Integrated Disease Surveillance and Response (IDSR) in Malawi: Implementation gaps and challenges for timely alert

Abstract

ObjectiveThe recent 2014 Ebola Virus Disease (EVD) outbreaks rang the bell to call upon global efforts to assist resource-constrained countries to strengthen public health surveillance system for early response. Malawi adopted the Integrated Disease Surveillance and Response (IDSR) strategy to develop its national surveillance system since 2002 and revised its guideline to fulfill the International Health Regulation (IHR) requirements in 2014. This study aimed to understand the state of IDSR implementation and differences between guideline and practice for future disease surveillance system strengthening.MethodsThis was a mixed-method research study. Quantitative data were to analyze completeness and timeliness of surveillance system performance from national District Health Information System 2 (DHIS2) during October 2014 to September 2016. Qualitative data were collected through interviews with 29 frontline health service providers from the selected district and 7 key informants of the IDSR system implementation and administration at district and national levels.FindingsThe current IDSR system showed relatively good completeness (73.1%) but poor timeliness (40.2%) of total expected monthly reports nationwide and zero weekly reports during the study period. Major implementation gaps were lack of weekly report and trainings. The challenges of IDSR implementation revealed through qualitative data included case identification, compiling reports for timely submission and inadequate resources.ConclusionsThe differences between IDSR technical guideline and actual practice were huge. The developing information technology infrastructure in Malawi and emerging mobile health (mHealth) technology can be opportunities for the country to overcome these challenges and improve surveillance system to have better timeliness for the outbreaks and unusual events detection.

Level and Predicators of quality of Integrated Disease Surveillance and Response for Infectious Disease in Tigray, Northern Ethiopia: Cross-Sectional Study

“…However, one out of five health facilities missed the national guideline. Standard case definitions for case detection were better available ( Table 2) in contrast with evidence from Malawi, Uganda and Burkina Faso [23][24][25] in which printed SCDs were rarely available. All available guidelines and standard case definitions were available in English version.…”

Infectious disease outbreaks in the African region: overview of events reported to the World Health Organization in 2018

“…Indeed, following the 2014–2016 West-Africa EVD outbreak, several African Member States have strengthened the implementation of the new IDSR strategy in order to improve early detection through routine surveillance [16–18]. Several studies have reported improvements in disease surveillance in the African countries as a result of lessons learned from the 2014–2016 West Africa EVD outbreak [17–20].…”

Systematic review of Integrated Disease Surveillance and Response (IDSR) implementation in the African region

“…The 47 studies included in this review focused on 17 countries, ordered by number of publications: Nigeria (10 [ 14 – 23 ]), Ghana (7 [ 24 – 30 ]), Uganda (5 [ 31 – 35 ]), Liberia (4 [ 36 – 39 ]), the Democratic Republic of Congo (3 [ 17 , 40 , 41 ]), Ethiopia (3 [ 17 , 42 , 43 ]), Kenya (3 [ 44 – 46 ]), Sierra Leone (2 [ 47 , 48 ]), Zimbabwe (2 [ 49 , 50 ]), Angola (1 [ 17 ]), Botswana (1 [ 51 ]), Cameroon (1 [ 52 ]), Madagascar (1 [ 53 ]), Malawi (1 [ 54 ]), Tanzania (1 [ 17 ]), Togo (1 [ 17 ]), and Zambia (1 [ 55 ]). Four studies examined IDSR strategy on a regional level [ 56 – 59 ] ( Table 1 ).…”