Two parallel reporting systems for malaria surveillance in Pakistan, 2013–17: is exact burden reflected?

Hammad Habib,Aashifa Yaqoob,Hina Najmi,Razia Fatima,Ahmad Wali,Abdul Majeed,Abdul Baseer Achakzai,Mahboob Ul Haq

doi:10.12688/f1000research.17202.1

Abstract

Background: Pakistan is facing challenges regarding the availability of reliable data for malaria surveillance. These include lack of coordination between different reporting systems and fragmented information system. This study aimed to compare the reporting of malaria surveillance systems in Pakistan. Methods: There are two parallel reporting systems for malaria surveillance in Pakistan, the District Health Information System (DHIS) and Malaria Information System (MIS). DHIS reports on all morbidity at health facility level, while MIS is only used for malaria surveillance in the donor supported districts. A cross sectional study was conducted between July-September 2018 by using the retrospective records of DHIS and MIS data reported to the Directorate of Malaria Control (DOMC) Islamabad during 2013-17. Descriptive and inferential analysis was performed to compare the coverage, outcome and impact indicators. Results: During 2013-17, all districts (n=145, 100%) across Pakistan reported on the DHIS. The MIS reporting coverage has gradually increased from 21 (14.5%) to 72 (49.7%) districts. Reported number of suspected screened and confirmed malaria cases were compared. MIS reported twice the number of suspects screened for malaria (100.5%) and confirmed malaria cases (124.4%) as compared to the DHIS. The difference in the reported average annual blood examination rate (ABER) was 3.8, test positivity rate (TPR) was -0.9 and the annual parasite incidence (API) was 4.9/1000 population over five years between two systems. DHIS reported only half the ABER and API as compared to MIS. Conclusion: There is huge under-reporting of suspected and confirmed malaria cases in the DHIS as compared to MIS. Urgent attention is needed to address this, as it is vital to have uniform reporting of true disease burden across the country. An integrated disease surveillance system, improved data validation systems, and use of the online DHIS-2 are potential options for better integrity and coherence of reported data.

Highlights

Malaria ranks sixth amongst the top ten causes of deaths in low income countries of the world[1]
District Health Information System (DHIS) reports on all morbidity at health facility level while Malaria Information System (MIS) is used in only the donor supported districts for malaria surveillance[13]
Fever cases with signs and symptoms of malaria are screened as suspected cases, confirmed through the microscopy or rapid diagnostic test (RDT) kits, and reported in the DHIS and MIS according to the identified species, i.e. P. falciparum, P. vivax or mix cases on monthly basis (Figure 1)

Summary

Introduction

Malaria ranks sixth amongst the top ten causes of deaths in low income countries of the world[1]. In 2016, 91 countries reported an increase in malaria cases (216 million) as compared to 2015 (211 million). Pakistan is facing challenges regarding the availability of reliable data for malaria surveillance These include lack of coordination between different reporting systems and fragmented information system. This study aimed to compare the reporting of malaria surveillance systems in Pakistan. Methods: There are two parallel reporting systems for malaria surveillance in Pakistan, the District Health Information System (DHIS) and Malaria Information System (MIS). Reported number of suspected screened and confirmed malaria cases were compared. MIS reported twice the number of suspects screened for malaria (100.5%) and confirmed malaria cases (124.4%) as compared to the DHIS. Conclusion: There is huge under-reporting of suspected and confirmed malaria cases in the DHIS as compared to MIS.

Objectives

Methods

Results