Evaluation of the Malaria Case Surveillance System in KwaZulu-Natal Province, South Africa, 2022: A focus on DHIS2

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Abstract Background South Africa set a target to eliminate malaria by 2023, with KwaZulu-Natal (KZN) Province the malaria-endemic province closest to achieving this goal. Objective two of the National Malaria Elimination Strategic Plan (NMESP) focused on strengthening surveillance systems to support the country’s elimination efforts. Regular evaluations of the malaria surveillance systems against the targets of the NMESP objective are crucial in improving the system's performance and impact. This study aimed to assess whether the malaria surveillance system in KwaZulu-Natal Province meets the NMESP surveillance objective and goals. Methodology: A mixed-methods cross-sectional study design was used to evaluate the malaria surveillance system, focusing on the District Health Information System 2 (DHIS2). The study assessed the data quality, timeliness, simplicity, and acceptability of the system. Key personnel from the KZN Province malaria control program were interviewed using self-administered questionnaires to evaluate their perception of the system's simplicity and acceptance. Malaria case data from January 2016 to December 2020 were extracted from the DHIS2 and evaluated for data quality and timeliness. Results The survey respondents generally found DHIS2 acceptable (79%, 11/14) and easy to use (71%, 10/14), stating that they could readily find, extract, and share data (64%, 9/14). Overall data quality was good (88.9%), despite some variables having low completeness and data availability. However, case notifications were not timely, with only 61% (2,622/4,329) of cases reported within 24 hours. During the 5-year study period, the DHIS2 captured 4,333 malaria cases. The majority of cases (81%, 3,489/4,330) were categorized as imported, mostly from Mozambique, while the majority of patients (67%, 2,914/4,333) were male. Conclusion The malaria surveillance system largely met the NMESP surveillance strategic goals, but it fell short of the overarching surveillance objective of achieving 100% notification of cases within 24 hours. The majority of reported cases in KZN Province are imported from neighboring countries. Engaging with healthcare professionals responsible for case notification is crucial to improve notification timeliness.

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