Evaluation of malaria surveillance system, Adaklu District, Volta Region, Ghana, 2019

Abstract

Background: Globally, 219 million cases of malaria were recorded in 2017 with Ghana contributing 10.2 million cases, deaths was 599 and 327 were among children under 5 years. Despite the multiple interventions implemented to control malaria in the Volta Region, prevalence still remains high. We evaluated the system in Adaklu District, Volta Region to determine if the system is meeting its objectives of monitoring trends, and detecting epidemics, and assessed its usefulness and attributes. Methods & Materials: We extracted and reviewed malaria data from District Health Management Information System II covering the period of January 2014 and December 2018. We interviewed stakeholders using semi-structured questionnaire on their awareness and involvement in the system, case detection and reporting. System attributes were assessed using the CDC updated guidelines for evaluating public health surveillance. We performed summary descriptive statistics on quantitative data and directed content analysis on qualitative data. Results: Of a total 76,384 suspected malaria cases recorded in Adaklu District over the five-year period, 27,498 (57.4%) cases were recorded between March and October. Health care workers demonstrated good knowledge about the disease but had no idea about the IDSR case definition. All fifteen facilities reported malaria data each month. Stakeholders demonstrated no difficulty diagnosing and reporting cases. The average estimated predictive value positive was 62.9%, data quality was 95% and 100% timely for report submission. The system was used to monitor morbidity trends and evaluate control and preventive measures. There were no alert or epidemic thresholds to detect epidemics. The system missed an epidemic in August 2016. Conclusion: The system in Adaklu District was useful, simple, acceptable, representative with good data quality. Seasonal pattern was observed between March and October each year. The district needs to implement Seasonal Malaria Chemoprevention especially among children to help reduce the incidence among children under five years. We assisted them to set alert and epidemic thresholds based on past data.