A Community-based Surveillance System to assess the effects of malaria interventions

The ACCESS Programme aims at understanding and improving access to prompt and effective malaria treatment and care in a rural Tanzanian setting with a set of integrated interventions. The objective of this study is to evaluate the programme’s impact on reported incidence of fever and malaria disease at both the community and health facility levels, and to investigate the value of community-based reporting for routine malaria control programme monitoring.

Methods

Community data:
•Demographic Surveillance Site
•25 villages
•Population apx 80 000
•Person exposure data
•Fever incidence (2 week recall)
Community fever rate= community reported fever cases / person weeks exposed (per month)
Treatment seeking surveys:
•Cross sectional
•2004, 2006, 2008
•100 fever cases
•Quantitative data on treatment seeking
% Fever cases brought to a HF
Health facility data
•15 health facilities
•Diagnoses per month from HMIS books
•Under 5 and over 5
HF fever rate= (malaria + pneumonia + ARI +measles + typhoid + UTI diagnoses) / person weeks exposed per month
Statistical analysis
Poisson regression with month of the year entered as categorical factor to account for seasonality

Discussion & Conclusion

The trends of fever cases indicated a reduction in malaria risk. This conclusion is strengthened by the great internal and external consistency of the data collected from four independent sources: (1) Temporal and quantitative relationship between data from community and health facility (especially in children <5); (2) Consistency between trends and treatment seeking survey; (3) National data collected by the Tanzania Malaria Indicator Survey (also found a 10% reduction in fever risk between 2005 and 2007). DSS fever reporting may therefore be used for morbidity monitoring.