Malaria Elimination Case Surveillance & Foci Investigation System Design¶

Introduction¶

Transforming the surveillance system into a core intervention is the third pillar of the Global technical strategy for malaria 2016–2030. As countries progress towards malaria elimination, the aim of surveillance is to detect all malaria cases; investigate every confirmed malaria case; identify the likely location of an infection in order to direct actions to interrupt transmission and to ensure that each detected case is promptly treated and monitored to prevent secondary infection. An ideal surveillance information system for malaria elimination includes rapid and complete case reporting, central data storage and management, automated data analysis, and customized outputs and feedback that lead to timely and targeted responses. The DHIS2 tracker package for malaria case surveillance and foci investigation is an aid for malaria surveillance in burden reduction and elimination settings.

The data elements included follow WHO-recommendations based on WHO global standards and normative guidance as stipulated in the organisations guidelines and guiding documents; in particular, the Malaria Surveillance, Monitoring and Evaluation: A reference manual. The data gathered is rendered into actionable indicators and dashboards in line with the work of the WHO surveillance assessment toolkit. The tracker packages supporting case notification, case investigation, foci investigation and classification workflows are designed to be used in conjunction with the aggregate DHIS2 packages for malaria programme monitoring in elimination and burden reduction settings to strengthen data quality, analysis and data-driven decision making.

System Design Overview¶

The Malaria metadata package for individual data contains two tracker programs supporting case notification, case investigation, foci investigation, and classification workflows as described WHO’s Malaria Surveillance, Monitoring and Evaluation: A reference manual Manual.

These tracker programs are intended to be deployed together to support typical workflows for:

1. Malaria case notification, investigation and classification
2. Foci investigation and classification
3. Linking case data with foci

In elimination settings, case investigation, detection and focus investigation are elimination surveillance activities that are interconnected and are important for reliable determination of source of infection and classification of cases and foci to inform appropriate response.

While national standard operating procedures may vary, the figure below illustrates typical elimination surveillance workflows with the examples of case notification within 1 day, case investigation within 3 days and focus investigation within 7 days, based on China’s “1–3–7” approach. In the DHIS2 package design, the Malaria Case Notification, Investigation & Response program supports the case notification and investigation in the left two panels of the diagram; while the Malaria Foci Investigation program supports the focus investigation shown on the right panel.

• FIG 1: Case notification and case and focus investigation systems according to the “1-3-7” approach supported by DHIS2 package design

Source: Malaria Surveillance, Monitoring and Evaluation: A reference manual Manua

• MAL CS - Malaria Case Notification, Investigation & Response program

This is a longitudinal case-based surveillance program that supports a typical workflow for notifying confirmed malaria cases and following them up through case investigation and focus investigation to determine the source of infection and classification of cases and foci in order to guide effective responses.

It allows for cases to be linked through relationships- case to cases (detected reactively) and; a case to a foci registered in the related tracker program “Foci Investigation”. The “Foci Investigation” programme provides details on the actions taken around the index case that triggered a case investigation and the appropriate response measures that were carried out within the focus.

• MAL-FOCI- Malaria Foci Investigation program

Is a registry of all foci and their classification status, as well as effective response interventions undertaken within a foci to manage them and potential for reclassification, should the need arise.

• Dashboards

In addition to the metadata, the package also includes seven preconfigured yet editable dashboards. These are populated with indicators from the respective programs. The programs are made to work in tandem and fulfil different aspects of the burden reduction process and malaria elimination.

Program structure¶

Program Summary¶

MAL-CS: Malaria Case Notification, Investigation & Response¶

Stage	Description
Enrollment	This section allows for the recording of information about the case and its associated organisation unit.. When a patient is enrolled in the case-based programme, they are also enrolled into their reporting health facility organisation unitand assigned a unique ID and collects general questions about the patient such as full name,age , Sex, occupation and contact details. This enrollment also serves as a case notification which is necessary to trigger an investigation.
Diagnosis and treatment stage	This stage records all information associated with the diagnosis of the patient, case detection setting, history of malaria and travel history of the patient which is necessary for a case to be preliminarily classified. This stage is conducted at the health facility level and is typically completed within 24 hours (1 day) of detection.
Case investigation and classification	This stage involves the recording of information on, household members screened and those testing positive s capturing of the household coordinated and recording of any vector control interventions undertaken. This stage is conducted at the index case household and is typically completed within 3 days of detection by the investigation team.
Neighbouring household investigation	This stage allows the investigators to investigate neighbouring households which are located within a predetermined radius around the index case. This stage involves the screening for malaria of all household members, capturing the neighbouring households' coordinates and recording of any vector control interventions that were carried out... This is a repeatable stage and is conducted at each neighbouring household visited and is typically completed within 3 days of index case detection by the investigation team.
Case outcome	In this stage once all investigations are concluded, registration of the final case classification as well as the outcome of the patient is recorded. This stage is to be completed ideally within 3 days of detection.
Routine focus investigation	This stage gathers information on the type of population in the focus and response vector control interventions carried out . The routine focus investigation is conducted typically within 7 days of every passively detected case.

MAL-FOCI: Malaria Foci Investigation¶

Stage	Description
Enrollment	This stage gathers basic information about the foci ranging from the date of its registration to the foci name and is assigned with a unique ID, creating a foci profile.
Focus status, investigation and classification	This is a repeatable stage which captures the status of the focus, vector behaviour, insecticide resistance status and final classification where the status of the focus is recorded and the focus is classified.
Foci Response	This stage is a repeatable stage that records responses and vector control interventions carried out in this focus.

Workflow¶

The program assumes that all people registered have tested positive for malaria and is divided in five non-repeatable stages which follow the case through the lifetime of their enrollment.

Intended Users¶

The programme is intended to be used at point of care facilities and field level for data entry purposes, and the indicators populate dashboards that are thought to be used at national, district, facility levels. Currently, data-entry users have access to all the stages, but depending on in-country workflows they could be divided by program stage, for example, granting only the investigation team access to the investigation stage.

User Groups¶

User groups have been divided on the basis of use and function. A user can belong to more than one user group if their functions overlap. In addition, further compartmentalisation can be made through assigning specific user groups for the different stages. Users will also need to be assigned an organisation unit.

• MAL-CS: Malaria Case Notification, Investigation & Response
• MAL-CS- Data Analysis: Has access to all dashboards but cannot modify metadata or enter new data
• MAL-CS- Data Entry: Can enter data and create new patient records
• MAL-CS- Metadata Admin: Can modify the metadata

The implementing country should ensure that users have data entry and search rights for their respective Organisation units.

• MAL-FOCI: Foci Investigation & Response
• MAL-FOCI- Data Analysis: Has access to all dashboards but cannot modify metadata or enter new data
• MAL-FOCI- Data Entry: Can enter data and create new patient records
• MAL-FOCI- Metadata Admin: Can modify the metadata

Tracker Configuration¶

MAL-CS: Malaria Case Notification, Investigation & Response - Program configuration¶

The “Malaria case notification, investigation and response” program follows a confirmed malaria case from when they are diagnosed with malaria until a decision on focus response is made. The case is represented by the tracked entity type “Malaria Case”. A case can be enrolled in the programme on more than one occasion.

The program displays the front page list in order to have an at a glance list of cases in the organisation unit, and it requires a minimum of two attributes to search for cases with 50 maximum of TEIs to return in search.

The program has been set as “Audited” meaning that users have access to enrollments in other org units, but that an audit trail of who has accessed which records is kept. For a more secure approach where access is more restricted, see here.

MAL-FOCI: Malaria Foci Investigation - Program configuration¶

The “Malaria Foci Investigation” program registers all the foci which have been identified. A foci is defined by the WHO as “a defined and circumscribed zone situated in an area that is or has been malarious and in which the necessary epidemiological and ecological factors are present for the transmission of malaria”. In practice investigation and detection of cases in the focus are part of the broader focus investigation, while the latter may also include additional investigations to determine causes of transmission. The foci are represented by the tracked entity type “focus area”.

The program displays the front page list in order to have an at a glance list of foci in the org unit, and it requires a minimum of one attribute to search for foci with no maximum of TEIs to return in search.

Foci do not do not have sensitive personal information registered in their enrollment as they are geographical settings, they have been set with access level “open”. This should be evaluated by local data protection legislation.

It currently has no feature point to capture coordinates at enrollment level as these are captured in the investigation stage.

Prefixes¶

Throughout the metadata package, elements are prefixed with either “MAL” an object which os shared with other Malaria programmes, “MAL-CS”; an object which is for the case surveillance program, “MAL-FOCI” for objects which are part of the Malaria Foci programme, and GEN, which are generic for our standard metadata packages.

Unique Identifiers¶

The programs use different unique identifiers to aid with deduplication and with locating a case/foci. These include automatically generated IDs and should be adapted to local needs.

System Case ID - An identifier which is unique for the whole system with an automatically generated pattern in the format RANDOM(XXX######).

Malaria Local Case - ID An identifier which is unique for the whole system. It is currently not automatically generated to allow for it to be based on e.g., a paper record.

Focus ID - An identifier which is unique for the whole system with an automatically generated pattern in the format RANDOM(XXX##) For more information about the text patterns in DHIS2, see here.

Tracked Entity Type¶

MAL-CS:Malaria Case Notification, Investigation & Response¶

The Case Surveillance program uses the tracked entity type “Case” instead of “Person” which is what is commonly used in our metadata packages. This means that each time someone becomes infected, they become a case. A case is only allowed to be enrolled once. If someone becomes re-infected with malaria, they will have to be registered as a new case, and there are fields (in the diagnosis and treatment stage) where information about their previous infection can be recorded.

This means that there could be several “case” tracked entities which represent the same individual, and have the same National ID number, and therefore, this attribute should not be unique for the instance. A new “System case ID” is generated for each case.

Depending on implementation needs, an alternative would be to use the tracked entity type “person” and allow for multiple enrollments. In such case, it would require a new case ID for every time an infection is recorded, which results in a new enrollment, and therefore it should not be an attribute in the enrollment of the person and should rather be added as a data element in a program stage.

MAL-FOCI: Foci Investigation & Response¶

The Foci program uses the tracked entity type “Focus Area”, with the mandatory attributes “Focus ID” and “Focus Name”

Relationships¶

It is recommended to confgure two relationship types to link malaria cases to each other (within the same Tracker program), and to link malaria cases with their focus area (between Tracker programs) using the relationships widget.

MAL - Case-to-case: this relationship type is intended to be a bidirectional relationship that links a malaria case with another malaria case within the same Tracker program. for example, two malaria cases that were identified within the same village and presumed to part of the same outbreak. * From contraint: Tracked entitity instance, using Tracked Entity Type 'Malaria Case' within the Program 'Malaria Case Notification, Investigation and Response' * To constraint: Tracked entity instance, using Tracked Entity Type 'Malaria Case' within the Program 'Malaria Case Notification, Investigation and Response'

MAL - Case-to-focus: this relationship type is intended to be a bidirectional relationship, in order to a malaria case (TEI in one tracker program) with a malaric focus (TEI in a separate tracker program). Case to focus allows the user to connect a case with an existing or new foci. Likewise, it allows for a foci to be linked with a reported case. * From contraint: Tracked entity instance, using Tracked Entity Type 'Malaria Case' within the Program 'Malaria Case Notification, Investigation and Response' * To constraint: Tracked entity instance, using Tracked Entity Type 'Focus area' within the Program 'Malaria Foci Investigation'

The information shown in the relationship widget can be changed by adding the attributes to the tracked entity type and marking the box “show in list”.

Stages in Detail¶

MAL-CS: Malaria Case Notification, Investigation & Response - Stages¶

1. Enrollment

In the enrollment stage, each case is registered and assigned a System case ID as well as a Malaria case ID. These can be configured to be automatically generated and unique, depending on the needs of the implementation.

Name	UID	Value type	Options/Logic (if applicable)	Mandatory?
Enrollment date	qDkgAbB5Jlk	DATE		YES
System Case ID	HAZ7VQ730yn	TEXT	Automatically assigned	NO
Malaria Local Case ID	NXazwhBRpfA	TEXT		NO
First Name	sB1IHYu2xQT	TEXT		NO
Surname	ENRjVGxVL6l	TEXT		NO
Date of birth	NI0QRzJvQ0k	DATE		NO
Date of birth is estimated	Z1rLc1rVHK8	TRUE_ONLY		NO
Age (years)	B6TnnFMgmCk	INTEGER_ZERO_OR_POSITIVE	Calculated by program rule	NO
Sex	oindugucx72	TEXT	FEMALE MALE	NO
Pregnancy Status	sPDKWSQ2vKQ	TEXT	Only visible if Female of reproductive age /YES NO	NO
Malaria - Occupation	ZZmkcCkzzWr	TEXT	NURSE STUDENT TEACHER TRUCKDRIVER MINEWORKER SEASONALWORKER MIGRANTWORKER FARMER	NO
Present Home Address	CpDhdm55uhl	TEXT		NO
Address (permanent)	XN0145qZ7kH	TEXT		NO
Nationality	spkM2E9dn2J	TEXT	Complete country list ISO codes	NO
Mobile phone number	fctSQp5nAYl	PHONE_NUMBER		NO
Head of Household (First Name)	YCKldfKePsC	TEXT		NO
Head of Household (Last Name)	uLvB95ZxIUL	TEXT		NO

1. Diagnosis and treatment stage

This stage is divided into three sections. It is mandatory to enter a date of diagnosis and a case detection setting. Both these elements are heavily used for indicator calculations.

Section	Name	UID	Value type	Logic/ Options (if any)	Mandatory?
N/A	Date of diagnosis	hYyB7FUS5eR	DATE		YES
Case Detection	Detection setting	fazCI2ygYkq	TEXT	PASSIVE REACTIVE PROACTIVE	YES

In the malaria diagnosis section, all data relevant to the diagnosis process are recorded. There are programme rules included to facilitate data entry and hiding options when not relevant.

Section	Name	UID	Value type	Logic/ Options (if any)	Mandatory?
Malaria diagnosis	Reason for conducting case investigation	zFiMMpGyBgr	TEXT	Only available if “Proactive is selected in detection setting. DEVELOPMENT_OF_ACTIVITIES POPULATION_MOVEMENT REFUGEE_CRISIS CLIMATIC_TRIGGERS OTHER	NO
Malaria diagnosis	Conducting case investigation (other)	J4fIuC5ZLsU	TEXT		NO
Malaria diagnosis	Temperature	J7hdx5FCJvG	NUMBER		NO
Malaria diagnosis	Weight	JINgGHgqzSN	INTEGER_POSITIVE		NO
Malaria diagnosis	Symptom onset date	YEpmDm1I01R	DATE	Calculated by program rule if days with symptoms are added	NO
Malaria diagnosis	Symptom onset date is estimated	S6uZEpdNh8o	YES_ONLY		NO
Malaria diagnosis	Number of days with symptoms	kJiPLxGq2yI	INTEGER_ZERO_OR_POSITIVE	Calculated by program rule if date is added	NO
Malaria diagnosis	Malaria Diagnosis confirmed by	qdjVZojEK8S	TEXT	RDT MICROSCOPY OTHER	NO
Malaria diagnosis	Diagnosis method (Other)	FxYWTORW4mT	TEXT	Only visible i “Other” is selected	NO
Malaria diagnosis	Malaria plasmodium species identified	vGxpKVMkmaW	TEXT	Only visible if a diagnosis method is selectedPF PK PM PO PV MIX OTHER	NO
Malaria diagnosis	Malaria positive species (other)	voV7EhjhyJ3	TEXT		NO
Malaria diagnosis	Malaria parasite density	Wwu7UAt7bZW	INTEGER_ZERO_OR_POSITIVE	Only visible if “Microscopy” is selected	NO
Malaria diagnosis	presence of gametocytes	LCxi1dciA1C	BOOLEAN	Only visible if “Microscopy” is selected	NO
Malaria diagnosis	MAL-CS Severity of disease	SzVk2KvkSSd	TEXT	SIMPLE SEVERE	NO
Malaria diagnosis	Malaria Medication	nTMP8Aj1rYA	TEXT	AL ALPLUSPQ AS-SP ASPLUSAQ ASPLUSMQ ASPLUSMQPLUSPQ ASPLUSSP ASPLUSSPPLUSPQ CHLOROQUINE DHA-PPQ DHA-PPQPLUSPQ RADICAL_CURE OTHER	NO
Malaria diagnosis	Admission Status	MKMyvXshCdB	TEXT	ADMITTED REFERRED OPD	NO
Malaria diagnosis	Reason for referral	Zlro25GTcNK	TEXT	Only visible if case admission status is “Referred”FURTHER_MANAGEMENT OUTOFSTOCK	NO

The travel details section refers to recent travel history of the case, both within and outside the country in order to determine preliminary classification pending investigation. Basic decision support programme rules are also included.

Section	Name	UID	Value type	Options (if any)	Mandatory?
Travel Details	Recent travel within the country	hiymQVgVG2v	TEXT	YES NO	NO
Travel Details	Travel within country (30 days symptoms)	qpp5fp1RVaX	TEXT	Only available if case has traveled recently YES NO	NO
Travel Details	Travel inside country Region/District	SI1D9IfXiI4	TEXT	Only available if case has traveled recently	NO
Travel Details	Travel inside country town/village name	eYOHoeSizJk	TEXT	Only available if case has traveled recently	NO
Travel Details	Travel inside country last night	BRNQ61bbt28	DATE	Only available if case has traveled recently	NO
Travel Details	Travel inside country First Night	Oc9Y7jvdU2g	DATE	Only available if case has traveled recently	NO
Travel Details	Travel outside country	OhU3RfPlQGR	TEXT	YES NO	NO
Travel Details	Travel outside country last month	B1zbtdPXMRk	TEXT	Only available if case has traveled recentlyYES NO	NO
Travel Details	Country traveled to	f9xYwUwrHq9	TEXT	Only available if case has traveled recentlyFull country list	NO
Travel Details	Travel outside country Region/District	kwv9fXr7gbj	TEXT	Only available if case has traveled recently	NO
Travel Details	Travel outside country town/village name	JZw2d0yzmHB	TEXT	Only available if case has traveled recently	NO
Travel Details	Travel outside country last night	mw2Rso4RHEF	DATE	Only available if case has traveled recently	NO
Travel Details	Travel outside country first night	JBBAwCahDQ3	DATE	Only available if case has traveled recently	NO
Travel Details	Travel history narrative	i7JwJXVEl2C	TEXT		NO
Travel Details	Preliminary case classification	bcGuRgKDZei	TEXT	LOCAL IMPORTED INTRODUCED RECRUDESCENT INDUCED	NO
Travel Details	Classification Narrative	pIcW9I0z5LL	TEXT		NO

The history of malaria section deals with data related to previous Malaria infections, including the previous treatment and species identified.

Section	Name	UID	Value type	Logic/ Options (if any)	Mandatory?
History of Malaria	Blood transfusion within past 3 months	yO0ZIegEsDk	BOOLEAN		NO
History of Malaria	history	cpXwLgQTLeO	BOOLEAN		NO
History of Malaria	Date of previous diagnosis	Urz28endlF6	DATE	Only available if there is a history of confirmed malaria	NO
History of Malaria	plasmodium species (previous)	xTeHON9Jisk	TEXT	Only available if there is a history of confirmed malariaPF PK PM PO PV MIX OTHER	NO
History of Malaria	Malaria Medication (previous)	JndDE3YbCEB	TEXT	Only available if there is a history of confirmed malariaAL ALPLUSPQ AS-SP ASPLUSAQ ASPLUSMQ ASPLUSMQPLUSPQ ASPLUSSP ASPLUSSPPLUSPQ CHLOROQUINE DHA-PPQ DHA-PPQPLUSPQ RADICAL_CURE OTHER	NO

The final section is not visible in the data entry screen, but it is of utmost importance for indicator calculations. It is always hidden through a program rule with the expression “true” meaning it's always hidden. Both data elements are automatically populated. The notification date comes from the current date when the report is being filled and the diagnosis date comes from the “date of diagnosis” feature in the event. The latter one is there to allow for that value to be used in indicators in other stages.

Section	Name	UID	Value type	Options (if any)	Mandatory?
Hidden section for indicator purposes (Diagnosis)	Notification date	fPbtS7glDT2	DATE		NO
Hidden section for indicator purposes (Diagnosis)	Diagnosis date	ObiXORrILyV	DATE		NO

1. Case investigation and classification

This is where the magic happens. The case notification, investigation and response is the stage that is recorded as close as possible to the cases. The investigation is conducted at household using a mobile device. It includes a feature point where investigators can record the coordinates of the cases at household level. These coordinates are then used to populate the geographical dashboards.

The first section deals with the location of the case

Section	Name	UID	Value type	Options (if any)	Mandatory?
Feature	Event point		Coordinates		NO
Feature	Date of case investigation	wYTF0YCHMWr	DATE		YES
Case household investigation	Location where case investigation is conducted	xS8sL2MMpc0	TEXT	HEALTHFACILITY HOUSEHOLD TELEPHONIC	NO
Case household investigation	Village name	Th6dW4kwZji	TEXT	Only available if investigation was held in a household	NO

The index case household investigation is the investigation of the physical location and screening of household members where the cases reside. Basic validation rules are triggered if numbers are not correct (for example, more household members own a net than there are household members)

Index case household investigation and response	Name of head of household	SlqoeFUJvUV	TEXT		NO
Index case household investigation and response	Number of household members	lezQpdvvGjY	INTEGER_ZERO_OR_POSITIVE		NO
Index case household investigation and response	Household members tested for malaria	y57kkdyw35d	INTEGER_ZERO_OR_POSITIVE		NO
Index case household investigation and response	Household members malaria positive	qxWAgIAfZAh	INTEGER_ZERO_OR_POSITIVE		NO
Index case household investigation and response	Sleeping places	QtZBHQORAvK	INTEGER_ZERO_OR_POSITIVE		NO
Index case household investigation and response	Household members own net	uPNwmZl8Clb	INTEGER_ZERO_OR_POSITIVE		NO
Index case household investigation and response	Residents in household who slept under a net the previous night	KA6RY4BB41F	INTEGER		YES
Index case household investigation and response	Household sprayed in the past 12 months	AeVEKN0zwJJ	BOOLEAN		YES
Index case household investigation and response	Malaria Vector Control Intervention - Indoor Residual Spraying	oYbOVrpDnRo	YES_ONLY		NO
Index case household investigation and response	Malaria Vector Control Intervention - LLIN Distribution	CSYSRYrevdf	YES_ONLY		NO
Index case household investigation and response	Vector Control Intervention - Larval Source Management	wwIvEJUmxx8	YES_ONLY		NO

The final section is not visible in the data entry screen, but it is of utmost importance for indicator calculations. It is always hidden through a program rule and both data elements are automatically populated. The two different data elements are automatically filled with data from the diagnosis stage using programme rules.

Section	Name	UID	Value type	Options (if any)	Mandatory?
Hidden section for indicator purposes (Investigation)	Detection setting	fazCI2ygYkq	TEXT	PASSIVE REACTIVE PROACTIVE	NO
Hidden section for indicator purposes (Investigation)	Diagnosis date	ObiXORrILyV	DATE		NO

1. Neighbouring household investigation

This stage records the data for the investigations done at the households in a predetermined radius of the case. Basic validation rules are triggered if numbers are not correct (for example, more household members own a net than there are household members).

Section	Name	UID	Value type	Options (if any)	Mandatory?
Nearby household investigation	Investigation date	VgsOuy9mXyZ	DATE		YES
Nearby household investigation	Name of head of household	SlqoeFUJvUV	TEXT		NO
Nearby household investigation	Number of household members	lezQpdvvGjY	INTEGER_ZERO_OR_POSITIVE		NO
Nearby household investigation	Household members tested for malaria	y57kkdyw35d	INTEGER_ZERO_OR_POSITIVE		NO
Nearby household investigation	Household members malaria positive	qxWAgIAfZAh	INTEGER_ZERO_OR_POSITIVE		NO
Nearby household investigation	Sleeping places	QtZBHQORAvK	INTEGER_ZERO_OR_POSITIVE		NO
Nearby household investigation	Household members own net	uPNwmZl8Clb	INTEGER_ZERO_OR_POSITIVE		NO
Nearby household investigation	Residents in household who slept under a net the previous night	KA6RY4BB41F	INTEGER		NO
Nearby household investigation	Household sprayed in the past 12 months	AeVEKN0zwJJ	BOOLEAN		NO
Nearby household investigation	Malaria Vector Control Intervention - LLIN Distribution	CSYSRYrevdf	yes_ONLY		NO
Nearby household investigation	Malaria Vector Control Intervention - Indoor Residual Spraying	oYbOVrpDnRo	yes_ONLY		NO

1. Case outcome

The case outcome records the final case classification after the case has been investigated as well as the outcome of the illness with the following data elements:

Case outcome	Report date	eHvTba5ijAh	DATE		TRUE
Case outcome	Malaria Final case classification	y3CG06h1Clh	TEXT	INDIGENOUS IMPORTED INTRODUCED RECRUDESCENT INDUCED	FALSE
Case outcome	Outcome of illness	zXNfOKXRBA9	TEXT	CURED DIED ABSCONDED	TRUE

It also includes a hidden section with the data element “Admission status”, which is assigned automatically from the same data element present in the “Diagnostic and Treatment” Stage.

Section	TEA / DE / eventDate	UID	valueType	optionSet	mandatory
Hidden Section for indicator purposes (Outcome)	Admission Status	MKMyvXshCdB	TEXT	ADMITTED REFERRED OPD	NO

1. Routine focus investigation and response

This stage is completed following every case outcome. It has five sections and is non repeatable.

In the locality section the user selects if the locality was urban or rural.

Section	Name	UID	Value type	Options (if any)	Mandatory?
feature	Date of focus investigation	KwrBvn1EJT3	DATE		YES
Locality	Locality	r4GBctr3Xdh	TEXT	URBAN RURAL	NO

In the Types of population section, users select the type or types of population that exist in the case’s foci. More than one can be selected

Section	TEA / DE / eventDate	UID	valueType	optionSet	mandatory
Type(s) of populations	MAL- Migrant	BK2d3ktuJWa	YES_ONLY		NO
Type(s) of populations	MAL- Refugee	HUzRTYRFcYn	YES_ONLY		NO
Type(s) of populations	MAL- Resident	Cd5AUkJT1mE	YES_ONLY		NO
Type(s) of populations	MAL- Temporary worker	VJ7qLlRgm7e	YES_ONLY		NO

The response section gathers the date of response.

Section	TEA / DE / eventDate	UID	valueType	optionSet	mandatory
Response	Date of response	G7f2D1vl3fD	DATE		NO

MAL-FOCI: Foci Investigation & Response - Stages¶

1. Enrollment

In the foci enrollment there are only four attributes in addition to the date of registration. It has a polygon attribute which has been configured from the Tracked Entity Type and which allows it to capture the perimeter of a focus. Note that this is not configured as a program feature, because there is no support for representing polygon features in the output maps.

Name	UID	valueType	optionSet	mandatory	mandatory
Date of Foci Registration	M3xtLkYBlKI	DATE		YES	NO
Polygon	TE type attribute	Polygonal coordinates		NO
Malaria foci investigation Focus Name	Kv4fmHVAzwX	TEXT		NO
Malaria foci investigation Locality	phxAY4PQdsT	TEXT	URBAN RURAL	NO
Malaria foci investigation Focus ID	K9innmM1nuW	TEXT		NO
Malaria foci investigation Focus Definition	cnXnFAStrrd	TEXT	VILLAGEFOCUS DISTRICTFOCUS REGIONFOCUS	NO

1. Focus Status investigation and classification stage

This is a repeatable stage where the details of the focus investigation are recorded. It has five sections and following the investigation the focus should be classified Subsequent stages will include previous classification and any interventions that might have been undertaken.

The first section is hidden through programme rules if there have not been any interventions or investigations previously. If there have been interventions, then the section is displayed and most of these data elements are automatically completed based on the values from their other stages.

It has a point feature which allows you to record coordinates as a point on the map to mark the location of the focus.

Stage	Section	TEA / DE / eventDate	UID	valueType	optionSet	mandatory
	Feature	Point		Coordinates
	Feature	Date of foci investigation	CWaAcQYKVpq	DATE		YES
	Focus Status	- Date of classification	Ah29MGrnVjJ	DATE		NO
	Focus Status	- Classification	V1OnhZYfSa2	TEXT	ACTIVE RESIDUAL_NON-ACTIVE CLEARED	NO
	Focus Status	- Previous Vector Control Interventions - LLIN distribution	jhoCqSTA2QB	YES_ONLY		NO
	Focus Status	- Previous Vector Control Intervention - INDOOR residual spraying	e6hRE1N1Fcc	YES_ONLY		NO
	Focus Status	- Previous Vector Control Intervention - Larval Source management	dbMsAGvictz	YES_ONLY		NO

1. The Foci investigation section is where the bulk of the work happens.

Section	TEA / DE / eventDate	UID	valueType	optionSet	mandatory
Foci Investigation	- Total Population in the Focus	HDRons6AfbL	INTEGER_POSITIVE		NO
Foci Investigation	- Malaria Households	VNM6zoPECqd	INTEGER_POSITIVE		NO
Foci Investigation	MAL- Resident	Cd5AUkJT1mE	YES_ONLY		NO
Foci Investigation	MAL- Migrant	BK2d3ktuJWa	YES_ONLY		NO
Foci Investigation	MAL- Temporary worker	VJ7qLlRgm7e	YES_ONLY		NO
Foci Investigation	MAL- Refugee	HUzRTYRFcYn	YES_ONLY		NO
Foci Investigation	- Type of Population - Other	QZZA5IfHAAU	YES_ONLY		NO
Foci Investigation	- Type of Population - Specify Other	ehBd9cR5bq4	TEXT	Only shown if other is selected	NO
Foci Investigation	- Geographical features	SaHE38QFFwZ	TEXT	HILLY PLATUE HILLY_AND_PLATUE	NO
Foci Investigation	- Development activity present	Tj642rK34Qf	YES_ONLY		NO
Foci Investigation	- Development activity type	jzksn7lA2ac	TEXT	Only shown if yes is selected previously--AGRICULTURE CONSTRUCTION MINING PLANTATION OTHER	NO
Foci Investigation	- Development activity other specify	gd8U1R3ALDA	TEXT	Only shown if other is selected	NO

The vector behaviour section deals with the resting and biting behaviour of the mosquitoes in the area.

Section	TEA / DE / eventDate	UID	valueType	optionSet	mandatory
Vector Behaviour	- Biting Behaviour	PxKiOhLn7mV	TEXT	INDOORBITING OUTDOORBITING	NO
Vector Behaviour	- Resting Behaviour	X1DpyS5FN3T	TEXT	INDOOR OUTDOOR	NO

The Insecticide resistance section registers if there is insecticide resistance in the area and to which insecticide.

Section	TEA / DE / eventDate	UID	valueType	optionSet	mandatory
Insecticide Resistance	- Malaria Proven insecticide resistance	fyjPqlHE7Dn	BOOLEAN		NO
Insecticide Resistance	- Malaria Insecticide Name	UFTvUJIMiH0	TEXT	Only appears if YES is previously selected.BENDIOCARB01 CARBOSULFAN04 DDT4 DIELDRIN4 MALATHION5 PIRIMPHOS025 DELTAMETHRIN005	NO

The classification section lets the health worker register the focus status and how it is classified based on the evidence gathered. For the next investigation, this value will be available in the data elements at the beginning of the form.

Section	TEA / DE / eventDate	UID	valueType	optionSet	mandatory
Classification	- Focus final classification	fjdU9F6EngS	TEXT	ACTIVE RESIDUAL_NON-ACTIVE CLEARED	YES
Classification	- Focus date of classification	bl7EMKxJIIT	DATE		YES
Classification	- Additional Information Evidence	PILB3GtIwiJ	TEXT		NO

1. Foci Response stage

Section	TEA / DE / eventDate	UID	valueType	optionSet	mandatory
Foci Response	Date of foci response	uvMKOn1oWvd	DATE		YES
Foci Response	- Households included	k0rev4WSffi	INTEGER_POSITIVE		NO
Foci Response	- People included	DX4LVYeP7bw	INTEGER_POSITIVE		NO

Section	TEA / DE / eventDate	UID	valueType	optionSet	mandatory
Vector Control	MAL- Follow-up Vector Control Intervention - LLIN Distribution	JhpYDsTUfi2	YES_ONLY		NO
Vector Control	MAL- Follow-up Vector Control Intervention - INDOOR Residual Spraying	yhX7ljWZV9q	YES_ONLY		NO
Vector Control	- Follow-up Vector Control Intervention - Larval Source Management	c2c62aRFIfr	YES_ONLY		NO

Program rules¶

Program rules have been configured to hide data elements/sections based on workflow logic during data entry, as well as to assign values to other data elements or event dates. Due to limitations in calculating indicators based on data from multiple events, some program rules have been used to move data into data elements that are part of “hidden sections" throughout the program. When modifying the package, extra care should be taken that the data elements in these hidden sections are being populated correctly. This can be tested directly in Tracker by removing the program rules which hide the sections. The rules for this are all called “Hide Section for indicator purposes”.

Analytics¶

Dashboards¶

The package includes seven dashboards, 6 of them are based exclusively on indicators from MAL-CS, the remaining one has a combination of Indicators from MAL-CS and MAL-FOCI. A number has been added to their name to keep them in a logical order and they are prefixed with the respective programme.

MAL-CS- 01 Trends¶

MAL-CS-02 Epidemiology¶

MAL-CS-03 Treatment and Diagnostic¶

MAL-CS-04 Case Notification & Investigation¶

MAL-CS-05- Case Classification¶

MAL-CS-06- Geolocation¶

Foci polygons¶

The Foci Investigation and Response programme allows for polygons to be captured instead of points. Currently these are not included as map objects in the programmes by default, but they can be added as a tracked entity layer.

MAL-FOCI¶

Indicators and Program Indicators¶

The indicators in this package have been built based on specifications from guiding documents from the WHO.

Program indicators are used most frequently in this package (e.g. counting events or enrollments filtered by a condition). Due to limitations in calculating indicators based on data from multiple events, some program rules have been used to move data into data elements that are part of “hidden sections" throughout the program. When modifying the package, extra care should be taken that the data elements in these hidden sections are being populated correctly. This can be tested directly in Tracker by removing the program rules which hide the sections. The rules for this are all called “Hide Section for indicator purposes”.

Indicators are used when there is a numerator and denominator. In this package, indicators typically contain program indicator in the numerator and denominator in order to calculate values such as % of cases investigated, % of cases notified on time, % of cases by risk group, etc.

Note: Indicators that calculate a percentage of cases based on detection vs. outcome can show a result exceeding 100%, this results from cases in which the outcome happens in the following period. In particular for confirmed cases classified, the percentage can be more than 100% since the confirmation comes from diagnosis and treatment and the classification from the outcome, in a report the outcome could be in a different period.

Android compatibility¶

The program as it stands is fully compatible with Android. When implementing with Android, especially if the program is modified, it is important to be familiar with the Android implementation guide