Table 1.
Existing surveillance systems for malaria elimination
| Country | System description | Data capture | Outputs | Strengths | Challenges |
|---|---|---|---|---|---|
| Cambodia | MIS is a stand-alone system developed to assess malaria transmission and intervention coverage.25 Two additional pilot systems | Passive Case Detection case notification | MIS: Automatically generated report including tabular summaries, graphics and mapping to village level26 | MIS: | Uncaptured private, migrant, military sectors |
| D0AS Pf cases | MIS: District level data reported monthly, including species, severe malaria, cases, deaths | D0AS: Real-time SMS alert to Provincial Health Department and National Malaria Center. Day-28 follow-up reminder is sent to the same plus health center management | Covers all endemic areas | Most data aggregated monthly, challenge to get real-time data | |
| D3AS Day 3 positive malaria smears to identify resistance | D0AS: Health staff send SMS for Pf cases from pilot areas | D3AS: Real-time SMS when parasites remain by Day 3 | Tracks severe malaria, deaths | Inconsistent decision making and response based on available data | |
| Population covered: > 3M | D3AS: Only includes Pf cases parasitemic after three days of treatment in areas of artemisinin-resistance | Malaria incidence and intervention coverage to village level | Does not capture time-to-case reporting, or intervention quality | ||
| Automatically generated monthly bulletin | Case follow-up challenges | ||||
| Pilot D0AS and D3AS | No mapping to household or where case acquired | ||||
| SMS and Internet-based notification systems | |||||
| Integrated with MIS | |||||
| China | Two integrated web-based systems: febrile illness reporting and focus investigation and intervention tracking. Data stored at the National Centers for Disease Control and Prevention.6,27 | PCD case notification: Data entered within 24 hours. Data include date, facility, reporting person, patient info and diagnostic result with method and treatment | SMS alerts | Web-based system integrated with reportable diseases system | Mobile technology not integrated |
| Population covered: > 1.3B | Monthly MoH report, tabular summary results, graphics and mapping | Data fed into HMIS | Limited baseline data | ||
| “1-3-7 strategy” time tracking to case notification (one day), case investigation (three days), completed interventions (seven days) | Very little missing data | Does not capture new interventions or intervention quality | |||
| Rapid case reporting | No mapping to household or where case acquired | ||||
| Diagnosis is confirmed by microscopy and PCR | |||||
| “1-3-7 strategy” is easy to use and understand | |||||
| Solomon Islands/Vanuatu | SDSS.17,35 Data are stored in a relational database, using local, provincial and nationally based servers (three levels for backup). | PCD case notification: Health facility calls provincial center within 48 hours. | Real-time case reporting | SDSS includes extensive baseline data28 | Mobile technology not integrated |
| Population covered: > 90 k, implemented in four island provinces | Frontline and active case detection planning by household, follow-up list of households that did not receive intervention | Rapid case reporting | Inconsistent decision making and response | ||
| Tabular output, spatial analysis, graphics, and mapping, including foci classification | Automated GIS-based queries with high-resolution mapping | Does not capture time-to-case reporting, or intervention quality | |||
| Generates lists to support targeted action at the household level | Human resource constraints | ||||
| Readily adaptable to other locations or systems | No mapping to where case was acquired | ||||
| Swaziland | HMIS, IDNS for 15 reportable diseases, and MSDS for case investigation and interventions.16,29,36 | PCD case notification: RDT or microscopy-confirmed malaria cases dictated through a toll-free hotline. Data entered on a central server, surveillance agent receives an SMS with date, facility, reporting person, patient info and case number to conduct case investigation and intervention. | IDNS: Toll-free hotline resulting in SMS to surveillance agent | Integrated with notifiable disease reporting system | Relatively low reporting completeness to IDNS |
| Population covered: 1.2M | MSDS: Monthly tabular and graphic summary, mapping to household. Maps of cases investigated, locations of positive cases, IRS, ITNs, breeding sites, risk maps, households screened, or remaining. | Web-based system using mobile technology | Low case reporting from private sector facilities | ||
| Free mobile reporting | Does not capture time-to-case reporting or intervention quality | ||||
| Entire country covered | No mapping to where case was acquired | ||||
| Simple, rapid case notification | |||||
| Temporal–spatial analysis of case distribution | |||||
| Thailand | Stand-alone, web-based system. Data storage is in a database at Mahidol University. GPS-enabled tablets for patient follow-up, data captured in same server. | PCD case notification: Case data entered at malaria clinic level within 24 hours. Data include date, facility, reporting person, patient info, diagnostic result with method and foci classification.30 | Pf case alerts to malaria clinic staffs' tablets within 24 hours | Web-based system with mobile technology being integrated | Hospital-based cases in a separate system |
| Population covered: > 21M | Tablet-based follow-up form for directly observed therapy and resistance monitoring | Implemented in large regions, covering all areas of multi-drug resistance | Challenges with migrant and cross-border follow-up | ||
| Monthly MoH report, tabular summary, graphics, maps, with mapping to Pf case household and likely case location.31 | Rapid case reporting | More baseline data needed, such as intervention coverage and forest sleeping locations | |||
| Captures DOT | No time to case reporting or intervention quality | ||||
| Captures Pf resistance | |||||
| Zambia | DHIS2 is a web-based health information system. Data storage and mobile phones linked to the same database.32,33 | PCD case notification: urban and rural health staff report weekly by mobile phone. Data include clinic visits, clinical cases, RDT-tested and positive cases, microscopy-tested and positive cases, ACT and RDT stock tracking. CHWs report cases monthly by mobile phone.33 | Regular reports, with online access to data in real-time | Open source free web-based system fully integrated with HMIS | Case data not reported to DHIS2 in real-time |
| Population covered: > 6M | Graphs created and provided in real time to mobile phones or computers, summarizing case reporting and stock data, with summary data from all areas, reporting to the facility | Tables, charts and maps shared with all users with online dashboard | Does not capture time to case reporting or intervention quality | ||
| Maps, graphs display village, clinic-level malaria incidence | Mobile technology fully integrated | Remains to be determined if DHIS2 can support full malaria elimination surveillance system to household level | |||
| Timeliness and completeness of data reporting tracked | |||||
| Zanzibar, Tanzania | Integrated system combining Coconut Surveillance and MCN. MCN includes rapid reporting and analysis, outputs with geo-location of cases, through Coconut Surveillance. Cases reported to health staff via SMS. Coconut uses data to guide household oriented index case follow up. | PCD case notification: | MCN: Real-time case reporting via Coconut Surveillance, monthly MoH reports. Tabular summary results, graphics and mapping to the village level. | MCN and Coconut are an integrated SMS-based system and tablet web-based system | Cases from extensive private sector not captured |
| Population covered: ∼1.3M | Public health unit staff send an SMS for each positive case. Data include all-cause visits, malaria tested/positive cases and age. | Coconut: Real-time tabular summary results, graphics, and detailed mapping to the household level. Real-time tracking of case follow-up and new interventions. | Mobile technology fully integrated | Limited capture of baseline data | |
| Coconut Surveillance notifies malaria officers of cases immediately via SMS. Patient and household follow-up with GPS enabled tablet. | Rapid case reporting | Does not currently capture intervention quality | |||
| Real-time tabular output of key variables makes it easy for management to track progress real time | No mapping to where case was acquired | ||||
| MEEDS data are used to calculate supply orders | Denominator (population) data not captured with Coconut |
D0AS = Day 0 Alert System; D3AS = Day 3 Alert System; DOT = directly observed therapy; HMIS = Health Management Information System; GIS = geographic information systems: MCN = malaria case notification; IDNS = Immediate Disease Notification System; MIS = Malaria Information System; MoH = Ministry of Health; MSDS = Malaria Surveillance Database System; Pf = Plasmodium falciparum; PCR = polymerase chain reaction; SDSS = Integrated Spatial Decision Support System; SMS = short message service.