Evaluating Response Time in Zanzibar’s Malaria Elimination Case-Based Surveillance–Response System

Abstract

As countries transition toward malaria elimination, malaria programs rely on surveillance-response systems, which are often supported by web-and mobile phone-based reporting tools. Such surveillance-response systems are interventions for elimination, making it important to determine if they are operating optimally. A metric to measure this by is timeliness. This study used a mixed-methods approach to investigate the response time of Zanzibar's malaria elimination surveillance-response system, Malaria Case Notification (MCN). MCN conducts both passive and reactive case detection, supported by a mobile phone-based reporting tool called Coconut Surveillance. Using data obtained from RTI International and the Zanzibar Malaria Elimination Program (ZAMEP), analysis of summary statistics was conducted to investigate the association of response time with geography, and time series techniques were used to investigate trends in response time and its association with the number of reported cases. Results indicated that response time varied by the district in Zanzibar (0.6-6.05 days) and that it was not associated with calendar time or the number of reported cases. Survey responses and focus groups with a cadre of health workers, district malaria surveillance officers, shed light on operational challenges faced during case investigation, such as incomplete health records and transportation issues, which stem from deficiencies in aspects of ZAMEP's program management. These findings illustrate that timely response for malaria elimination depends on effective program management, despite the automation of webbased or mobile phone-based tools. For surveillance-response systems to work optimally, malaria programs should ensure that optimal management practices are in place.

Epidemic risk of arboviral diseases: Determining the habitats, spatial-temporal distribution, and abundance of immature Aedes aegypti in the Urban and Rural areas of Zanzibar, Tanzania

“…Both methods are hampered by the development of insecticide resistance [26], while LLINs are ineffective against diurnal Aedes mosquitoes. Nonetheless, these efforts have contributed to a dramatic reduction in malaria prevalence and incidence in Zanzibar [26][27][28]. Whereas malaria cases are declining, ongoing waste generation, unreliable domestic water supply creating a demand for localized water storage, and environmental and climatic changes seem to be favoring the proliferation of Aedes mosquitoes [24,29].…”

Operational Coverage and Timeliness of Reactive Case Detection for Malaria Elimination in Zanzibar, Tanzania

“…A previous evaluation of the MCN system suggested that operational issues such as mobile phone network failures and delays in obtaining funds for refueling DMSO motorbikes may at times lead to delays in case review and household follow-up. 27 The standard number of two DMSOs per district irrespective of the district's area, population size, or expected malaria incidence may, at particular times of the year or days of the week, be insufficient. The program has, therefore, made changes including hiring a larger number of DMSOs in some districts to compensate for this.…”

Surveillance to achieve malaria elimination in eastern Myanmar: a 7-year observational study

“…Data collected by malaria posts, including the number of positive cases and the number of consultations, are crucial in the planning and timely delivery of necessary targeted interventions in areas of high P. falciparum burden [ 4 ] or in response to increases in incidence in low transmission settings, in the monitoring of intervention impact, and in responding to decreases in malaria post service uptake. However, the utility of the data depends on how quickly it is collected, analysed, and responded to [ 5 , 6 ].…”