Evaluation of malaria surveillance system in Kano State, Nigeria, 2013-2016

Malaria surveillance system strengthening is essential in the progress towards malaria elimination. In Nigeria, more attention is being given to this recently as the country is striving towards achieving elimination. However, the surveillance system performance is fraught with challenges including poor data quality with varying magnitude by state. This study evaluated the operation of the Kano State malaria surveillance system and assessed its key attributes.

An observational study design comprising a survey, record review and secondary data analysis, and mixed methods data collection approach were used. Four key stakeholders' and 35 Roll Back Malaria Focal Persons (RBMs) semi-structured interviews on operation of the system and attributes of the surveillance system, were conducted. We analyzed the abstracted 2013-2016 National Health Management Information System web-based malaria datasets. The surveillance system was evaluated using the "2001 United States Centers for Disease Control's updated guidelines for Evaluating Public Health Surveillance Systems". Data were described using means, standard deviation, frequencies and proportions. Chi-squared for linear trends was used.

Overall, 24 RBMs (68.6%) had ≤ 15-year experience on malaria surveillance, 29 (82.9%) had formal training on malaria surveillance; 32 RBMs (91.4%) reported case definitions were easy-to-use, reporting forms were easy-to-fill and data flow channels were clearly defined. Twenty-seven respondents (69.2%) reported data tools could accommodate changes and all RBMs understood malaria case definitions. All respondents (4 stakeholders and 34 RBMs [97.1%]) expressed willingness to continue using the system and 33 (84.6%) reported analyzed data were used for decision-making. Public health facilities constituted the main data source. Overall, 65.0% of funding were from partner agencies. Trend of malaria cases showed significant decline (χ²_trend = 7.49; P = 0.0006). Timeliness of reporting was below the target (≥ 80%), except being 82% in 2012.

Malaria surveillance system in Kano State was simple, flexible, acceptable, useful and donor-driven but the data were not representative of all health facilities. Timeliness of reporting was suboptimal. We recommended reporting from private health facilities, strengthening human resource capacity for supportive supervision and ensuring adequate government funding to enhance the system's representativeness and improve data quality.