Abstract
Background: Papua has a high burden of malaria, with an annual parasite incidence 300 times the national average. A key component of malaria elimination strategies is robust surveillance which is essential for monitoring trends in case numbers, guiding public health interventions, and prioritizing resource allocation. This study aimed to enhance malaria surveillance in Central Papua, Indonesia, by improving data collection, record-keeping, and treatment practices.
Methods: The study was conducted at five public clinics in Central Papua province, Indonesia, as part of a wider health systems strengthening programme to promote safer and more effective anti-malarial treatment (The SHEPPI Study). Clinical and laboratory details of patients with malaria and their treatment were documented in clinic registers which were digitalized into an electronic database. Automated reports were generated each month and used to provide regular feedback to clinic staff. Continuous Quality Improvement (CQI) workshops were conducted with clinic staff using the Plan-Do-Study-Act approach to address challenges and drive sustained improvements.
Results: Between January 2019 and December 2023, a total of 314,561 patients were tested for malaria, of whom 41.9% (131,948) had peripheral parasitaemia detected. The first round of Continuous Quality Improvement (CQI) workshops were held in May 2019 and improved data quality significantly, increasing data completeness from 46.3% (4540/9802) in the initial period (Jan-May 2019) to 71.5% (9053/12,665) after the first CQI (Jun-Oct 2019), p < 0.001. The second CQI round reduced DHP prescribing errors from 17.1% (1111/6489) in the initial period to 5.7% (607/10,669) after the second CQI (Sep 2019-Jan 2020) and PQ prescribing errors from 17.4% (552/3175) to 3.4% (160/4659) over the same time interval, p < 001. In total, 347 patients were prescribed fewer than the recommended number of PQ tablets during the initial period, 89 (25.6%) of whom were erroneously given only a single dose. Over the 4 year study period, a total of 11 workshops were conducted, driving continuous improvements in data quality and prescribing practices.
Conclusion: One or two rounds of CQI, supported by regular follow-up, can enhance the quality of malariometric surveillance, however interventions needed to be tailored to address specific needs of participating clinics. Improvements in data quality and prescribing practices have potential to contribute to better malaria management, improved clinical outcomes, and strengthened trust in healthcare providers.