Abstract
BackgroundHeath facility-based sentinel site surveillance has been proposed as a means of monitoring trends in malaria morbidity but may also provide an opportunity to improve malaria case management. Here we described the impact of a sentinel site malaria surveillance system on promoting laboratory testing and rational antimalarial drug use.Methodology/Principal FindingsSentinel site malaria surveillance was established at six health facilities in Uganda between September 2006 and January 2007. Data were collected from all patients presenting to the outpatient departments including demographics, laboratory results, diagnoses, and treatments prescribed. Between the start of surveillance and March 2010, a total 424,701 patients were seen of which 229,375 (54%) were suspected of having malaria. Comparing the first three months with the last three months of surveillance, the proportion of patients with suspected malaria who underwent diagnostic testing increased from 39% to 97% (p<0.001). The proportion of patients with an appropriate decision to prescribe antimalarial therapy (positive test result prescribed, negative test result not prescribed) increased from 64% to 95% (p<0.001). The proportion of patients appropriately prescribed antimalarial therapy who were prescribed the recommended first-line regimen artemether-lumefantrine increased from 48% to 69% (p<0.001).Conclusions/SignificanceThe establishment of a sentinel site malaria surveillance system in Uganda achieved almost universal utilization of diagnostic testing in patients with suspected malaria and appropriate decisions to prescribed antimalarial based on test results. Less success was achieved in promoting prescribing practice for the recommended first-line therapy. This system could provide a model for improving malaria case management in other health facilities in Africa.
Highlights
Malaria surveillance is essential to guide program planning and management, inform governments and donors on progress towards malaria control, and assist with advocacy
The average number of patients seen per month ranged from 968 (Kasmbya) to 2,488 (Kamwezi), and was fairly consistent during the observation period with the exception of Kamwezi where the average number of patients seen per month increased almost 2-fold following May 2009 (1,907 vs. 3,476) due to a presumed malaria epidemic in the southwest part of the country
The proportion of patients seen with suspected malaria and the proportion of diagnostic tests that were positive were fairly consistent over the observation period at all of the sites with the exception of Kamwezi, where suspected malaria cases increased from 35% to 59% and the proportion of positive diagnostic tests increased from 26% to 50% following the presumed malaria epidemic in May 2009
Summary
Malaria surveillance is essential to guide program planning and management, inform governments and donors on progress towards malaria control, and assist with advocacy. Most malaria control programs in Africa rely on routinely collected health facility-based data for surveillance needs as part of a country’s Health Management Information Services (HMIS). The methods used to collect data at health facilities vary widely and are highly subject to bias, as there are many factors that influence whether a patient with malaria will be captured by this system [3]. The slide positivity rate (SPR), defined as the number of laboratory-confirmed malaria cases per 100 suspected cases examined, provides an alternative method for estimating temporal changes in malaria morbidity. Heath facility-based sentinel site surveillance has been proposed as a means of monitoring trends in malaria morbidity but may provide an opportunity to improve malaria case management. We described the impact of a sentinel site malaria surveillance system on promoting laboratory testing and rational antimalarial drug use
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