The online version of this article (doi:10.1186/1475-2875-11-330) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
DJ, MW, AAl, AT, NA, and AAd set up and managed the IDSR database; DJ, WD, ZT, TG, FOR and PG devised data management and analysis plan and did data analysis; AWM did the mapping; PG and DJ wrote the draft manuscript with extensive input from TG, FOR, AT, MW, AAl and NA; all authors commented on the draft manuscript and approved the final version.
Routine malaria surveillance data is useful for assessing incidence and trends over time, and in stratification for targeting of malaria control. The reporting completeness and potential bias of such data needs assessment.
Data on 17 malaria indicators were extracted from the Integrated Disease Surveillance and Response System database for July 2004 to June 2009 (Ethiopian calendar reporting years 1997 to 2001). Reporting units were standardized over time with 2007 census populations. The data were analysed to show reporting completeness, variation in risk by reporting unit, and incidence trends for malaria indicators.
Reporting completeness, estimated as product of unit-month and health facility reporting, was over 80% until 2009, when it fell to 56% during a period of reorganization in the Ministry of Health. Nationally the average estimated annual incidence of reported total malaria for the calendar years 2005 to 2008 was 23.4 per 1000 persons, and of confirmed malaria was 7.6 per 1,000, with no clear decline in out-patient cases over the time period. Reported malaria in-patient admissions and deaths (averaging 6.4 per 10,000 and 2.3 per 100,000 per year respectively) declined threefold between 2005 and 2009, as did admissions and deaths reported as malaria with severe anaemia. Only 8 of 86 reporting units had average annual estimated incidence of confirmed malaria above 20 per 1,000 persons, while 26 units were consistently below five reported cases per 1,000 persons per year.
The Integrated Disease Surveillance and Response System functioned well over the time period mid 2004 to the end of 2008. The data suggest that the scale up of interventions has had considerable impact on malaria in-patient cases and mortality, as reported from health centres and hospitals. These trends must be regarded as relative (over space and time) rather than absolute. The data can be used to stratify areas for improved targeting of control efforts to steadily reduce incidence. They also provide a baseline of incidence estimates against which to gauge future progress towards elimination. Inclusion of climate information over this time period and extension of the dataset to more years is needed to clarify the impact of control measures compared to natural cycles on malaria.
Additional file 1: IDSR reporting form, 2004 to 2009. Scanned copy of IDSR monthly form used during 2004 to 2009 at health centres and hospitals showing data items reported. (DOC 160 KB)12936_2012_2553_MOESM1_ESM.doc
Additional file 2: Malaria indicators (original and generated) in the IDSR database. List of variables relating to malaria in the IDSR database, name changes and variable definitions for old and newly created variables. (DOC 48 KB)12936_2012_2553_MOESM2_ESM.doc
Additional file 3: Regions, Zones and Populations of IDSR reporting units, 2007. Lists of 108 reporting units in 2008/2009 showing their regions and names, names as spelled in census, name of original zone in 2004/2005, populations of each unit from Census 2007 and how the 108 reporting units were assigned in collapsing of new to old units. (DOC 45 KB)12936_2012_2553_MOESM3_ESM.doc
Additional file 4: Reporting periods and number of eligible months for 108 IDSR reporting units. List of 108 eligible units, the starting and ending year and month of eligibility for reporting and the number of eligible months. (DOC 44 KB)12936_2012_2553_MOESM4_ESM.doc
Additional file 5: Reporting completeness by month, site and overall for 108 reporting units. List of 108 reporting units by region; the number of eligible months and the number and % of months actually reported; the number of eligible sites and the number and % actually stated to be reporting. (DOC 52 KB)12936_2012_2553_MOESM5_ESM.doc
Additional file 6: Average annual incidence of reported total (clinical and confirmed) out-patient malaria per 1000 persons by zone, Ethiopia 2004–2009. List of 86 collapsed reporting units by region, with census 2007 population, annual incidence/1000 of total out-patient malaria cases each year from 2004/2005 to 2008/2009, average annual incidence per year for 2004 to 2009, and expected annual number of total malaria cases. The reporting units with >50,000 expected total malaria cases per year are highlighted. (DOC 46 KB)12936_2012_2553_MOESM6_ESM.doc
Additional file 7: Average annual incidence of confirmed outpatient malaria per 1000 persons by zone, Ethiopia 2004–2009. List of 86 collapsed reporting units by region, with census 2007 population, annual incidence/1000 of confirmed out-patient malaria cases each year from 2004/2005 to 2008/2009, average annual incidence per year for 2004 to 2009, and expected annual number of confirmed cases. The reporting units with >15,000 expected confirmed malaria cases per year are highlighted. (DOC 45 KB)12936_2012_2553_MOESM7_ESM.doc
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