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The Elimination 8 Regional Surveillance Database (ERSD)

`Annie Martin May 8, 2017
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To achieve malaria elimination, an understanding of neighboring country malaria situations is critical for the prevention of introduction of parasites. Malaria parasites don’t stop at country borders, so effective elimination strategies shouldn’t either. That is why the Elimination 8 (E8), in its strategy on cross-border collaboration, identified Akros to support the development of the E8 Regional Surveillance Database System (ERSD) for the eight member states constituting the E8: Botswana, Namibia, South Africa, Swaziland, Angola, Mozambique, Zambia, and Zimbabwe. This innovative approach is a means to level the playing field and conduct malaria surveillance at a regional scale.

Figure 1. Cross-border incidence* in districts in Zambia, Mozambique, and Zimbabwe: Having access to several countries in one database allows these kinds of visualizations, which may highlight transmission patterns that occur between countries, which in turn supports decisions to invest in control methods in border areas.
*All data shown is used purely for illustrative purposes and do not reflect current or historic epidemiological status of countries. Current data can be accessed in the database itself by those granted authority.

Malaria is hardly an emerging disease, and though the interventions of preventing, treating, and monitoring malaria are somewhat standardized, each country has slight permutations of their approach to doing so. Indicators may differ slightly, investment in one prevention method versus another likely differs too, and policies surrounding implementation certainly are not identical.

Figure 2. Country malaria incidence* over time: Visualizing time trends within each country may help illuminate whether outbreaks in different countries are related. It also helps identify which countries are doing well in elimination efforts and may have lessons to share.
*All data shown is used purely for illustrative purposes and do not reflect current or historic epidemiological status of countries. Current data can be accessed in the database itself by those granted authority.

In supporting the E8 in the creation of the Elimination 8 Regional Surveillance database (ERSD), Akros leveraged its experience in developing DHIS2 databases to design a system that was specific enough to fit country needs, but also flexible enough to balance various aspects of malaria disease and response. Together, Akros and the E8 team conducted country assessments to determine current data collection and monitoring strategies and worked to harmonize these in the DHIS2 database. The ERSD now contains data from five countries, with plans to incorporate the remaining three. In addition to developing the database itself, Akros developed full training materials and system administration guides to support the longevity and expansion of the system.

The Elimination 8 secretariat and Akros have worked together, combining resident country malaria expertise and strategic technical expertise. Streamlining indicators of eight different countries into one set of indicators is complicated and creating multi-country policies surrounding the use of a shared database is complex. However, in the end the effort yields the ability to do cross-country comparisons that are critical to interpretation of disease transmission and may be catalytic in decision making surrounding strategies for disease control and elimination.

Figure 3. Zambia inpatient malaria data*: In addition to cross-country comparisons, the database also allows for comparison of indicators within countries, making it a useful tool for countries in planning resource distribution.
*All data shown is used purely for illustrative purposes and do not reflect current or historic epidemiological status of countries. Current data can be accessed in the database itself by those granted authority.


About Annie Martin

Annie Martin is a health informatics officer and Global Health Corps fellow at Akros. Her work in health spans both the private and public sector, and her interests lie in using quantitative analysis to improve health programs and make the case for better investment in health.


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