Enhanced surveillance and data feedback loop associated with improved malaria data in Lusaka, Zambia
Enhanced surveillance and data feedback loop associated with improved malaria data in Lusaka, Zambia
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DOI：
10.1186/s12936-015-0735-y
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发表时间：
2015-05-29
期刊：
影响因子：
3
通讯作者：
Winters, Anna M.
中科院分区：
文献类型：
--
作者：
Chisha, Zunda;Larsen, David A.;Winters, Anna M.
背景：准确和及时的疟疾数据对于监测消灭疟疾的进展和实现消灭疟疾的目标至关重要。赞比亚首都卢萨卡在疟疾指标调查中报告疟疾流行率很低。然而，疟疾检测率低、未经证实的疟疾病例多以及抗疟药过度使用等问题在卢萨卡的诊所很常见。赞比亚政府（GRZ）及其合作伙伴寻求解决这些问题，通过加强监测和反馈方案在诊所level.Methods：加强疟疾监测方案开始于2011年，以核实报告的疟疾的趋势，以及实施数据反馈回路，以提高数据的吸收，使用和质量。在卢萨卡区的所有GRZ保健诊所内，每月进行数据收集和提供反馈。在诊所访问期间，访问诊所登记册以记录报告的疟疾病例数、疟疾检测阳性率、疟疾检测率以及经诊断检测确诊的疑似疟疾总数的比例。在加强监测方案后，对疑似疟疾病例进行诊断检测的可能性增加了（OR = 1.54，95%CI = 0.96-2.49），随时间推移呈上升趋势（OR= 1.05，95%CI = 1.01-1.09）。报告的疟疾病例被诊断确诊的几率也每月增加（1.09，95%CI 1.04-1.15）。在最初增加140%（95%CI = 91- 183%）后，成本每月下降11%（95%CI = 5. 7 - 10. 9%）。虽然平均检测率从18.9%增加到64.4%，在这段时间内，报告的疟疾诊断未证实的比例仍然很高，在76%.Conclusions：加强监测和实施的数据反馈回路大大增加了疟疾检测率和减少未经证实的疟疾病例和疗程的ACT消耗在卢萨卡区在短短两年内。建议继续支持在卢萨卡加强监测，并在全国扩大该系统的规模，以加强良好的病例管理，并确保及时提供可靠的数据，以指导赞比亚将有限的疟疾预防和控制资源用于目标。
Background: Accurate and timely malaria data are crucial to monitor the progress towards and attainment of elimination. Lusaka, the capital city of Zambia, has reported very low malaria prevalence in Malaria Indicator Surveys. Issues of low malaria testing rates, high numbers of unconfirmed malaria cases and over consumption of anti-malarials were common at clinics within Lusaka, however. The Government of Zambia (GRZ) and its partners sought to address these issues through an enhanced surveillance and feedback programme at clinic level.Methods: The enhanced malaria surveillance programme began in 2011 to verify trends in reported malaria, as well as to implement a data feedback loop to improve data uptake, use, and quality. A process of monthly data collection and provision of feedback was implemented within all GRZ health clinics in Lusaka District. During clinic visits, clinic registers were accessed to record the number of reported malaria cases, malaria test positivity rate, malaria testing rate, and proportion of total suspected malaria that was confirmed with a diagnostic test.Results and discussion: Following the enhanced surveillance programme, the odds of receiving a diagnostic test for a suspected malaria case increased (OR = 1.54, 95 % CI = 0.96-2.49) followed by an upwardmonthly trend (OR= 1.05, 95 % CI = 1.01-1.09). The odds of a reported malaria case being diagnostically confirmed also increased monthly (1.09, 95 % CI 1.04-1.15). After an initial 140 % increase (95 % CI = 91-183 %), costs fell by 11 % each month (95 % CI = 5.7-10.9 %). Although the mean testing rate increased from 18.9 to 64.4 % over the time period, the proportion of reported malaria unconfirmed by diagnostic remained high at 76 %.Conclusions: Enhanced surveillance and implementation of a data feedback loop have substantially increased malaria testing rates and decreased the number of unconfirmed malaria cases and courses of ACT consumed in Lusaka District within just two years. Continued support of enhanced surveillance in Lusaka as well as national scale-up of the system is recommended to reinforce good case management and to ensure timely, reliable data are available to guide targeting of limited malaria prevention and control resources in Zambia.