MALARIA SURVEILLANCE, MONITORING & EVALUATION: A REFERENCE MANUAL MALARIA SURVEILLANCE, MONITORING & EVALUATION: A REFERENCE MANUAL Malaria surveillance, monitoring & evaluation: a reference manual ISBN 978-92-4-156557-8 © World Health Organization 2018 Some rights reserved. This work is available under the Creative Commons Attribution- NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons. org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non- commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. 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If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Please consult the WHO Global Malaria Programme website for the most up-to-date version of all documents (www.who.int/malaria) Printed in France Contents Acknowledgements vii Abbreviations and acronyms ix 1. Malaria surveillance as a core intervention 2 1.1 Introduction 2 1.2 Updates of past guidance 3 1.3 Target readership and use of this manual 4 1.4 Malaria surveillance on the continuum 5 1.5 Principles of the design and establishment of malaria surveillance 7 2. Establishing malaria surveillance systems 11 2.1 Requirements and processes 12 2.2 People-centred surveillance 15 2.3 Recording 16 2.4 Reporting 22 2.5 Data analysis and interpretation 23 2.6 Using data for making decisions in malaria control programmes 27 2.7 Structure of surveillance systems 29 2.8 Surveillance during prevention of re-establishment 37 2.9 Certification of elimination 38 3. Concepts and practice of malaria surveillance 40 3.1 Case definitions 40 3.2 Case detection 43 3.3 Case classification 47 3.4 Focus classification 52 3.5 Routine activities in malaria elimination surveillance and response 53 3.6 Reactive surveillance activities in the focus 56 3.7 Focus response 67 iii 4. Surveillance of antimalarial drug efficacy and drug resistance 69 4.1 Introduction 69 4.2 Therapeutic efficacy studies 69 4.3 Molecular markers of resistance to antimalarial drugs 73 4.4 Monitoring the efficacy of antimalarial drugs in settings with very low transmission 73 5. Entomological surveillance and vector control monitoring and evaluation 82 5.1 Rationale, definition and objectives 82 5.2 Surveillance systems for entomology and vector control 85 5.3 Main malaria entomological indicators 88 5.4 Frequency of surveys 95 5.5 Priorities for entomological surveillance by transmission setting 95 5.6 Monitoring of vector control 102 5.7 Use of entomological data in programme response 103 6. Early warning, detection and response to malaria outbreaks and epidemics 106 6.1 Definition and classification of epidemics 106 6.2 Epidemic curves of P. falciparum and P. vivax malaria 107 6.3 Factors that may contribute to epidemics 108 6.4 Definition of areas that are prone to epidemics 110 6.5 Surveillance system for epidemics 111 6.6 Preparedness and response 120 6.7 Post-epidemic assessment 122 7. Monitoring and evaluation of national programmes 124 7.1 Aims of monitoring and evaluation 124 7.2 Types of information required for monitoring 126 7.3 Roles of routine systems and surveys 127 7.4 Use of information at national level 129 7.5 Recommended indicators on the continuum to elimination 146 7.6 Use of information at regional and global levels 146 References 148 iv Annexes 155 Annex 1. Glossary 156 Annex 2. Example of individual case investigation form for a national malaria case register 162 Annex 3. Example of individual focus investigation form for a national malaria case register 165 Annex 4. Form for updating registration of foci 168 Annex 5. Geographical reconnaissance during focus investigation 169 Annex 6. Proposed register for community health workers, health posts and outpatient departments in health centres and hospitals 172 Annex 7. Tally sheet for outpatient attendance at health centres and hospitals 173 Annex 8. Daily and weekly records of outpatient attendance at health centres and hospitals 174 Annex 9. Discharge register for inpatient departments of health centres and hospitals 175 Annex 10. Reports from health posts and community health workers to health facilities 176 Annex 11. Reports from health facilities to district level 177 Annex 12. Line lists of malaria cases and deaths among inpatients to be reported to district level in low-transmission settings 180 Annex 13. Line lists of all confirmed malaria cases to be reported to district level in low-transmission settings 181 Annex 14. Supervisory checklist for countries with high or moderate transmission 182 Annex 15. Model monthly surveillance bulletins for countries with high or moderate transmission 183 Annex 16. Sampling methods and analytical techniques in entomological surveillance 185 Annex 17. Core indicators for surveillance, monitoring and evaluation 186 Annex 18. Example of questionnaire for assessment before and after a malaria epidemic 194 Annex 19. Examples of operational responses to various stages of a malaria epidemic 196 v vi Acknowledgements Malaria surveillance, monitoring & evaluation: a reference manual was prepared by the WHO Global Malaria Programme (GMP) by extensive consultation beginning in February 2017, review by the WHO Surveillance, Monitoring and Evaluation Technical Expert Group and WHO Malaria Policy Advisory Committee of various drafts in March, June and August 2017 and a final draft in February 2018. The GMP is grateful to the members of the Surveillance, Monitoring and Evaluation Technical Expert Group for their participation in various developmental and review meetings and for their valuable contributions. These are (in alphabetical order): Adam Bennett, Chris Drakeley (Co- chair), Erin Eckert, Khalid Elmardi, Arantxa Roca-Feltrer (Co-chair), Kes Herdiana, Arnaud Le Menach, Paola Marchesini, Medoune Ndiop, John Painter, Francesco Saute, Laurence Slutsker and Jian Wei Xu, supported by Abdisalan Noor (GMP). The following members of the Malaria Policy Advisory Committee are also gratefully acknowledged: Ahmed Adeel, Tom Burkot, Gabriel Carrasquilla, Maureen Coetzee, Abdullahi Djimde, Azra Ghani, Brian Greenwood, Caroline Jones, Patrick Kachur, Kevin Marsh, Kamini Mendis, Gao Qi, Pratap Singhasivanon, Laurence Slutsker and Neena Valecha. Various groups of individuals contributed to several sections of the manual. Entomological surveillance benefited from the expertise of members of the GMP Vector Control Technical Expert Group and the Vector Control Advisory Group: Juan I. Arredondo-Jiménez, Samson Awolola, Marc Coosemans, Camila Pinto Damasceno, Denis Gustavo Escobar Robles, Josiane Etang, Christen Fornadel, John Gimning, Roland Gosling, Jeffrey Hii, Zhou Hong- Ning, Hmooda Toto Kafy, Jonathan Lines, Michael B. Macdonald, Stephen Magesa, Leonard Mboera, Eunice Misiani, Abraham Peter Mnzava, Yasmin Rubio-Palis and Rajender Singh Sharma. Other