Date: 2024-09-27 Page is: DBtxt003.php txt00011470
Health ... Malaria
Dialog via GHDonline
The importance of surveillance in Malaria elimination
Burgess COMMENTARY
Peter Burgess
Gmail Peter Burgess
Dear Colleagues,
The international community is focused on malaria control and a possible elimination in the coming next several decades. Many countries are succeeding in this effort. The death toll has been reduced by 48% from 2000 to 2015 (see WHO malaria report 2015 attached). In order to maintain these important gains we need to maintain a steady effort to help malaria endemic countries to stay focused on this path of success. In my discussions I will emphasize more on malaria elimination, and what we can do to achieve this noble goal. Today's discussion is on the importance of epidemiological and entomological surveillance. You are invited to contribute novel ideas and resources.
Below is an introduction of a background paper about the surveillance systems to facilitate Malaria elimination that was written by the Bill and Melinda Gates Foundation.
Introduction
Robust and responsive surveillance systems are critical for the success of malaria control and elimination.1–5 In elimination settings,surveillance must be an intervention in which immediate action is taken in response to case identification.Data collection, analysis, output and response must occur quickly to identify symptomatic and asymptomatic cases, prevent onward transmission and reduce vectorial capacity. Information needs to flow from the community, be analyzed, and return to the local level framed as specific actions to identify and prevent additional cases. Access to data and ease of reporting at all levels are essential to ensure that local implementers can target interventions quickly and effectively.
When a malaria control program transitions to elimination, the surveillance system must change (Figure 1).
These changes include rapid notification of individual cases, geo-referencing cases, and prompt response and foci investigation. Early in the development of a malaria strategy, planning should incorporate transitions that occur in the shift from control to elimination, even if elimination is a distant goal. This can help ensure that the surveillance system is flexible enough to adapt to the changes in scale and reporting time necessary when approaching elimination. Specifically, in an elimination setting, case reporting needs to shift from being periodic and aggregated at the district or provincial level to real-time reporting of individual geo-located cases. The advent of technologies that support surveillance for malaria elimination, including internet and communication technologies (ICTs), can facilitate many essential elements such as real-time reporting and case and intervention mapping. However, these technologies should only be applied where they are locally appropriate and when they can be used effectively.
Attached resources:
Surveillance Systems to Facilitate Malaria Elimination
EPIDEMIOLOGICAL SURVEILLANCE OF MALARIA IN COUNTRIES OF CENTRAL AND EASTERN EUROPE AND SELECTED NEWLY INDEPENDENT STATES
World Malaria Report 2015
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Gordon Cressman via GHDonline
Dear Colleagues:
My colleagues and I contributed information about the malaria surveillance and response system in Zanzibar to the following key reference.
Ohrt, C., et al. (2015). 'Information Systems to Support Surveillance for Malaria Elimination.' Am J Trop Med Hyg.
Since publication, we have continued working with the US President’s Malaria Initiative (PMI) and Zanzibar Malaria Elimination Program (ZAMEP) to continue to enhance this mobile system, which is called Coconut Surveillance. The name “Coconut Surveillance” was inspired by the tremendous versatility of coconuts. The need for such a system emerged as Zanzibar transitioned from control to elimination. ZAMEP is confronting the challenges of maintaining the gains won by large scale IRS and bed net distribution campaigns, eliminating local transmission, responding rapidly to imported cases, and accurately targeting limited intervention resources. Many other malaria elimination contexts confront these same problems.
Coconut Surveillance, has been used by ZAMEP for more than 3 years. It has helped malaria surveillance officers in Zanzibar respond to more than 9,500 reported cases of malaria, complete nearly 10,500 household visits, test more than 40,000 household members, and identify and treat more than 2,100 previously unknown cases. Twenty district malaria surveillance officers equipped with inexpensive Android tablets and motorbikes are keeping malaria prevalence in Zanzibar below 1%—a steady and sustained decrease from more than 35% just 15 years ago.
Coconut Surveillance is free and open source software designed by malaria experts for malaria elimination. There are no licensing fees, and it is available at no cost. It includes an interactive SMS system for case notification, a mobile software application designed for field response workers, and an analytics software application designed for surveillance and response program managers. It makes it easy for any health care worker to use any mobile phone to submit new case notifications. It helps field response workers follow up with each new case and quickly contain outbreaks. It helps program supervisors monitor the case notification and follow-up process. It gives program managers real-time data analytics needed to target interventions precisely. Coconut Surveillance was developed by RTI International with the support of the U.S. President’s Malaria Initiative and in close collaboration with ZAMEP.
Coconut Surveillance supports passive case detection (cases reported by clinics), active case detection at the household level, reactive case detection (mass/focal screening and treatment), epidemic detection, mobile decision support, and high-resolution targeting of preventive interventions
We are currently investing resources in significant enhancements to this tool, with the objectives of improving it for Zanzibar, and making it easier to integrate into other malaria elimination contexts. The following links provide more information.
https://stories.usaid.gov/zanzibars-malaria-hunter/
http://www.rti.org/impact/coconut-surveillance
https://www.rti.org/sites/default/files/brochures/rti_coconut_surveill_malaria.pdf
I’m happy to answer questions about our experience and current work researching and improving surveillance and response for malaria elimination.
Best Regards,
-gmc
Was this email too brief? Here is why
Peter Burgess
Dear Colleagues
GOOD ... BUT ...
I have been involved in international development and humanitarian assistance since the 1980s. Before that I was a corporate manager (VP Manufacturing / Chief Financial Officer) for almost 20 years. There is a huge difference in the way resources are managed in the corporate for profit environment and in international and national projects of various types. Even though the technology was primitive compared to what exists today, in every company where I worked we had comprehensive monthly analytical accounting to show how well we were doing in terms of cost control and revenue generation. In other words we knew where we were, where we had been and therefore a pretty good idea of where we were going.
This same level of useful information does not exist in most development assistance projects and in most funding organizations. Essentially they use something like advanced journalism in order to report and provide accountability. I think this is appalling, but worse is that it is perfectly understandable. Hardly anyone in the official development assistance community either in the funding function (World Bank, USAID, etc) or the implementing function (international NGOs, beneficiary government departments, etc.) have had any training or experience in general accounting, and far less in the ways to do cost accounting and analytical accounting.
I have spent some time over the years asking how much it was costing to run different mosquito and malaria control interventions ... and the bottom line is that nobody knows (or if they do know they are hiding the knowledge very effectively). I have been given a thousand and one reasons why this information is not available ... but in my old world of corporate management ... these reasons sound like incompetence or ignorance packaged beautifully,
Mosquito and malaria control science is quite well developed ... and we should know how much different interventions have cost in various different situations. We should also know what results were achieved as a result of a specific set of interventions. This information has value when it is dis-aggregated spatially and available also as a time series. In time all sorts of conclusions can be drawn from this dis-aggregated data ... but it is all lost when the only data available has been consolidated at the country level.
As far as I am concerned we have wasted a huge amount of time and money ... 10 years of time ... multi-billions of dollars of expenditure done most likely in a very sub-optimal manner.
Why is this state of affairs happening in the 21st century?
Time we did something better ... or if I am wrong, please give me some facts to prove it. Happy to help, but only in a meaningful way!
Peter Burgess
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http://www.ncbi.nlm.nih.gov/pubmed/26013378
http://www.ajtmh.org/content/93/1/145.full.pdf
Gordon M. Cressman
Senior Program Director | Research Computing Division | RTI International
Email: gmc@rti.org
truevaluemetrics.org