Improving Disease Surveillance in Developing Countries

Improving Disease Surveillance in Developing Countries
Improving Disease Surveillance in Developing Countries

Improving Disease Surveillance in Developing Countries

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Improving Disease Surveillance in Developing Countries

The dearth of disease surveillance in developing nations is an immediate opportunity for public health professionals to improve the health of underserved populations. As presented in Chapter 9 of your course text, implementing disease surveillance in developing nations requires that public health professionals acclimate to the variety of unique obstacles in each country. From insufficient lab diagnostics to a lack of personnel with necessary professional skills, there are many potential challenges to establishing surveillance systems in developing nations.

To prepare for this Application Assignment, review your Learning Resources. Go to the World Health Organization (WHO) website and identify conditions or diseases that occur in developing countries where the establishment of disease surveillance systems would help to prevent or mitigate the spread of disease (e.g., hospital-acquired infections, food- and water-borne diseases, tuberculosis, cervical cancer, etc.). Select a country and a corresponding disease or condition that you believe would be greatly impacted by the implementation of a disease surveillance system. Research the literature pertaining to the surveillance system in your chosen country and condition.

To complete this Application Assignment, write a 3- to 4-page paper that provides an overview of your selected country and condition or disease.

Be sure to address the following:

  • Describe the condition/disease and the developing country.
  • Describe the current monitoring procedures used in the developing country.
  • Provide a rationale as to why the country would greatly benefit from a disease surveillance system.
  • Describe two additional special features that should be a part of surveillance systems in your chosen country.
  • Describe challenges public health officials face in establishing disease surveillance systems in this country.
  • Describe how you would address these challenges.


Malaria and Condition in Kenya

Malaria is a major health concern in the Sub-Saharan region of Africa. Prevalence of this disease in the region calls for effort to ensure proper surveillance and management of the disease in the region. Kenya is one of the countries within the Sub-Sahara region where malaria is preponderant and needs improved surveillance.  According to World Health Organization (WHO), about 90% of all global malaria deaths occur in the Sub-Sahara Africa where Kenya is part of. Further, about 627,000 deaths recorded each year around the globe are due to malaria. This implies that about 564,000 deaths resulting from malaria are recorded within the Sub-Sahara Africa each year. This makes malaria a leading killer in the region and disease surveillance of the disease in the region is warranted and urgent (Yukich et al., 2012).

In terms of costs one of the challenges of malaria is the cost of management. On the other hand, the number of deaths as a result of malaria fever has reduced but there is still a lot to be done since in 2013 alone there were 30,000 deaths attributed to malaria fever. According to KEMRI (Kenya Medical Research Institute) malaria fever is the leading cause of death in Kenya, accounting for between 30% and 50% outpatient attendance in health care facilities. Moreover, malaria fever accounts for 20% of the total number of admissions to hospitals and healthcare facilities.

Current Monitoring Procedures

Malaria surveillance and reporting in Kenya is achieved through utilization of a number of reporting systems. These reporting systems comprise of District Health Information Systems (DHIS), Integrated Disease Surveillance and Response (IDSR), Logistics Management Information System (LMIS), and Laboratory Information Management System (LIMS). Surveillance data derived from these systems are conveyed at diverse intervals with broad variations across the systems.

In order for the malaria surveillance and reporting system to work, it needs to provide reports about rapid diagnostic kit (RDT), timely report of malaria drug stocks, the number of outpatients coming to the health facility, the number of patients tested for malaria, the number that tests positive for malaria and the number of patients treated with anti-malaria (Bastiaens et al., 2011).

Rationale for the SMS-Based Malaria Surveillance System for Kenya

The proposed Short-Message Based (SMS-Based) malaria surveillance is philosophically sound based on its ability to solve the problems and difficulties presented by the existing surveillance systems. Firstly, the existing malaria surveillance and reporting system is delayed and inaccurate. Secondly, the delay and inaccuracy that accompany it lead to characteristically low approximations of malaria incidence from custom surveillance data. Therefore, effective surveillance procedures to gather, accumulate and handle information from communities to national levels in a timely fashion are urgently desired to monitor realization of the new case-management guidelines (Githinji et al., 2014). Kenya, just like most developing countries, has seen rapid increase in mobile phone connections and this boosts the potential of utilizing mobile phone text messages in collection of data from the field. This is because it makes it possible for immediate communication besides providing an added advantage of ease of use. Mobile telephony in field data collection also reduces data transmission delays hence solves a big problem that that faces the existing surveillance strategy.

Additional Special Features for Malaria Surveillance in Kenya

Technology integration especially short-message platforms can immensely help in disseminating information from health care facilities. Mobile phone platform will be an essential feature of the surveillance system. This feature will enable data from the rural and sub-county regions to be sent to the national malaria surveillance centers through short messages.

Health worker training will be another feature that will encompass proper understanding utilization of the system and reporting of the data. This training will involve how to access and extract the relevant surveillance data. The training will further have an objective geared toward achieving the “T3: Test-Treat-Track” of the WHO launched in 2010 (WHO 2012).

Challenges in Establishing Malaria Surveillance in Kenya

Insufficient supply of diagnostic equipment in health facilities besides poor knowledge about malaria are among the most evident challenges that public health officials who handle malaria management encounter. In addition, there has been reluctance in the way the public takes preventive measures against malaria. Such preventive measures include sleeping under nets treated with necessary insecticide. Another challenge is that while taking anti-malarial drugs is important for management of the disease, many pregnant women do not take anti-malarial drugs (Mphatswe et al 2012). Investment in malaria has also seen a steady decline and this has limited the extent to which the management and surveillance can be achieved given that resources needed to handle the endemic are limited.

Solution for the Challenges

The surveillance system will be designed to specifically address the imprecision in timing of the existing system. As such, SMS system will be made to contemporaneously report malaria incidence on a weekly basis. Accuracy will also make an integral part of the system, where medical practitioners will be trained on the proper use and reporting of the system.


Bastiaens G. J, Schaftenaar E, Ndaro A, Keuter M, Bousema T, Shekalaghe S. A (2011): Malaria diagnostic testing and treatment practices in three different Plasmodium falciparum transmission settings in Tanzania: before and after a government policy change. Malaria Journal, 10:76

Mphatswe W, Mate K. S., Bennett B, Ngidi H, Reddy J, Barker P. M, & Rollins N (2012): Improving public health information: a data quality intervention in KwaZulu-Natal, South Africa. Bull World Health Organ, 90:176-182.

Githinji, S., Kigen, S., Memusi, D., Nyandigisi, A., Wamari, A., Muturi, A., Jagoe, G., Ziegler, R., Snow, R., W. & Zurovac, D (2014) Using mobile phone text messaging for malaria surveillance in rural Kenya. Malaria Journal 13:107

WHO: (2012) Test. Treat. Track. Scaling up Diagnostic Testing, Treatment and Surveillance for Malaria. Geneva: World Health Organization; 2012

Yukich J. O, Bennett A, Albertini A, Incardona S, Moonga H, Chisha Z, Hamainza B, Miller JM, Keating J, Eisele TP, Bell D (2012): Reductions in artemisinin-based combination therapy consumption after the nationwide scale up of routine malaria rapid diagnostic testing in Zambia. American Journal of Tropical Medical Hygiene, 87:437-446

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