Abstract:
BACKGROUND : As surveillance is a key strategy for malaria elimination in South Africa, ensuring strong surveillance
systems is a National Department of Health priority. Historically, real time tracking of case trends and reporting within
24 h—a requirement in South Africa’s National surveillance guidelines—has not been possible. To enhance surveillance
and response efficiency, a mobile surveillance tool, MalariaConnect, was developed using Unstructured Supplementary
Service Data (USSD) technology. It was rolled out in health facilities in malaria endemic areas of South Africa
to provide 24-h reporting of malaria cases.
METHODS : To evaluate the efficiency of the mobile tool to detect an outbreak data were extracted from the paper
based and MalariaConnect reporting systems in Bushbuckridge from 1 January to 18 June 2017. These data were
subject to time series analyses to determine if MalariaConnect provided sufficient data reliably to detect increasing
case trends reported through the paper system. The Chi squared test was used to determine goodness of fit between
the following indicator data generated using MalariaConnect and paper reporting systems: timeliness, completeness,
and precision.
RESULTS : MalariaConnect adequately tracked case trends reported through the paper system. Timeliness of reporting
increased significantly using MalariaConnect with 0.63 days to notification compared to 5.65 days using the papersystem
(p < 0.05). The completeness of reporting was significantly higher for the paper system (100% completion;
p < 0.05), compared to confirmed MalariaConnect cases (61%). There was a moderate association between data precision
and the reporting system (p < 0.05). MalariaConnect provided an effective way of reliably and accurately identifying
the onset of the malaria outbreak in Bushbuckridge.
CONCLUSION : Timeliness significantly improved using MalariaConnect and in a malaria elimination setting, can be
used to markedly improve case investigation and response activities within the recommended 72-h period. Although
data completeness and precision were lower compared to paper reporting, MalariaConnect data can be used to trigger
outbreak responses.
