Field-based evaluation of malaria outbreak detection and response in Mudzi and Goromonzi districts, Zimbabwe – 2017

ABSTRACT

National-level evaluations may fail to identify capacity improvements for detecting and responding to outbreaks which begin and are first detected at the local level. In response to this issue, we conducted a field-based assessment of the malaria outbreak surveillance system in Mashonaland East, Zimbabwe. We visited eleven clinics in Mudzi and Goromonzi districts. Twenty-one interviews were conducted with key informants from the provincial (n = 2), district (n = 7), and clinic (n = 12) levels. Interviews focused on surveillance system activities, preparedness, data quality, timeliness, stability, and usefulness. Main themes were captured utilising standard qualitative data analysis techniques. While the surveillance system detects malaria outbreaks at all levels, we identified several gaps. Clinics experience barriers to timely and reliable reporting of outbreaks to the district level and staff cross-training. Stability of resources, including transportation (33% of informants, n = 7) and staff capacity (48% of informants, n = 10), presented barriers. Strengthening these surveillance barriers may improve staff readiness to detect malaria outbreaks, resulting in timelier outbreak response and a reduction in malaria outbreaks, cases, and deaths. By focusing at the local level, our assessment approach provides a framework for identifying and addressing gaps that may be overlooked when utilising tools that evaluate surveillance capacity at the national level.

KEYWORDS:

• Malaria
• surveillance
• outbreak detection
• outbreak response

Acknowledgements

The authors would like to thank Zimbabwe Ministry of Health and Child Care, National Malaria Control Programme, and Field Epidemiology Training Program staff for their guidance, support, and contributions to this work, key informants in Mashonaland East for their participation in this assessment, and the University of Washington, Department of Epidemiology and SEAL team stakeholders for their support.

Disclosure statement

No potential conflict of interest was reported by the authors.