Analysing the quality of routine malaria data in Mozambique

Abstract

Background: In Mozambique, malaria is the principal cause of morbidity and mortality. Efforts are being made to increase control activities within communities. These activities require management decisions based on evidence of malaria incidence. Although some data generated are of poor quality, there is little research towards improving the reporting systems.

Methods: An analysis of the quality of routine malaria data was performed in selected districts in Southern Mozambique from August to September 2003. The aim was to assess the quality of the source data in terms of completeness, correctness and consistency across management levels.

Results: Analysis revealed primary data to be of poor quality. The diversity of reporting systems with limited coordination give rise to redundancies and wastage of resources. There was evidence of "invention" of data in health facilities contributing to an incorrect representation of malaria incidence. Large, "non-clinical", time-based variations of malaria cases due to reporting delays were also noted, contributing to false alerts of outbreaks.Furthermore, targets established in the national strategic plan for malaria cannot be calculated through the existing systems; this is the case, for example, for data related to pregnant women and children under-five years.

Discussion and recommendations: The existing reporting system for malaria is currently not satisfying the information needs of managers. It is suggested that one standardized system, including the creation of one form to include the essential variables required for the calculation of key indicators by age, gender and pregnancy status, and to establish a national database that maps malaria by location.

Figure 1

Map of southern Mozambique – research sites shown in arrows

Figure 2

Several malaria case reporting channels in Mozambique Malaria data are gathered from register books and flow through four reporting channels, namely (a) a specific Malaria Programme reporting system; (b) the weekly epidemiological bulletin; (c) the monthly summary for inpatients from district hospitals and (d) the clinical laboratory reporting system.

Figure 3

Chart showing unusual week to week variations of malaria cases reported by Maxixe District, 1^st semester 2003 The arrows show the unusual time based variations of data reported on a weekly basis.

Figure 4

Discrepancy between positive malaria tests in the laboratory register book and confirmed malaria cases reported by Malaria Programme, 1st semester 2003, "W" health centre

Figure 5

Discrepancy of adult in-patient malaria data reported at a district level (paper format) with digitalized data at the provincial level in the Planning Department (digital format) – Province "Z", 1st Semester 2003

Figure 6

Proposed diagram for malaria data reporting from health facilities to the national level and vice-versa