Abstract
BackgroundIn moving toward malaria elimination, one strategy is to implement an active surveillance system for effective case management. Thailand has developed and implemented the electronic Malaria Information System (eMIS) capturing individualized electronic records of suspected or confirmed malaria cases.ObjectiveThe main purpose of this study was to determine how well the eMIS improves the quality of Thailand’s malaria surveillance system. In particular, the focus of the study was to evaluate the effectiveness of the eMIS in terms of the system users’ perception and the system outcomes (ie, quality of data) regarding the management of malaria patients.MethodsA mixed-methods technique was used with the framework based on system effectiveness attributes: data quality, timeliness, simplicity, acceptability, flexibility, stability, and usefulness. Three methods were utilized: data records review, survey of system users, and in-depth interviews with key stakeholders. From the two highest endemic provinces, paper forms matching electronic records of 4455 noninfected and 784 malaria-infected cases were reviewed. Web-based anonymous questionnaires were distributed to all 129 eMIS data entry staff throughout Thailand, and semistructured interviews were conducted with 12 management-level officers.ResultsThe eMIS is well accepted by system users at both management and operational levels. The data quality has enabled malaria personnel to perform more effective prevention and control activities. There is evidence of practices resulting in inconsistencies and logical errors in data reporting. Critical data elements were mostly completed, except for a few related to certain dates and area classifications. Timeliness in reporting a case to the system was acceptable with a delay of 3-4 days. The evaluation of quantitative and qualitative data confirmed that the eMIS has high levels of simplicity, acceptability, stability, and flexibility.ConclusionsOverall, the system implemented has achieved its objective. The results of the study suggested that the eMIS helps improve the quality of Thailand’s malaria surveillance system. As the national malaria surveillance system, the eMIS’s functionalities have provided the malaria staff working at the point of care with close-to-real-time case management data quality, covering case detection, case investigation, drug compliance, and follow-up visits. Such features has led to an improvement in the quality of the malaria control program; the government officials now have quicker access to both individual and aggregated data to promptly react to possible outbreak. The eMIS thus plays one of the key roles in moving toward the national goal of malaria elimination by the next decade.
Highlights
Data were assembled from 97 countries and territories with ongoing malaria transmission, and AN ADDITIONAL six countries working to prevent reintroduction.The World malaria report 2014 summarizes the status of global efforts to control and eliminate malaria
Indicators derived from household surveys are in bold. * In areas where public health facilities are able to provide a parasitological test for all suspected malaria cases, near zero malaria deaths is defined as no more than 1 confirmed malaria death per 100 000 population at risk. ** Universal access to and utilization is defined as every person at risk sleeping under a quality insecticide-treated net or in a space protected by indoor residual spraying and every pregnant woman at risk receiving a dose of IPTp at each antenatal care (ANC) visit after the first trimester
In the World Health Organization (WHO) African Region – which has the highest proportion of the population at high risk of malaria, and in which the characteristics of the malaria vectors in most areas make them amenable to intervention with insecticide-treated mosquito nets (ITNs) – mass campaigns are supplemented by distribution of ITNs to pregnant women at antenatal care (ANC) clinics in 37 countries, and to infants through expanded programme on immunization (EPI) clinics in 29 countries
Summary
An estimated 3.3 billion people are at risk of being infected with malaria and developing disease, and 1.2 billion are at high risk. Malaria exacts a heavy burden on the poorest and most vulnerable communities It primarily affects low- and lower-middle income countries (Figure 1.2). Malaria is caused by five species of the parasite belonging to the genus Plasmodium Four of these – P. falciparum, P. vivax, P. malariae and P. ovale – are human malaria species, which are spread from one person to another by female mosquitoes of the genus Anopheles. P. vivax has a wider geographic distribution than P. falciparum because it can develop in the Anopheles mosquito vector at lower temperatures, and can survive at higher altitudes and in cooler climates. It has a dormant liver stage (known as a hypnozoite) that enables it to survive for long periods as a potential reservoir of infection. Malaria can be prevented and cured by highly cost‐effective interventions
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