Volume 102, Issue 2
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645



Since 2012, the Zanzibar Malaria Elimination Program has been implementing reactive case detection (RACD). Health facility (HF) staff send individual malaria case notifications by using mobile phones, triggering a review of HF records and malaria testing and treatment at the household level by a district malaria surveillance officer. We assessed the completeness and timeliness of this system, from case notification to household-level response. We reviewed two years (2015–2016) of primary register information in 40 randomly selected HFs on Zanzibar’s two islands Unguja and Pemba and database records of case notifications from all registered HFs for the period 2013–16. The operational coverage of the system was calculated as proportion of HF-registered cases that were successfully reviewed and followed up at their household. Timeliness was defined as completion of each step within 1 day. Public HFs notified almost all registered cases (91% in Unguja and 87% in Pemba), and 74% of cases registered at public HFs were successfully followed up at their household in Unguja and 79% in Pemba. Timely operational coverage (defined as each step, diagnosis to notification, notification to review, and review to household-level response, completed within 1 day) was achieved for only 25% of registered cases in Unguja and 30% in Pemba. Records and data from private HFs on Unguja indicated poor notification performance in the private sector. Although the RACD system in Zanzibar achieved high operational coverage, timeliness was suboptimal. Patients diagnosed with malaria at private HFs and hospitals appeared to be largely missed by the RACD system.

[open-access] This is an open-access article distributed under the terms of the Creative Commons Attribution (CC-BY) License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, 2018. Malaria Surveillance, Monitoring & Evaluation: A Reference Manual. Geneva, Switzerland: WHO. [Google Scholar]
  2. Cohen JM, Smith DL, Cotter C, Ward A, Yamey G, Sabot OJ, Moonen B, , 2012. Malaria resurgence: a systematic review and assessment of its causes. Malar J 11: 122. [Google Scholar]
  3. World Health Organization, 2017. A Framework for Malaria Elimination. Geneva, Switzerland: WHO. [Google Scholar]
  4. Johansson EW, Cibulskis RE, Steketee RW, , 2010. Global Partnership to Roll Back Malaria: Malaria Funding and Resource Utilization: the First Decade of Roll Back Malaria. Geneva, Switzerland: WHO. [Google Scholar]
  5. Bhattarai A, 2007. Impact of artemisinin-based combination therapy and insecticide-treated nets on malaria burden in Zanzibar. PLoS Med 4: e309. [Google Scholar]
  6. Zanzibar Malaria Control Programme, 2009. Malaria Elimination in Zanzibar: A Feasibility Assessment. Zanzibar, Tanzania: Zanzibar Malaria Control Programme. [Google Scholar]
  7. Zanzibar Malaria Elimination Programme, 2013. Malaria Strategic Plan III 2013/14–2017/18. Zanzibar, Tanzania: Revolutionary Government of Zanzibar, Ministry of Health and Social Welfare. [Google Scholar]
  8. Galactionova K, Tediosi F, de Savigny D, Smith T, Tanner M, , 2015. Effective coverage and systems effectiveness for malaria case management in sub-Saharan African countries. PLoS One 10: e0127818. [Google Scholar]
  9. malERA Refresh Consultative Panel on Health Systems and Policy Research, 2017. malERA: an updated research agenda for health systems and policy research in malaria elimination and eradication. PLoS Med 14: e1002454. [Google Scholar]
  10. Zhou SS, Rietveld AE, Velarde-Rodriguez M, Ramsay AR, Zhang SS, Zhou XN, Cibulskis RE, , 2014. Operational research on malaria control and elimination: a review of projects published between 2008 and 2013. Malar J 13: 473. [Google Scholar]
  11. malEra Consultative Group on Monitoring Evaluation and Surveillance, 2011. A research agenda for malaria eradication: monitoring, evaluation, and surveillance. PLoS Med 8: e1000400. [Google Scholar]
  12. Zachariah R, Harries AD, Ishikawa N, Rieder HL, Bissell K, Laserson K, Massaquoi M, Van Herp M, Reid T, , 2009. Operational research in low-income countries: what, why, and how? Lancet Infect Dis 9: 711717. [Google Scholar]
  13. Ramsay A, Olliaro P, Reeder JC, , 2016. The need for operational research and capacity-building in support of the global technical strategy for malaria 2016–2030. Malar J 15: 235. [Google Scholar]
  14. World Health Organization, 2012. T3: Test. Treat. Track. Scaling up Diagnostic Testing, Treatment and Surveillance for Malaria. Geneva, Switzerland: WHO. [Google Scholar]
  15. Zanzibar Malaria Elimination Programme, 2014. Zanzibar Guidelines for Malaria Diagnosis and Treatment. Zanzibar, Tanzania: Revolutionary Government of Zanzibar, Ministry of Health and Social Welfare. [Google Scholar]
  16. Ohrt C, Roberts K, Sturrock H, Wegbreit J, Gosling R, Lee B, , 2014. Surveillance systems to facilitate malaria elimination. Prepared for the Bill & Melinda Gates foundation to inform strategy development. San Francisco, CA: UCSF Global Health Sciences, The Global Health Group.
  17. Lu G, Liu Y, Beiersmann C, Feng Y, Cao J, Muller O, , 2016. Challenges in and lessons learned during the implementation of the 1-3-7 malaria surveillance and response strategy in China: a qualitative study. Infect Dis Poverty 5: 94. [Google Scholar]
  18. Dalrymple U, Arambepola R, Gething PW, Cameron E, , 2018. How long do rapid diagnostic tests remain positive after anti-malarial treatment? Malar J 17: 228. [Google Scholar]
  19. Yukich JO, Butts J, Miles M, Berhane Y, Nahusenay H, Malone JL, Dissanayake G, Reithinger R, Keating J, , 2014. A description of malaria sentinel surveillance: a case study in Oromia regional state, Ethiopia. Malar J 13: 88. [Google Scholar]
  20. Bennett A, Avancena ALV, Wegbreit J, Cotter C, Roberts K, Gosling R, , 2017. Engaging the private sector in malaria surveillance: a review of strategies and recommendations for elimination settings. Malar J 16: 252. [Google Scholar]
  21. Githinji S, Kigen S, Memusi D, Nyandigisi A, Wamari A, Muturi A, Jagoe G, Ziegler R, Snow RW, Zurovac D, , 2014. Using mobile phone text messaging for malaria surveillance in rural Kenya. Malar J 13: 107. [Google Scholar]
  22. Montagu D, Goodman C, , 2016. Prohibit, constrain, encourage, or purchase: how should we engage with the private health-care sector? Lancet 388: 613621. [Google Scholar]
  23. Celone M, Person B, Ali SM, Lyimo JH, Mohammed UA, Khamis AN, Mohammed YS, Mohammed KA, Rollinson D, Knopp S, , 2016. Increasing the reach: involving local Muslim religious teachers in a behavioral intervention to eliminate urogenital schistosomiasis in Zanzibar. Acta Trop 163: 142148. [Google Scholar]
  24. Robinson MN, 2014. Mass media health communication campaigns combined with health-related product distribution: a community guide systematic review. Am J Prev Med 47: 360371. [Google Scholar]
  25. Wakefield MA, Loken B, Hornik RC, , 2010. Use of mass media campaigns to change health behaviour. Lancet 376: 12611271. [Google Scholar]
  26. Rumisha SF, Mboera LE, Senkoro KP, Gueye D, Mmbuji PK, , 2007. Monitoring and evaluation of integrated disease surveillance and response in selected districts in Tanzania. Tanzan Health Res Bull 9: 111. [Google Scholar]
  27. Khandekar E, Kramer R, Ali AS, Al-Mafazy AW, Egger JR, LeGrand S, Mkali HR, McKay M, Ngondi JM, , 2019. Evaluating response time in zanzibar’s malaria elimination case-based surveillance-response system. Am J Trop Med Hyg 100: 256263. [Google Scholar]
  28. Huaman MA, Araujo-Castillo RV, Soto G, Neyra JM, Quispe JA, Fernandez MF, Mundaca CC, Blazes DL, , 2009. Impact of two interventions on timeliness and data quality of an electronic disease surveillance system in a resource limited setting (Peru): a prospective evaluation. BMC Med Inform Decis Mak 9: 16. [Google Scholar]

Data & Media loading...

Supplemental appendix, tables, and figures

  • Received : 05 Jul 2019
  • Accepted : 03 Oct 2019
  • Published online : 25 Nov 2019

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error