Case-based Reporting and Analysis to Enhance the Value and Use of Routine Health Facility Data for Health Policy, Programming and Research: Case Study of a New Malaria Surveillance System in The Gambia

A sustained decline in the burden of malaria from 2003 to 2007 in The Gambiahighlighted the need for real-time data to monitor the changing epidemiology ofmalaria. The aim of the studies described in this thesis was to determine thevalue and use of routine case-based health facility data for malaria policy,programming and research.To achieve this aim, individual, rather than aggregate, malaria case records atthe six sentinel sites were analysed by age, sex, month, season and location.The impact of malaria on anaemia was analysed at individual and populationlevels. Malaria data from one of the sentinel sites and from village healthworkers in the catchment community were compared. The use of data wasinvestigated through 31 key informant interviews and document review.Quantitative and qualitative data were analysed in R. A CATWOE analysis wasdone to characterise health system strengthening barriers and facilitators.Case-based analyses revealed previously unreported age and sex distributionsof malarial illness. Young children had the lowest rates of malaria parasitaemiabut highest rates of severe anaemia if they had malaria. However, at populationlevel, the prevalence of malaria-attributable severe anaemia was less than 2%in all age groups. Health facility malaria data were representative of malarialillness in the community despite small-area heterogeneity. The availability anduse of surveillance data led to changes in malaria policy, programming anddesign of surveys.Case-based reporting is feasible and enhances the value and use of routinehealth facility data as it enabled a depth and breadth of analysis that is notpossible with aggregated data. Changes to WHO recommendations on malariareporting are required to facilitate the adoption of case-based reporting inmalaria control settings. Systems thinking is required to ensure that actions andcapabilities required to generate, report, analyse and use data are clarified andaccommodated.