Current Surveillance for Malaria in Uganda primarily relies on clinical diagnosis without laboratory confirmation of malaria. Furthermore, laboratory results are not linked to clinical data. There is limited data on treatment practices. The HMIS reports are based on aggregate data and one is unable to perform sub-group analysis (i.e. age stratification). The reporting is frequently incomplete and not timely.

UMSP developed the Sentinel Site Surveillance to complement HMIS surveillance. A Sentinel Site is a site which generates data on malaria cases in the catchment area of the health facility. The aim of this approach is to obtain high quality data from a limited representative number of sites.  It was initiated in June 2006 by UMSP and MOH to provide accurate malaria surveillance data for quick response systems, to support ongoing malaria control activities and strengthen HMIS at sentinel sites. Sentinel sites were selected to reflect the geographic and ecological diversity of malaria transmission.The local epidemiology of malaria (EIR, drug resistance patterns) is well studied at the sites
Objectives

• Collect accurate data on the burden of malaria and clinical practices at the sentinel sites
• Complement & strengthen data collected under HMIS
• Monitor the impact of various interventions (IRS, ITNs, training etc…) on key malaria indicators
• Inform clinical practice and national policy
• Build capacity and create a sustainable malaria surveillance system
• Create “centers of excellence” for malaria diagnostics, training, case management and data collection

 

Data collected is initially focused on a few key variables  including basic patient demographics, blood smear results, whether patient was diagnosed with malaria, and what antimalarial treatment was prescribed. The database was later expanded to collect data on other laboratory tests, other reportable illness, and other therapies. A standardized case record form for collecting individual patient data including whether or not patient had fever was created.
The data is collected at several points including Outpatient clinics, Maternity clinics and ward, and Inpatient wards (admitted patients). We use existing staff assigned to record data at each point. The staff are trained at start of data collection.

The data collection methods have evolved over time. It initially started by making copies of counter book registers then moved to provide duplicate copy registers. The original data was  brought to Kampala to be entered while the copy remains at the site. Data collection later transitioning to computerized data entry at the site with electronic transfer of database. Data is collected on a standard form that captures common diagnosis and treatment. Data entry is on site to increase efficiency of producing timely summary reports.
Indicators of interest include the following.

• Total number of patients seen per month
• Proportion of cases suspected to have malaria
• Proportion treated for malaria
• Proportion of suspected malaria cases with blood smear done
• Proportion with a malaria positive result
• Health worker treatment practices
• Antimalarials prescribed
• Inpatient mortality attributed to malaria.