Optimizing the malaria data recording system through a study of case detection and treatment in Sri Lanka

Abstract

The potential of using malaria incidence data routinely collected from endemic regions for disease control and research has increased with the availability of advanced computer‐based technologies, but will depend on the quality of the data itself. We report here an investigation into the relevance of malaria statistics provided by the routine data collection system in Moneragala, a rural malaria‐endemic region in Sri Lanka. All patients (n = 321) treated for malaria in 2 clusters of health care centres (HCCs) of both the private and the public sector in the administrative regions of Moneragala and Buttala Divisional Secretariat (D.S.). Divisions were studied in December 1995/January 1996. The catchment area of these HCCs included a population resident in 53 Grama Niladhari (GN) areas, the smallest administrative units of the country. Almost equal numbers of malaria patients were detected and treated at Government and private health care institutions, and in 70% of them treatment was based on a diagnosis confirmed by microscopy. The routine data recording system, however, included only statistics from the Government sector, and only of patients whose diagnosis was microscopically confirmed. In compiling data, the origin of a case of malaria is attributed to the D.S. Division in which the institution (at which the patient was treated) was located, rather than the area in which the patient was resident, which was inaccurate because 90% of malaria patients sought health care at institutions located closest to their residence, thus crossing administrative boundaries. It also led to a loss of resolution of spatial data because patients' addresses recorded at the Government HCCs to the village‐level are replaced in the statistics by the D.S. Division, which is a coarse spatial unit. Modifications to the system for malaria case recording needed to correct these anomalies are defined here. If implemented, these could result in major improvements to the quality of data, a valuable resource for the future of malaria control. The paper reiterates the call for the use of a standard spatial unit within a country to facilitate exchange of data among health and other sectors for the control of tropical diseases.

Defining Clinical Malaria: The Specificity and Incidence of Endpoints from Active and Passive Surveillance of Children in Rural Kenya

“…However, passive surveillance may miss clinical episodes that are treated or resolve spontaneously without presentation to health care facilities[14], [15], [16]. Cohorts under active surveillance often record higher rates of malaria episodes than those under passive surveillance [17], [18] which may be interpreted either as the inclusion of false-positives by the former, or an under-estimation of the true malaria burden by the latter [19], [20], [21]. Estimates of the global burden of malaria disease has relied on cohorts under active case detection [22].…”

Estimating the Global Clinical Burden of Plasmodium falciparum Malaria in 2007

“…Nevertheless, in computing disease burdens it is important to impute some measure of completeness of formal malaria reporting within these marginal, unstable transmission areas. A number of malaria treatment-seeking behaviour studies and qualitative examinations of routine malaria reporting frequency suggest large inadequacies in a range of national reporting systems from a variety of causes that can act multiplicatively: Cambodia (actual number of cases 2.7× greater than reported) [35], India (9–50×) [28],[61]–[65], Mozambique (2.7×) [32], Pakistan (5.9×) [30], Peru (4.3×) [34], Solomon Islands (4.7×) [38], Sri Lanka (1.9×) [29], and Syria (4.5×) [31].…”

“…Third, with few exceptions across malaria-endemic countries, fevers or other malaria-like syndromes are often self-medicated and may resolve regardless of cause before reaching formal health systems [27]. Fourth, inaccurate diagnoses [21],[25],[28] might be used to report disease rates, and these errors may be compounded through inadequate and incomplete national reporting systems [29]–[38].…”

Sri Lanka Malaria Maps

“…Due to the armed conflict there was shortage of trained microscopists in these areas and only a small part of the clinical cases is microscopically confirmed [2]. In the rest of the country, the availability of field assistants for blood film collection and the availability of microscopists was high, and the authors estimate the proportion of microscopically confirmed cases to be about 70% [3]. Unfortunately, we have no precise data available to study the effect of the availability of field assistants and microscopists on the number of blood films examined.…”