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Data Quality Audit and Assessment of Epidemic Preparedness and Response for Malaria in Nandi County

The overall goal for Division of National Malaria Program (DNMP) is to reduce the Malaria incidence and deaths by 75% by 2023. The Kenya Malaria Strategy (2019 – 2023) seeks to protect 100% of people living in malaria risk areas through access to appropriate malaria interventions, manage 100% of suspected malaria cases according to Kenya Malaria Treatment Guidelines and to strengthen malaria surveillance and use of information to improve decision making (KMS, 2019). In order to achieve these, there is need to closely monitor the malaria data from all levels of reporting to ensure timely and effective interventions. Data quality, therefore, is paramount in the attainment of the program’s objectives. The success in controlling and reducing malaria incidence in these endemic and epidemic prone counties is dependent on reliable surveillance, monitoring and evaluation of systems put in place with generation of high-quality data that can be relied on.

An unpublished report from Kenya Field Epidemiology Program identified data quality issues on Malaria reporting in several counties. Major discrepancies are noted between the various Malaria reporting tools. Data reported through the KHIS system indicates data quality challenges still prevail at the county level. A reporting variance is noted between the main reporting tools for confirmed malaria in the KHIS system showing a variance in the values reported between MOH 505, 705 and 706. KHIS routine data shows declined reporting rates for the EPR monitoring data with reporting rates for MOH 505 below the recommended 90% set by the Division of National Malaria Program.

Nandi county borders Kisumu county to the south which falls within then lake endemic epidemiological zone. The county falls within the epidemic prone areas of the Western highlands. Malaria transmission in this region is seasonal with considerable year to year variation. Epidemics occur when climatic conditions favour sustained minimum temperatures of around 18 degrees Celsius that sustain vector breeding that result to increased intensity of malaria transmission. Malaria is the 2nd leading cause of morbidity and mortality in Nandi County with a prevalence of 21%.

In light of the above, a team comprising of two FELTP Advanced level residents, the Resident Advisor, a representative from the DNMP and the sub-county Malaria Coordinators jointly carried out a routine Data Quality Audit (rDQA) and assess the level of Epidemic Preparedness and Response (EPR) for malaria in Nandi county. The activity was carried out for a period of 12 days from 8th to 20th May 2022.

The data quality data audit was done using the revised digital malaria routine Data Quality Assessment (rDQA) tool. The data reviewed was for a period of three months from February to April 2022.The outpatient register for children below the age of five years:(MOH 204A) was reviewed. This data was then compared to what is in the outpatient monthly summary tool (MOH 705A) and subsequently what was reported in KHIS was checked. The Laboratory register (MOH 240) was then reviewed and this was compared with data on the Laboratory monthly summary tool (MOH 706) and KHIS. The malaria commodities daily activity register (DAR, MOH 645), and the malaria commodities monthly summary tool were also reviewed. This was done with an aim of confirming the consistency of reported data for the period under review.

In addition, the facility in charge was interviewed as part of identifying system challenges that could lead to poor data quality.

For assessment of EPR, a standard questionnaire developed by the Division of national malaria program (DNMP) was used. The Sub County Malaria Control Co-ordinator (SCMCC), the facility in charge and a Community Health Extension Worker were interviewed in order to establish the state of EPR. The tool was assessing any EPR activities undertaken during three phases: the pre epidemic, epidemic and post epidemic phase.

At the end of the exercise, the findings and recommendations were shared with the County Health Management Team and the Division of National Malaria Program.

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