ABSTRACT
Mozambique addressed critical malaria surveillance system challenges by rolling out an integrated malaria information storage system (iMISS) at the district level in February 2021. The iMISS integrates malaria data from existing systems across thematic program areas to improve data availability and use. In seven districts, the platform was extended to health facilities (HFs), allowing HFs to access iMISS and use tablets to submit monthly malaria reports to a central database, eliminating the need for paper-based reporting to districts. A structured evaluation of the iMISS rollout to HFs was carried out in February-July 2021. The four evaluation areas were data quality (reporting rate, timeliness, and fidelity) of monthly malaria reports electronically submitted to the iMISS, adoption of the iMISS for data-informed decision-making, system maintenance, and acceptability of the iMISS among target users. All 94 HFs in the seven targeted districts were assessed. Over the 6-month period, 86.1% of reported cases on the iMISS were consistent with cases recorded in paper-based reports, allowing for up to 10% discrepancy. In addition, 69.0% of expected monthly district meetings were held, and information from iMISS was discussed during 58.6% of these meetings. Maintenance issues, mostly related to tablet access and internet connectivity, were experienced by 74.5% of HFs; 33.7% of issues were resolved within 1 month. The iMISS and electronic submission of malaria reports were well accepted by HF- and district-level users. Continued political commitment and timely execution of issue management workflows are crucial to ensure trust in the new platform and facilitate higher levels of data use.
Subject(s)
Humans , Male , Female , Information Storage and Retrieval/statistics & numerical data , Malaria/epidemiology , Information Storage and Retrieval/trends , Health Information Systems/instrumentation , MozambiqueABSTRACT
Background Malaria is a significant cause of morbidity and mortality in children aged under 5 years in Mozambique. The World Health Organization recommends seasonal malaria chemoprevention (SMC), the administration of four monthly courses of sulfadoxine-pyrimethamine (SP) and amodiaquine (AQ), to children aged 3-59 months during rainy season. However, as resistance to SP is widespread in East and Southern Africa, SMC has so far only been implemented across the Sahel in West Africa. Objective This protocol describes the first phase of a pilot project that aims to assess the protective effect of SP and AQ when used for SMC and investigate the levels of molecular markers of resistance of Plasmodium falciparum to antimalarial medicines in the study districts. In addition, it is important to understand whether SMC is a feasible and acceptable intervention in the context of Nampula Province, Mozambique. Methods This study will adopt a hybrid effectiveness-implementation design to conduct a mixed methods evaluation with six objectives: a molecular marker study, a nonrandomized controlled trial, an analysis of reported malaria morbidity indicators, a documentation exercise of the contextual SMC adaptation, an acceptability and feasibility assessment, and a coverage and quality assessment. Results Ethical approval for this study was granted by the Mozambican Ministry of Health National Bioethics Committee on September 15, 2020. Data collection began in October 2020, and data analysis is expected to be completed by August 2021. Conclusions This research will make a unique contribution to our understanding of whether the combination of SP and AQ, when used for SMC, can confer a protective effect against malaria in children aged 3-59 months in a region where malaria transmission is seasonal and SP resistance is expected to be high. If the project is successful, subsequent phases are expected to provide a more comprehensive assessment of the effectiveness and sustainability of SMCs.
