Protocol to implement a syndromic surveillance survey of COVID-19 in Malawi

Maphosa, Thulani; Woelk, Godfrey; Baack, Brittney N.; Kim, Andrea A.; Machekano, Rhoderick; Mwale, Annie Chauma; Kalua, Thokozani; Zimba, Suzgo; Kanyenda, Rachel; Maida, Alice; Auld, Andrew F.; Azman, Andrew S.; Oziemkowska, Maria; Sunguti, Joram; Golowa, Cathy; Kapanda, Lester; Nkhoma, Harrid; Velusamy, Sampathkumar; Ahimbisibwe, Allan; Kalitera, Louiser; Masina, Elton; Lumala, Rumours; Kudiabor, Kwashie; Joaki, Zuze; Muchuchuti, Cephas; Mengezi, Tadala H.; Nyirenda, Rose; Guay, Laura

doi:10.1016/j.puhip.2022.100339

Cited by 2 publications

(5 citation statements)

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“…These phone numbers are typically generated electronically using computer algorithms to ensure randomness. 10 11 Phone numbers were dialled up to three times on the same day at different times and were considered non-responsive if there was no answer. In cases where the participant answered but was busy during the call, the interviewers arranged an alternate time, as suggested by the participant.…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…The estimated sample size allowed for the estimation of weekly proportions/rates of the outcomes of interest, ensuring a precision of 2.3% in estimating the prevalence of suspected cases of SARS-CoV-2. 10 The survey included various questions, including age, sex, region of residence, the presence of CLS/ILS within the preceding 2 weeks, SARS-CoV-2 testing history, and details of household illness and death (online supplemental file 1). Respondents were asked whether any deaths occurred in their households between 1 January 2020, and the date of the survey respondent interview.…”

Section: Methodology Study Design and Samplingmentioning

confidence: 99%

“…A mobile phone-based syndromic surveillance system for acute public health events has shown that the timeliness and efficiency of public health surveillance could be improved using this approach. 10 11 …”

Section: Introductionmentioning

confidence: 99%

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Enhancing SARS-CoV-2 surveillance in Malawi using telephone syndromic surveillance from July 2020 to April 2022

Woelk,

Maphosa,

Machekano

et al. 2024

BMJ Glob Health

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IntroductionMonitoring the SARS-CoV-2 pandemic in low-resource countries such as Malawi requires cost-effective surveillance strategies. This study explored the potential utility of phone-based syndromic surveillance in terms of its reach, monitoring trends in reported SARS-CoV-2-like/influenza-like symptoms (CLS/ILS), SARS-CoV-2 testing and mortality.MethodsMobile phone-based interviews were conducted between 1 July 2020 and 30 April 2022, using a structured questionnaire. Randomly digital dialled numbers were used to reach individuals aged ≥18 years who spoke Chichewa or English. Verbal consent was obtained, and trained research assistants with clinical and nursing backgrounds collected information on age, sex, region of residence, reported CLS/ILS in the preceding 2 weeks, SARS-CoV-2 testing and history of household illness and death. Data were captured on tablets using the Open Data Kit database. We performed a descriptive analysis and presented the frequencies and proportions with graphical representations over time.FindingsAmong 356 525 active phone numbers, 138 751 (38.9%) answered calls, of which 104 360 (75.2%) were eligible, 101 617 (97.4%) consented to participate, and 100 160 (98.6%) completed the interview. Most survey respondents were aged 25–54 years (72.7%) and male (65.1%). The regional distribution of the respondents mirrored the regional population distribution, with 45% (44%) in the southern region, 41% (43%) in the central region and 14% (13%) in the northern region. The reported SARS-CoV2 positivity rate was 11.5% (107/934). Of the 7298 patients who reported CLS/ILS, 934 (12.8%) reported having undergone COVID-19 testing. Of the reported household deaths, 47.2% (982 individuals) experienced CLS/ILS 2 weeks before their death.ConclusionTelephonic surveillance indicated that the number of SARS-CoV-2 cases was at least twice as high as the number of confirmed cases in Malawi. Our findings also suggest a substantial under-reporting of SARS-CoV-2-related deaths. Telephonic surveillance has proven feasible in Malawi, achieving the ability to characterise SARS-CoV-2 morbidity and mortality trends in low-resource settings.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodology Study Design and Samplingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Enhancing SARS-CoV-2 surveillance in Malawi using telephone syndromic surveillance from July 2020 to April 2022

Woelk,

Maphosa,

Machekano

et al. 2024

BMJ Glob Health

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“…We conducted a mobile phone-based cross-sectional COVID-19 syndromic surveillance survey in Malawi [ 23 ]. We included data on COVID-19 vaccination among adults living in Malawi with access to an active mobile phone number from July 2021 to April 2022.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with COVID-19 vaccine receipt among mobile phone users in Malawi: Findings from a national mobile-based syndromic surveillance survey, July 2021-April 2022

Makonokaya,

Kapanda,

Maphosa

et al. 2024

PLOS Glob Public Health

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Malawi recommended COVID-19 vaccines for adults aged ≥18 years in March 2021. We assessed factors associated with receiving COVID-19 vaccines in Malawi as part of a telephone-based syndromic surveillance survey. We conducted telephone-based syndromic surveillance surveys with questions on COVID-19 vaccine receipt among adults (≥18 years old) upon verbal consent from July 2021 to April 2022. We used random digit dialing to select mobile phone numbers and employed electronic data collection forms on secure tablets. Survey questions included whether the respondent had received at least one dose of a COVID-19 vaccine. We used multivariable analysis to identify factors associated with COVID-19 vaccine receipt. Of the 51,577 participants enrolled; 65.7% were male. Males were less likely to receive the COVID-19 vaccine than females (AOR 0.83, 95% CI 0.80–0.86). Compared to those aged 18–24 years, older age had increased odds of vaccine receipt: 25–34 years (AOR 1.32, 95% CI 1.24–1.40), 35–44 years (AOR 2.00, 95% CI 1.88–2.13), 45–54 years (AOR 3.02, 95% CI 2.82–3.24), 55–64 years (AOR 3.24, 95% CI 2.93–3.57) and 65 years+ (AOR 3.98, 95% CI 3.52–4.49). Respondents without formal education were less likely to receive vaccination compared to those with primary (AOR 1.30, 95% CI 1.14–1.48), secondary (AOR 1.76, 95% CI 1.55–2.01), and tertiary (AOR 3.37, 95% CI 2.95–3.86) education. Respondents who thought COVID-19 vaccines were unsafe were less likely to receive vaccination than those who thought it was very safe (AOR 0.26, 95% CI 0.25–0.28). Residents of the Central and Southern regions had reduced odds of vaccine receipt compared to those in the North (AORs 0.79, (95% CI 0.74–0.84) and 0.55, (95% CI 0.52–0.58) respectively). Radio (72.6%), health facilities (52.1%), and social media (16.0%) were the more common self-reported sources of COVID-19 vaccine information. COVID-19 vaccine receipt is associated with gender, age, education, and residence. It is important to consider these factors when implementing COVID-19 vaccination programs.

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Protocol to implement a syndromic surveillance survey of COVID-19 in Malawi

Cited by 2 publications

References 5 publications

Enhancing SARS-CoV-2 surveillance in Malawi using telephone syndromic surveillance from July 2020 to April 2022

Enhancing SARS-CoV-2 surveillance in Malawi using telephone syndromic surveillance from July 2020 to April 2022

Factors associated with COVID-19 vaccine receipt among mobile phone users in Malawi: Findings from a national mobile-based syndromic surveillance survey, July 2021-April 2022

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