Role of data quality and health worker capacity in an artefactual increase in malaria incidence: An investigation of cases in Kwale County, Kenya, 2021

Abstract

Objective: To investigate the reported increase in malaria incidence in Kwale County, Kenya, in 2021.

Design: Retrospective review of health facility records and key informant interviews.

Setting: County and sub-county hospitals in Kwale County, Kenya.

Subjects: Hospital records of suspected malaria cases managed in hospitals and healthcare workers in public hospitals in Kwale County.

Interventions: Implementation of the test-and-treat guidelines for malaria.

Main outcome measures: Data quality (timeliness, completeness, data accuracy, and overall system assessment).

Results: Of the 17,607 suspected malaria cases identified in the study, 40.1% were children under five years, and 59.1% were females.  Msambweni and Kinango hospitals used microscopy, while Kwale and Lunga Lunga hospitals also used rapid diagnostic tests (mRDTs) for  diagnosis. Confirmed malaria cases were 1,633, peaking in February. The overall test positivity rate (TPR) was 9.3% (microscopy 9.2%,  mRDT 19.5%). Kwale Hospital had the highest TPR (17.3%). The source documents completion rate was 42%, while monthly report timeliness was 58%. There was inadequate sensitization on revised surveillance tools, no written reporting guidelines, nor established  malaria control targets in the study hospitals.

Conclusion: The apparent increase in incidence was due to poor data quality. The Ministry of Health should strengthen the dissemination  of malaria policies and cascade capacity building on malaria surveillance and data management to all healthcare workers.