about their health would be neutral or beneficial. They perceived being asked about their health as standard of care. Providers and in-charges reported that introduction of ANC surveillance was within their scope of practice. Nine of 21 indicated it could potentially benefit women's health. Six providers expressed concern about staffing shortages and need for reimbursement for extra time and noted that data management occurs after hours. CONCLUSIONS Pregnant women and providers generally perceived ANC surveillance for malaria as acceptable and positive. Pregnant and recently delivered women saw this as a reasonable and even helpful intervention. To be seen as a part of standard practice, efforts are needed to ensure providers perceive a benefit for ANC clients and that staffing concerns are addressed. In addition, staff should receive feedback related to data submissions regarding malaria prevalence and risk factors among women at their facility, with actions to take.
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Micek K, Hester KA, Chanda C, Darwar R, Dounebaine B, Ellis AS, Keskinocak P, Leslie A, Manyando M, Sililo Manyando M, Nazzal D, Awino Ogutu E, Sakas Z, Castillo-Zunino F, Kilembe W, Bednarczyk RA, Freeman MC. Critical success factors for routine immunization performance: A case study of Zambia 2000 to 2018. Vaccine X 2022; 11:100166. [PMID: 35707220 PMCID: PMC9189203 DOI: 10.1016/j.jvacx.2022.100166] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 02/01/2022] [Accepted: 04/25/2022] [Indexed: 11/19/2022] Open
Abstract
This paper describes how policies and programs contributed to improved vaccine coverage in Zambia. Communication, coordination, and collaboration between implementing levels were imperative. Adjacent successes in health systems strengthening and governance were leveraged. Policies in Zambia include flexibility in implementation for tailored approaches in each district.
Introduction The essential components of a vaccine delivery system are well-documented, but robust evidence on how and why the related processes and implementation strategies prove effective at driving coverage is not well-established. To address this gap, we identified critical success factors associated with advancing key policies and programs that may have led to the substantial changes in routine childhood immunization coverage in Zambia between 2000 and 2018. Methods We identified Zambia as an exemplar in the delivery of childhood vaccines through analysis of DTP1 and DTP3 coverage data. Through interviews and focus group discussions at the national and subnational levels, we investigated factors that contributed to high and sustained vaccination coverage. We conducted a thematic analysis through application of implementation science frameworks to determine critical success factors. We triangulated these findings with quantitative analyses using publicly available data. Results The following success factors emerged: 1) the Inter-agency Coordinating Committee was strengthened for long-term engagement which, complemented by the Zambia Immunization Technical Advisory Group, is valued by the government and integrated into national-level decision-making; 2) the Ministry of Health improved the coordination of data collection and review for informed decision-making across all levels; 3) Regional multi-actor committees identified development priorities, strategies, and funding, and iteratively adjusted policies to account for facilitators, barriers, and lessons learned; 4) Vaccine messaging was disseminated through multiple channels, including the media and community leaders, increasing trust in the government by community members; 5) The Zambia Ministry of Health and Churches Health Association of Zambia formalized a long-term organizational relationship to leverage the strengths of faith-based organizations; and 6) Neighborhood Health Committees spearheaded community-driven strategies via community action planning and ultimately strengthened the link between communities and health facilities. Conclusion Broader health systems strengthening and strong partnerships between various levels of the government, communities, and external organizations were critical factors that accelerated vaccine coverage in Zambia. These partnerships were leveraged to strengthen the overall health system and healthcare governance.
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Affiliation(s)
- Katie Micek
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Kyra A. Hester
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Chama Chanda
- Center for Family Health Research in Zambia, Lusaka, Zambia
| | - Roopa Darwar
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Anna S. Ellis
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Pinar Keskinocak
- College of Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | | | | | | | - Dima Nazzal
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | | | - Zoe Sakas
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Francisco Castillo-Zunino
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | | | | | - Matthew C. Freeman
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Corresponding author at: 404-712-8767; 1518 Clifton Road NE, Atlanta, GA, 30322
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Moukénet A, de Cola MA, Ward C, Beakgoubé H, Baker K, Donovan L, Laoukolé J, Richardson S. Health management information system (HMIS) data quality and associated factors in Massaguet district, Chad. BMC Med Inform Decis Mak 2021; 21:326. [PMID: 34809622 PMCID: PMC8609810 DOI: 10.1186/s12911-021-01684-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022] Open
Abstract
Background Quality data from Health Management Information Systems (HMIS) are important for tracking the effectiveness of malaria control interventions. However, HMIS data in many resource-limited settings do not currently meet standards set by the World Health Organization (WHO). We aimed to assess HMIS data quality and associated factors in Chad. Methods A cross-sectional study was conducted in 14 health facilities in Massaguet district. Data on children under 15 years were obtained from the HMIS and from the external patient register covering the period January–December 2018. An additional questionnaire was administered to 16 health centre managers to collect data on contextual variables. Patient registry data were aggregated and compared with the HMIS database at district and health centre level. Completeness and accuracy indicators were calculated as per WHO guidelines. Multivariate logistic regressions were performed on the Verification Factor for attendance, suspected and confirmed malaria cases for three age groups (1 to < 12 months, 1 to < 5 years and 5 to < 15 years) to identify associations between health centre characteristics and data accuracy. Results Health centres achieved a high level of data completeness in HMIS. Malaria data were over-reported in HMIS for children aged under 15 years. There was an association between workload and higher odds of inaccuracy in reporting of attendance among children aged 1 to < 5 years (Odds ratio [OR]: 10.57, 95% CI 2.32–48.19) and 5– < 15 years (OR: 6.64, 95% CI 1.38–32.04). Similar association was found between workload and stock-outs in register books, and inaccuracy in reporting of malaria confirmed cases. Meanwhile, we found that presence of a health technician, and of dedicated staff for data management, were associated with lower inaccuracy in reporting of clinic attendance in children aged under five years. Conclusion Data completeness was high while the accuracy was low. Factors associated with data inaccuracy included high workload and the unavailability of required data collection tools. The results suggest that improvement in working conditions for clinic personnel may improve HMIS data quality. Upgrading from paper-based forms to a web-based HMIS may provide a solution for improving data accuracy and its utility for future evaluations of health interventions. Results from this study can inform the Ministry of Health and it partners on the precautions to be taken in the use of HMIS data and inform initiatives for improving its quality. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01684-7.
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Affiliation(s)
- Azoukalné Moukénet
- Malaria Consortium Chad Country Office, Angle Bureau de L'Entente Des Eglises (EEMET), Rue 2175, Porte 0150, B.P. 6180, N'Djamena, Chad
| | - Monica Anna de Cola
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | - Charlotte Ward
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Honoré Beakgoubé
- Malaria Consortium Chad Country Office, Angle Bureau de L'Entente Des Eglises (EEMET), Rue 2175, Porte 0150, B.P. 6180, N'Djamena, Chad
| | - Kevin Baker
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | - Laura Donovan
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK
| | | | - Sol Richardson
- Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK.
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Okiring J, Epstein A, Namuganga JF, Kamya V, Sserwanga A, Kapisi J, Ebong C, Kigozi SP, Mpimbaza A, Wanzira H, Briggs J, Kamya MR, Nankabirwa JI, Dorsey G. Relationships between test positivity rate, total laboratory confirmed cases of malaria, and malaria incidence in high burden settings of Uganda: an ecological analysis. Malar J 2021; 20:42. [PMID: 33441121 PMCID: PMC7805073 DOI: 10.1186/s12936-021-03584-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/07/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Malaria surveillance is critical for monitoring changes in malaria morbidity over time. National Malaria Control Programmes often rely on surrogate measures of malaria incidence, including the test positivity rate (TPR) and total laboratory confirmed cases of malaria (TCM), to monitor trends in malaria morbidity. However, there are limited data on the accuracy of TPR and TCM for predicting temporal changes in malaria incidence, especially in high burden settings. METHODS This study leveraged data from 5 malaria reference centres (MRCs) located in high burden settings over a 15-month period from November 2018 through January 2020 as part of an enhanced health facility-based surveillance system established in Uganda. Individual level data were collected from all outpatients including demographics, laboratory test results, and village of residence. Estimates of malaria incidence were derived from catchment areas around the MRCs. Temporal relationships between monthly aggregate measures of TPR and TCM relative to estimates of malaria incidence were examined using linear and exponential regression models. RESULTS A total of 149,739 outpatient visits to the 5 MRCs were recorded. Overall, malaria was suspected in 73.4% of visits, 99.1% of patients with suspected malaria received a diagnostic test, and 69.7% of those tested for malaria were positive. Temporal correlations between monthly measures of TPR and malaria incidence using linear and exponential regression models were relatively poor, with small changes in TPR frequently associated with large changes in malaria incidence. Linear regression models of temporal changes in TCM provided the most parsimonious and accurate predictor of changes in malaria incidence, with adjusted R2 values ranging from 0.81 to 0.98 across the 5 MRCs. However, the slope of the regression lines indicating the change in malaria incidence per unit change in TCM varied from 0.57 to 2.13 across the 5 MRCs, and when combining data across all 5 sites, the R2 value reduced to 0.38. CONCLUSIONS In high malaria burden areas of Uganda, site-specific temporal changes in TCM had a strong linear relationship with malaria incidence and were a more useful metric than TPR. However, caution should be taken when comparing changes in TCM across sites.
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Affiliation(s)
- Jaffer Okiring
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Adrienne Epstein
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - Jane F Namuganga
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Victor Kamya
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Asadu Sserwanga
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - James Kapisi
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Chris Ebong
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Simon P Kigozi
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | - Arthur Mpimbaza
- Infectious Diseases Research Collaboration, 2C Nakasero Hill Road, Kampala, Uganda
| | | | - Jessica Briggs
- Department of Medicine, University of California, San Francisco, USA
| | - Moses R Kamya
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joaniter I Nankabirwa
- Clinical Epidemiology Unit, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grant Dorsey
- Department of Medicine, University of California, San Francisco, USA
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Alegana VA, Suiyanka L, Macharia PM, Ikahu-Muchangi G, Snow RW. Malaria micro-stratification using routine surveillance data in Western Kenya. Malar J 2021; 20:22. [PMID: 33413385 PMCID: PMC7788718 DOI: 10.1186/s12936-020-03529-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing need for finer spatial resolution data on malaria risk to provide micro-stratification to guide sub-national strategic plans. Here, spatial-statistical techniques are used to exploit routine data to depict sub-national heterogeneities in test positivity rate (TPR) for malaria among patients attending health facilities in Kenya. METHODS Routine data from health facilities (n = 1804) representing all ages over 24 months (2018-2019) were assembled across 8 counties (62 sub-counties) in Western Kenya. Statistical model-based approaches were used to quantify heterogeneities in TPR and uncertainty at fine spatial resolution adjusting for missingness, population distribution, spatial data structure, month, and type of health facility. RESULTS The overall monthly reporting rate was 78.7% (IQR 75.0-100.0) and public-based health facilities were more likely than private facilities to report ≥ 12 months (OR 5.7, 95% CI 4.3-7.5). There was marked heterogeneity in population-weighted TPR with sub-counties in the north of the lake-endemic region exhibiting the highest rates (exceedance probability > 70% with 90% certainty) where approximately 2.7 million (28.5%) people reside. At micro-level the lowest rates were in 14 sub-counties (exceedance probability < 30% with 90% certainty) where approximately 2.2 million (23.1%) people lived and indoor residual spraying had been conducted since 2017. CONCLUSION The value of routine health data on TPR can be enhanced when adjusting for underlying population and spatial structures of the data, highlighting small-scale heterogeneities in malaria risk often masked in broad national stratifications. Future research should aim at relating these heterogeneities in TPR with traditional community-level prevalence to improve tailoring malaria control activities at sub-national levels.
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Affiliation(s)
- Victor A Alegana
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya. .,Geography and Environmental Science, University of Southampton, Southampton, SO17 1BJ, UK. .,Faculty of Science and Technology, Lancaster University, Lancaster, LAI 4YW, UK.
| | - Laurissa Suiyanka
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Peter M Macharia
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Grace Ikahu-Muchangi
- National Malaria Control Programme, Ministry of Health, P.O Box 30016-00100, Nairobi, Kenya
| | - Robert W Snow
- Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LJ, UK
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Rumisha SF, Lyimo EP, Mremi IR, Tungu PK, Mwingira VS, Mbata D, Malekia SE, Joachim C, Mboera LEG. Data quality of the routine health management information system at the primary healthcare facility and district levels in Tanzania. BMC Med Inform Decis Mak 2020; 20:340. [PMID: 33334323 PMCID: PMC7745510 DOI: 10.1186/s12911-020-01366-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 12/08/2020] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Effective planning for disease prevention and control requires accurate, adequately-analysed, interpreted and communicated data. In recent years, efforts have been put in strengthening health management information systems (HMIS) in Sub-Saharan Africa to improve data accessibility to decision-makers. This study assessed the quality of routine HMIS data at primary healthcare facility (HF) and district levels in Tanzania. METHODS This cross-sectional study involved reviews of documents, information systems and databases, and collection of primary data from facility-level registers, tally sheets and monthly summary reports. Thirty-four indicators from Outpatient, Inpatient, Antenatal care, Family Planning, Post-natal care, Labour and Delivery, and Provider-Initiated Testing and Counselling service areas were assessed. Indicator records were tracked and compared across the process of data collection, compilation and submission to the district office. Copies of monthly report forms submitted by facilities to the district were also reviewed. The availability and utilization of HMIS tools were assessed, while completeness and data accuracy levels were quantified for each phase of the reporting system. RESULTS A total of 115 HFs (including hospitals, health centres, dispensaries) in 11 districts were involved. Registers (availability rate = 91.1%; interquartile range (IQR) 66.7-100%) and report forms (86.9%; IQR 62.2-100%) were the most utilized tools. There was a limited use of tally-sheets (77.8%; IQR 35.6-100%). Tools availability at the dispensary was 91.1%, health centre 82.2% and hospital 77.8%, and was low in urban districts. The availability rate at the district level was 65% (IQR 48-75%). Wrongly filled or empty cells in registers and poor adherence to the coding procedures were observed. Reports were highly over-represented in comparison to registers' records, with large differences observed at the HF phase of the reporting system. The OPD and IPD areas indicated the highest levels of mismatch between data source and district office. Indicators with large number of clients, multiple variables, disease categorization, or those linked with dispensing medicine performed poorly. CONCLUSION There are high variations in the tool utilisation and data accuracy at facility and district levels. The routine HMIS is weak and data at district level inaccurately reflects what is available at the source. These results highlight the need to design tailored and inter-service strategies for improving data quality.
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Affiliation(s)
- Susan F Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Emanuel P Lyimo
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Irene R Mremi
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Patrick K Tungu
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzania
| | - Victor S Mwingira
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzania
| | - Doris Mbata
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Sia E Malekia
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Catherine Joachim
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Leonard E G Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, Morogoro, Tanzania.
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Gwitira I, Mukonoweshuro M, Mapako G, Shekede MD, Chirenda J, Mberikunashe J. Spatial and spatio-temporal analysis of malaria cases in Zimbabwe. Infect Dis Poverty 2020; 9:146. [PMID: 33092651 PMCID: PMC7584089 DOI: 10.1186/s40249-020-00764-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/14/2020] [Indexed: 01/26/2023] Open
Abstract
Background Although effective treatment for malaria is now available, approximately half of the global population remain at risk of the disease particularly in developing countries. To design effective malaria control strategies there is need to understand the pattern of malaria heterogeneity in an area. Therefore, the main objective of this study was to explore the spatial and spatio-temporal pattern of malaria cases in Zimbabwe based on malaria data aggregated at district level from 2011 to 2016. Methods Geographical information system (GIS) and spatial scan statistic were applied on passive malaria data collected from health facilities and aggregated at district level to detect existence of spatial clusters. The global Moran’s I test was used to infer the presence of spatial autocorrelation while the purely spatial retrospective analyses were performed to detect the spatial clusters of malaria cases with high rates based on the discrete Poisson model. Furthermore, space-time clusters with high rates were detected through the retrospective space-time analysis based on the discrete Poisson model. Results Results showed that there is significant positive spatial autocorrelation in malaria cases in the study area. In addition, malaria exhibits spatial heterogeneity as evidenced by the existence of statistically significant (P < 0.05) spatial and space-time clusters of malaria in specific geographic regions. The detected primary clusters persisted in the eastern region of the study area over the six year study period while the temporal pattern of malaria reflected the seasonality of the disease where clusters were detected within particular months of the year. Conclusions Geographic regions characterised by clusters of high rates were identified as malaria high risk areas. The results of this study could be useful in prioritizing resource allocation in high-risk areas for malaria control and elimination particularly in resource limited settings such as Zimbabwe. The results of this study are also useful to guide further investigation into the possible determinants of persistence of high clusters of malaria cases in particular geographic regions which is useful in reducing malaria burden in such areas.
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Affiliation(s)
- Isaiah Gwitira
- Department of Geography Geospatial Sciences and Earth Observation, University of Zimbabwe, P. O. Box MP 167, Mount Pleasant, Harare, Zimbabwe.
| | - Munashe Mukonoweshuro
- Department of Geography Geospatial Sciences and Earth Observation, University of Zimbabwe, P. O. Box MP 167, Mount Pleasant, Harare, Zimbabwe
| | - Grace Mapako
- Department of Geography Geospatial Sciences and Earth Observation, University of Zimbabwe, P. O. Box MP 167, Mount Pleasant, Harare, Zimbabwe
| | - Munyaradzi D Shekede
- Department of Geography Geospatial Sciences and Earth Observation, University of Zimbabwe, P. O. Box MP 167, Mount Pleasant, Harare, Zimbabwe
| | - Joconiah Chirenda
- Department of Community Medicine, University of Zimbabwe, 3rd Floor New Health Sciences Building, College of Health Sciences, P O Box A178, Avondale, Harare, Zimbabwe
| | - Joseph Mberikunashe
- National Malaria Control Program, Ministry of Health and Child Care, 4th Floor, Kaguvi Building, Central Avenue (Between 4th and 5th Street), Harare, Zimbabwe
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Kamau A, Mtanje G, Mataza C, Malla L, Bejon P, Snow RW. The relationship between facility-based malaria test positivity rate and community-based parasite prevalence. PLoS One 2020; 15:e0240058. [PMID: 33027313 PMCID: PMC7540858 DOI: 10.1371/journal.pone.0240058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 09/17/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Malaria surveillance is a key pillar in the control of malaria in Africa. The value of using routinely collected data from health facilities to define malaria risk at community levels remains poorly defined. METHODS Four cross-sectional parasite prevalence surveys were undertaken among residents at 36 enumeration zones in Kilifi county on the Kenyan coast and temporally and spatially matched to fever surveillance at 6 health facilities serving the same communities over 12 months. The age-structured functional form of the relationship between test positivity rate (TPR) and community-based parasite prevalence (PR) was explored through the development of regression models fitted by alternating the linear, exponential and polynomial terms for PR. The predictive ranges of TPR were explored for PR endemicity risk groups of control programmatic value using cut-offs of low (PR <5%) and high (PR ≥ 30%) transmission intensity. RESULTS Among 28,134 febrile patients encountered for malaria diagnostic testing in the health facilities, 12,143 (43.2%: 95% CI: 42.6%, 43.7%) were positive. The overall community PR was 9.9% (95% CI: 9.2%, 10.7%) among 6,479 participants tested for malaria. The polynomial model was the best fitting model for the data that described the algebraic relationship between TPR and PR. In this setting, a TPR of ≥ 49% in all age groups corresponded to an age-standardized PR of ≥ 30%, while a TPR of < 40% corresponded to an age-standardized PR of < 5%. CONCLUSION A non-linear relationship was observed between the relative change in TPR and changes in the PR, which is likely to have important implications for malaria surveillance programs, especially at the extremes of transmission. However, larger, more spatially diverse data series using routinely collected TPR data matched to community-based infection prevalence data are required to explore the more practical implications of using TPR as a replacement for community PR.
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Affiliation(s)
- Alice Kamau
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Grace Mtanje
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Christine Mataza
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Ministry of Health, Kilifi County Government, Kilifi, Kenya
| | - Lucas Malla
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Philip Bejon
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Robert W. Snow
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
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Alegana VA, Okiro EA, Snow RW. Routine data for malaria morbidity estimation in Africa: challenges and prospects. BMC Med 2020; 18:121. [PMID: 32487080 PMCID: PMC7268363 DOI: 10.1186/s12916-020-01593-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/14/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The burden of malaria in sub-Saharan Africa remains challenging to measure relying on epidemiological modelling to evaluate the impact of investments and providing an in-depth analysis of progress and trends in malaria response globally. In malaria-endemic countries of Africa, there is increasing use of routine surveillance data to define national strategic targets, estimate malaria case burdens and measure control progress to identify financing priorities. Existing research focuses mainly on the strengths of these data with less emphasis on existing challenges and opportunities presented. CONCLUSION Here we define the current imperfections common to routine malaria morbidity data at national levels and offer prospects into their future use to reflect changing disease burdens.
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Affiliation(s)
- Victor A Alegana
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya.
- Geography and Environmental Science, University of Southampton, Southampton, SO17 1BJ, UK.
- Faculty of Science and Technology, Lancaster University, Lancaster, LAI 4YW, UK.
| | - Emelda A Okiro
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya
| | - Robert W Snow
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640, Nairobi, 00100, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, OX3 7LJ, UK
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Diallo MA, Badiane AS, Diongue K, Sakandé L, Ndiaye M, Seck MC, Ndiaye D. A twenty-eight-year laboratory-based retrospective trend analysis of malaria in Dakar, Senegal. PLoS One 2020; 15:e0231587. [PMID: 32413069 PMCID: PMC7228107 DOI: 10.1371/journal.pone.0231587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/27/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Health facility-based records offer a rich source of information to understand trends and changes in malaria cases over time. This study is aimed at determining the changes in malaria occurrence over the last 28 years, from 1989 to 2016 in Dakar, Senegal. METHODS Laboratory suspected and confirmed malaria records from 1989 to 2016 were reviewed from the laboratory registers of the Laboratory of Parasitology and Mycology of Aristide Le Dantec Hospital. Interrupted time series (ITS) analysis was used to estimate the changes by comparing malaria cases post-intervention (2006-2016) with that of the pre-intervention (1989-2005) period. RESULTS A total of 5,876 laboratory confirmed malaria cases were reported out of 29,852 tested cases, with total slide positivity rate (SPR) of 19.7%. Malaria case counts exhibited a fluctuating trend with major peaks occurring in the years 1995 and 2003 with SPR of 42.3% and 42.5%, respectively. Overall, a remarkable decline in the total number of laboratory confirmed malaria cases was observed over the last 28 years. P. falciparum was almost the only reported species, accounting for 99.98% of cases. The highest SPR was observed in the age group of under five years during the pre-intervention period while this shifted to the age group of 6-15 years old for the subsequent years. Two major malaria peak seasons were observed: one in September during the pre-intervention period and the other in November for the post-intervention period. The ITS analysis showed a dramatic decline of 83.6% in SPR following the scale-up of interventions in 2006. CONCLUSION A remarkable decline in laboratory confirmed malaria cases in Dakar over 28 years was observed. The period of rapid decline in malaria SPR coincided with the scale-up in interventions beginning in 2006 with the introduction of ACTs, followed by the widespread introduction in 2008 of bed nets treated with insecticides. Robust surveillance data should be maintained in the context of malaria elimination efforts.
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Affiliation(s)
- Mamadou Alpha Diallo
- Department of Parasitology, Cheikh Anta Diop University, Dakar, Senegal
- * E-mail:
| | | | - Khadim Diongue
- Department of Parasitology, Cheikh Anta Diop University, Dakar, Senegal
| | - Linda Sakandé
- Department of Parasitology, Cheikh Anta Diop University, Dakar, Senegal
| | - Mouhamadou Ndiaye
- Department of Parasitology, Cheikh Anta Diop University, Dakar, Senegal
| | - Mame Cheikh Seck
- Department of Parasitology, Cheikh Anta Diop University, Dakar, Senegal
| | - Daouda Ndiaye
- Department of Parasitology, Cheikh Anta Diop University, Dakar, Senegal
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