An assessment of national surveillance systems for malaria elimination in the Asia Pacific

Abstract

Background: Heads of Government from Asia and the Pacific have committed to a malaria-free region by 2030. In 2015, the total number of confirmed cases reported to the World Health Organization by 22 Asia Pacific countries was 2,461,025. However, this was likely a gross underestimate due in part to incidence data not being available from the wide variety of known sources. There is a recognized need for an accurate picture of malaria over time and space to support the goal of elimination. A survey was conducted to gain a deeper understanding of the collection of malaria incidence data for surveillance by National Malaria Control Programmes in 22 countries identified by the Asia Pacific Leaders Malaria Alliance.

Methods: In 2015-2016, a short questionnaire on malaria surveillance was distributed to 22 country National Malaria Control Programmes (NMCP) in the Asia Pacific. It collected country-specific information about the extent of inclusion of the range of possible sources of malaria incidence data and the role of the private sector in malaria treatment. The findings were used to produce recommendations for the regional heads of government on improving malaria surveillance to inform regional efforts towards malaria elimination.

Results: A survey response was received from all 22 target countries. Most of the malaria incidence data collected by NMCPs originated from government health facilities, while many did not collect comprehensive data from mobile and migrant populations, the private sector or the military. All data from village health workers were included by 10/20 countries and some by 5/20. Other sources of data included by some countries were plantations, police and other security forces, sentinel surveillance sites, research or academic institutions, private laboratories and other government ministries. Malaria was treated in private health facilities in 19/21 countries, while anti-malarials were available in private pharmacies in 16/21 and private shops in 6/21. Most countries use primarily paper-based reporting.

Conclusions: Most collected malaria incidence data in the Asia Pacific is from government health facilities while data from a wide variety of other known sources are often not included in national surveillance databases. In particular, there needs to be a concerted regional effort to support inclusion of data on mobile and migrant populations and the private sector. There should also be an emphasis on electronic reporting and data harmonization across organizations. This will provide a more accurate and up to date picture of the true burden and distribution of malaria and will be of great assistance in helping realize the goal of malaria elimination in the Asia Pacific by 2030.

Keywords: Asia Pacific; Epidemiology; Malaria elimination; National Malaria Control Programme; Surveillance.

Fig. 1

Confirmed malaria cases in 22 Asia Pacific countries in 2015 [8]

Fig. 2

Questionnaire responses on sources of malaria incidence data collected by each NMCP. Additional sources of data were identified in nine countries and were labeled as follows: a tea estates; b police; c sentinel surveillance sites; d railways, Central Government Health Scheme, Employees’ State Insurance and Public Sector Undertakings; e police provincial hospitals, provincial anti-malaria stations; f Institute of Medical Research sites; g private laboratories, university parasitology departments; h Border guards, Ministries of Agriculture and Rural Development, Transportation, Industry and Trade. ‘All data’/‘Some data’/‘No data’ = the extent to which data from that source are collected by the NMCP. ‘Does not exist’ indicates that the source does not exist in that country

Fig. 3

Questionnaire responses about private sector treatment of malaria in each country. The questions asked are shown at the top. ‘Not sure’ the respondent did not know the answer, ‘Does not exist’ that entity does not exist in that country, ‘No response’ no response was provided to that question