World Malaria Report 2013: Surveillance and Monitoring, Getting to the Heart of the Matter

Although “Malaria surveillance, monitoring and evaluation” is the seventh of eight chapters in the 2013 World Malaria Report (WMR), it is in fact the heart of the matter.  Progress on goals, finance, vector control, preventive therapies, diagnosis and treatment and of course impact (chapters 2-6 and 8) could not be produced without the documentation processes discussed in Chapter Seven. So what does WMR 2013 tell us about the status of malaria surveillance?

DSCN1496The global press has been taken by World Health Organization estimates that deaths from malaria world-wide have reduced by fifty percent since 2000.[i] These claims have been made despite the note in WMR 2013 that, “In 2012, in 62 countries of 103 that had ongoing malaria transmission in 2000, reporting was considered to be sufficiently consistent to make a reliable judgment about malaria trends for 2000–2012. In the 41 remaining countries, which account for 80% of estimated cases, it is not possible to reliably assess malaria trends using the data submitted to WHO. Information systems are weakest, and the challenges for strengthening systems are greatest, where the malaria burden is greatest.”[ii]

WHO explains that, “Improved surveillance for malaria cases and deaths will help ministries to determine which areas or population groups are most affected and help to target resources to communities most in need.”  WHO suggests that the design of malaria surveillance systems focuses on two fundamental factors. First, the level of malaria transmission should be ascertained, and the resources available to conduct surveillance must be made available. WHO has released two manuals to strengthen malaria surveillance depending on whether the country is high burden and still at the level of “Malaria Control,”[iii] or the country is approaching “Malaria Elimination.”[iv]

3T BrocheureThe World Health Organization has issued a series of documents focusing on “Test. Treat. Track.” or ‘3T’.  In short these documents support malaria-endemic countries in their efforts to achieve universal coverage with 1) diagnostic testing, 2) antimalarial treatment, and 3) strengthening their malaria surveillance systems to track the disease.[v]

WHO notes that in elimination settings, surveillance systems should seek to identify and immediately provide notification of all malaria infections, whether they are symptomatic or not. A summary of WHO’s recommendations for the “Track” or surveillance aspect of 3T follow:

  1. Individual cases should be registered at health facility level. This allows for the recording of suspected cases, diagnostic test results, and treatments administered
  2. In the malaria control phase, countries should report suspected, presumed and confirmed cases separately, and summarize aggregate data on cases and deaths on a monthly basis
  3. Countries in elimination phase should undertake a full investigation of each malaria case.

Some country examples of surveillance efforts in the move toward malaria elimination will be featured in the upcoming January 2014 issue of Africa Health. Watch for it at:

[i] Pizzi M. WHO: Malaria deaths of young children cut by half, but gains ‘fragile’. Aljazeera America. December 11, 2013.

[ii] WHO GLOBAL MALARIA PROGRAMME. World Malaria Report: 2013. World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland, 2013.

[iii] World Health Organization. Disease surveillance for malaria control. World Health Organization, Geneva, 2012.

[iv] World Health Organization. Disease surveillance for malaria elimination: an operational manual. World Health Organization, Geneva, 2012.

[v] World Health Organization. Test. Treat. Track. Scaling up diagnostic testing, treatment and surveillance for malaria. World Health Organization, Geneva, 2012.

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