ABSTRACT
Introduction
The use of information systems to understand the dynamics of malaria
disease and inform decisions on control proved valuable to a malaria control
programme. Development of simple practical and sustainable information system
tools has been slow in coming for many resource-poor environments. This thesis
addresses many issues relating to the conceptual development and implementation
of simple tools and their integration into operational malaria control to support
decision making and advocacy.
Methods
A basic Microsoft Access malaria data collection and repository tool has
been in existence since 1997 focussing mainly on case reporting alone. Better
utilization of data and further expansion to include outbreak identification and
response, cluster detection and intervention monitoring has been the main focus
over time.
Eight years of retrospective malaria case data from Mpumalanga Province,
South Africa were used to explore disease dynamics including spatial as well as
temporal variation in malaria epidemiology. The identification of specific risk
areas and the confirmation of the unstable nature of malaria occurrence lead to the
conceptualization and development of an outbreak model using binomial
statistics. The novel three tier outbreak identification and response system was
field tested over a two season period to establish acceptance and the ability to
direct resources in times of elevated case loads. Comparison against other
existing malaria outbreak systems was conducted.
SaTScan freely available software was used to detect spatial and spacetime
disease clusters within towns in the highest risk area of the province.
A malaria case control study was conducted in seven
localities/towns/villages to explore risk and protective characteristics of household
structure and practices, including the use of impregnated nets. The micro
economic status of households as a determinant of malaria risk was also explored.
A spray operations component as part of the malaria information system
was developed and implemented during the time to allow for routine monitoring and historical exploration of indoor residual spray activities. Results
Retrospective malaria case data analysis identified heterogeneity of
malaria risk in the Province and spatial analysis identified significant clusters at
small geographical area resolution rejecting the hypothesis that malaria is
homogeneously distributed over space and time.
The importance of intervention monitoring to identify low coverage areas,
over or under application of insecticides, and assessment of the productivity of
spray operators was identified.
The outbreak identification and response system was successfully
implemented, integrated and sustained with a set of response activities developed
for implementation at defined threshold levels. The outbreak systems can be
considered for utilization in other low transmission settings.Results of the case control study indicated that malaria risk was associated
with living in traditional housing and the practice of re-opening windows at night
when peak biting behaviour of the main mosquito vector, Anopoheles arabiensis
is expected. Higher household socio economic status (SES) profile was associated with a lower risk of malaria.
Conclusions
The conceptualization, development and implementation of operationally
feasible malaria information management tools in a rural African environment
proved useful for enhancing malaria control. The novel malaria outbreak
identification and response, cluster detection as well as the spray monitoring
systems were successfully implemented and adopted as an integral part of the routine malaria control programme monitoring and surveillance system. This
research has enabled more informed real-time decision-making for effective
programme management.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/6958 |
| Date | 20 May 2009 |
| Creators | Coleman, Marlize |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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