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

Eeshan Khandekar Duke Global Health Institute, Duke University, Durham, North Carolina;

Search for other papers by Eeshan Khandekar in
Current site
Google Scholar
PubMed
Close
,
Randall Kramer Duke Global Health Institute, Duke University, Durham, North Carolina;

Search for other papers by Randall Kramer in
Current site
Google Scholar
PubMed
Close
,
Abdullah S. Ali Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania;

Search for other papers by Abdullah S. Ali in
Current site
Google Scholar
PubMed
Close
,
Abdul-Wahid Al-Mafazy Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania;

Search for other papers by Abdul-Wahid Al-Mafazy in
Current site
Google Scholar
PubMed
Close
,
Joseph R. Egger Duke Global Health Institute, Duke University, Durham, North Carolina;

Search for other papers by Joseph R. Egger in
Current site
Google Scholar
PubMed
Close
,
Sara LeGrand Duke Global Health Institute, Duke University, Durham, North Carolina;

Search for other papers by Sara LeGrand in
Current site
Google Scholar
PubMed
Close
,
Humphrey R. Mkali The Palladium Group, Zanzibar, Tanzania;

Search for other papers by Humphrey R. Mkali in
Current site
Google Scholar
PubMed
Close
,
Michael McKay RTI International, Nairobi, Kenya;

Search for other papers by Michael McKay in
Current site
Google Scholar
PubMed
Close
, and
Jeremiah M. Ngondi RTI International, Dar es Salaam, Tanzania

Search for other papers by Jeremiah M. Ngondi in
Current site
Google Scholar
PubMed
Close
Restricted access

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 web-based or mobile phone–based tools. For surveillance–response systems to work optimally, malaria programs should ensure that optimal management practices are in place.

Author Notes

Address correspondence to Eeshan Khandekar, Duke Global Health Institute, Duke University, Durham, NC 27710. E-mail: eeshan.khandekar@gmail.com

Financial support: This study was made possible through support provided to the Tanzania Vector Control Scale-up Project (Cooperative Agreement 621-A-00-10-00015-00) by the President’s Malaria Initiative (PMI) via the U.S. Agency for International Development (USAID) and an interagency agreement with the U.S. Centers for Disease Control and Prevention (CDC).

Authors’ addresses: Eeshan Khandekar, Randall Kramer, and Joseph R. Egger, Duke Global Health Institute, Duke University, Durham, NC, E-mails: eeshan.khandekar@gmail.com, kramer@duke.edu, and jre18@duke.edu. Abdullah S. Ali and Abdul-Wahid Al-Mafazy, Zanzibar Malaria Elimination Programme, Zanzibar, Tanzania, E-mails: abdullahsuleimanali@yahoo.com and mtash2@gmail.com. Sara LeGrand, Center for Health Policy, Duke Global Health Institute, Durham, NC, E-mail: sara.legrand@duke.edu. Humphrey R. Mkali, The Palladium Group, Zanzibar, Tanzania, E-mail: hrmkali@gmail.com. Michael McKay, RTI International, Nairobi, Kenya, E-mail: mikeymckay@gmail.com. Jeremiah M. Ngondi, RTI International, International Development (Global Health), Dar es Salaam, Tanzania, E-mail: jngondi@rti.org.

  • 1.

    WHO, 2016. World Malaria Report. Geneva, Switzerland: World Health Organization.

  • 2.

    WHO, 2017. A Framework for Malaria Elimination. Geneva, Switzerland: World Health Organization.

  • 3.

    Newby G, Bennett A, Larson E, Cotter C, Shretta R, Phillips AA, Feachem RGA, 2016. The path to eradication: a progress report on the malaria-eliminating countries. Lancet 387: 17751784.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Feachem RGA et al. 2010. Shrinking the malaria map: progress and prospects. Lancet 376: 15661578.

  • 5.

    Landier J, Parker DM, Thu AM, Carrara VI, Lwin KM, Bonnington CA, Pukrittayakamee S, Delmas G, Nosten FH, 2016. The role of early detection and treatment in malaria elimination. Malar J 15: 363.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Sturrock HJW, Hsiang MS, Cohen JM, Smith DL, Greenhouse B, Bousema T, Gosling RD, 2013. Targeting asymptomatic malaria infections: active surveillance in control and elimination. PLoS Med 10: e1001467.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Galatas B, Bassat Q, Mayor A, 2016. Malaria parasites in the asymptomatic: looking for the hay in the haystack. Trends Parasitol 32: 296308.

  • 8.

    Moonen B et al. 2010. Operational strategies to achieve and maintain malaria elimination. Lancet 376: 15921603.

  • 9.

    Smith JL, Auala J, Tambo M, Haindongo E, Katokele S, Uusiku P, Gosling R, Kleinschmidt I, Mumbengegwi D, Sturrock HJW, 2017. Spatial clustering of patent and sub-patent malaria infections in northern Namibia: implications for surveillance and response strategies for elimination. PLoS One 12: e0180845.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10.

    Searle KM et al. 2016. Evaluation of the operational challenges in implementing reactive screen-and-treat and implications of reactive case detection strategies for malaria elimination in a region of low transmission in southern Zambia. Malar J 15: 412.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Herdiana H et al. 2016. Malaria risk factor assessment using active and passive surveillance data from Aceh Besar, Indonesia, a low endemic, malaria elimination setting with Plasmodium knowlesi, Plasmodium vivax, and Plasmodium falciparum. Malar J 15: 468.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Sturrock HJ, Novotny JM, Kunene S, Dlamini S, Zulu Z, Cohen JM, Hsiang MS, Greenhouse B, Gosling RD, 2013. Reactive case detection for malaria elimination: real-life experience from an ongoing program in Swaziland. PLoS One 8: e63830.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 13.

    Gerardin J, Bever CA, Bridenbecker D, Hamainza B, Silumbe K, Miller JM, Eisele TP, Eckhoff PA, Wenger EA, 2017. Effectiveness of reactive case detection for malaria elimination in three archetypical transmission settings: a modelling study. Malar J 16: 248.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Bergquist R, Yang G-J, Knopp S, Utzinger J, Tanner M, 2015. Surveillance and response: tools and approaches for the elimination stage of neglected tropical diseases. Acta Trop 141: 229234.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Ohrt C, Roberts KW, Sturrock HJ, Wegbreit J, Lee BY, Gosling RD, 2015. Information systems to support surveillance for malaria elimination. Am J Trop Med Hyg 93: 145152.

  • 16.

    Bjorkman A, Cook J, Sturrock H, Msellem M, Ali A, Xu W, Molteni F, Gosling R, Drakeley C, Martensson A, 2017. Spatial distribution of falciparum malaria infections in Zanzibar: implications for focal drug administration strategies targeting asymptomatic parasite carriers. Clin Infect Dis 64: 12361243.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Global Fund, 2006. Implementation of a New Malaria Treatment Policy in Zanzibar. Available at: http://portfolio.theglobalfund.org/en/Grant/Index/ZAN-102-G01-M-00. Accessed June 8, 2017.

    • PubMed
    • Export Citation
  • 18.

    PMI, 2006. 2006 Tanzania Malria Country Action Plan. Washington, DC: United States Presidents Malaria Initiatve.

  • 19.

    ZMCP, 2009. Malaria Elimination in Zanzibar: A Feasibility Assessment .Zanzibar City, Zanzibar: Ministry of Health and Social Welfare.

  • 20.

    PMI, 2007. 2007 Tanzania Malaria Operational Plan. Washingotn, DC: United States Presidents Malaria Initative.

  • 21.

    RTI, 2013. Coconut Surveillance. Available at: http://www.rti.org/impact/coconut-surveillance. Accessed June 10, 2017.

    • PubMed
    • Export Citation
  • 22.

    USAID, 2016. Tanzania Vector Scale-up Project (TVSCP): Final Report .Washington, DC: United States Agency for International Development.

  • 23.

    ZAMEP, 2012. 2013–2018 Strategic Plan. Zanzibar City, Zanzibar: Ministry of Health and Social Welfare.

  • 24.

    Cotter C, Sudathip P, Herdiana H, Cao Y, Liu Y, Luo A, Ranasinghe N, Bennett A, Cao J, Gosling RD, 2017. Piloting a programme tool to evaluate malaria case investigation and reactive case detection activities: results from 3 settings in the Asia Pacific. Malar J 16: 347.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    CDC, 2011. Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. MMWR Recomm Rep 50: 135.

  • 26.

    Lin W, Chen S, Seguy N, Chen Z, Sabin K, Calleja JG, Bulterys M, 2012. Is the HIV sentinel surveillance system adequate in China? Findings from an evaluation of the national HIV sentinel surveillance system. Western Pac Surveill Response J 3: 7685.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Vogt RL, Spittle R, Cronquist A, Patnaik JL, 2006. Evaluation of the timeliness and completeness of a web-based notifiable disease reporting system by a local health department. J Public Health Manag Pract 12: 540544.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Jones G, Le Hello S, Jourdan-da Silva N, Vaillant V, de Valk H, Weill F, Le Strat Y, 2014. The French human Salmonella surveillance system: evaluation of timeliness of laboratory reporting and dactors associated with delays, 2007 to 2011. Euro Surveill 19: pii: 20664.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Rachas A, Nakoune E, Bouscaillou J, Paireau J, Selekon B, Senekian D, Fontanet A, Kazanji M, 2014. Timeliness of yellow fever surveillance, central African Republic. Emerg Infect Dis 20: 10041008.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 30.

    Akbari H, Majdzadeh R, Foroushani AR, Raeisi A, 2013. Timeliness of malaria surveillance system in Iran. Iran J Public Health 42: 3947.

  • 31.

    Quan V, Hulth A, Kok G, Blumberg L, 2014. Timelier notification and action with mobile phones-towards malaria elimination in South Africa. Malar J 13: 151158.

  • 32.

    Sun JL, Zhou S, Geng QB, Zhang Q, Zhang ZK, Zheng CJ, Hu WB, Clements ACA, Lai SJ, Li ZJ, 2016. Comparative evaluation of the diagnosis, reporting and investigation of malaria cases in China, 2005–2014: transition from control to elimination for the national malaria programme. Infect Dis Poverty 5: 65.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33.

    Chisha Z et al. 2015. Enhanced surveillance and data feedback loop associated with improved malaria data in Lusaka, Zambia. Malar J 14: 222.

  • 34.

    PATH, 2014. Zanzibar Trip Report. Project DIAMETER (Diagnostisc for Malaria Elimination Towards Eradication). Seattle, WA: PATH.

  • 35.

    RTI, 2018. Tanzania Vector Control Scale-Up Project (TVCSP). Available at: https://www.rti.org/impact/tanzania-vector-control-scale-project-tvcsp. Accessed June 8, 2017.

    • PubMed
    • Export Citation
  • 36.

    PMI, 2015. Harnessing Innovation and Technology to Scale Up Malaria Case Notification in Zanzibar. Available at: https://www.pmi.gov/news/stories-from-the-field/stories-from-the-field-detail/harnessing-innovation-and-technology-to-scale-up-malaria-case-notification-in-zanzibar. Accessed June 12, 2017.

    • PubMed
    • Export Citation
  • 37.

    WHO, 2012. Disease Surveillance for Malaria Elimination. Geneva, Switzerland: World Health Organization.

  • 38.

    Littrell M, Sow GD, Ngom A, Ba M, Mboup BM, Dieye Y, Mutombo B, Earle D, Steketee RW, 2013. Case investigation and reactive case detection for malaria elimination in northern Senegal. Malar J 12: 331342.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39.

    Gosling J, Case P, Tulloch J, Chandramohan D, Wegbreit J, Newby G, Gueye CS, Koita K, Gosling R, 2015. Effective program management: a cornerstone of malaria elimination. Am J Trop Med Hyg 93: 135138.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40.

    Gueye CS, Newby G, Tulloch J, Slutsker L, Tanner M, Gosling RD, 2016. The central role of national programme management for the achievement of malaria elimination: a cross case-study analysis of nine malaria programmes. Malar J 15: 488.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 41.

    Le Menach A, Tatem AJ, Cohen JM, Hay SI, Randell H, Patil AP, Smith DL, 2011. Travel risk, malaria importation and malaria transmission in Zanzibar. Sci Rep 1: 93.

  • 42.

    Sturrock HJW, Roberts KW, Wegbreit J, Ohrt C, Gosling RD, 2015. Tackling imported malaria: an elimination endgame. Am J Trop Med Hyg 93: 139144.

  • 43.

    Abeid KI, 2015. Assessment of customer satisfaction in public transport services in Zanzibar. Int J Adv Soc Sci Humanit 3: 4151.

  • 44.

    Kincaide Godbout S, 2016. Assessing Surveillance Elements of the Zanzibar Malaria Elimination Program to Support Malaria Elimination in Zanzibar. Durham, NC: Duke Global Health Institute, Duke University.

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45.

    Cohen JM, Smith DL, Cotter C, Ward A, Yamey G, Sabot OJ, Moonen B, 2012. Malaria resurgence: a systematic review and assessment of its causes. Malar J 11: 122.

  • 46.

    Canavati SE, Lawpoolsri S, Quintero CE, Nguon C, Ly P, Pukrittayakamee S, Sintasath D, Singhasivanon P, Peeters Grietens K, Whittaker MA, 2016. Village malaria worker performance key to the elimination of artemisinin-resistant malaria: a western Cambodia health system assessment. Malar J 15: 282.

    • PubMed
    • Search Google Scholar
    • Export Citation
Past two years Past Year Past 30 Days
Abstract Views 550 453 55
Full Text Views 859 10 1
PDF Downloads 308 12 1
 
 
 
 
Affiliate Membership Banner
 
 
Research for Health Information Banner
 
 
CLOCKSS
 
 
 
Society Publishers Coalition Banner
Save