Malawi's COVID-19 Surveillance: A New Approach

In early April 2020, Malawi confirmed its first case of COVID-19. This put the country on a path to tackle the pandemic, which included activating a national health emergency center. While the government did its best with the resources available, the situation quickly grew complicated with a rise in cases and porous entry points. These issues made it tough to keep track of how the virus was spreading. Plus, a lack of investment in health facilities made routine testing for COVID-19 quite the challenge.

#The Challenge of Tracking COVID-19

With the number of COVID-19 cases increasing, it became harder to monitor the situation accurately. Even though tests were done on both symptomatic and asymptomatic people, the approach to surveillance was rather passive. Some variants of the virus also went undocumented, making it tough to know how the virus was changing over time. Testing mostly focused on those showing symptoms. Yet, we all know by now that asymptomatic individuals can spread the virus just as effectively.

As time passed, the public's compliance with preventive measures started to wane, particularly when reported COVID-19 cases were low. Testing dropped, and reports were often delayed. To make matters worse, outbreaks of polio and cholera in early 2022 diverted attention from COVID-19. The response to these challenges led to a new strategy in Malawi: active, real-time COVID-19 surveillance. This new system aimed to detect changes in cases rapidly and provide better insight into the virus's behavior.

#Setting Up Sentinel Surveillance

In July 2022, Malawi set up sentinel surveillance in seven selected sites across the country. These locations included five health facilities and two border points. The health facilities were chosen from areas that had reported high numbers of COVID-19 cases and where many patients visited. Meanwhile, the border points were selected due to their high volume of travelers coming from Mozambique and Tanzania.

#Who Was Included in the Study?

The study aimed to include anyone seeking healthcare, regardless of age. However, severely ill patients, children without guardians, and those who participated in the survey within the last 14 days were excluded. Participants who were eligible went through a screening process to determine if they were symptomatic or asymptomatic based on specific guidelines.

At the border entry points, anyone aged five and above entering the country could take part. In both scenarios, participants or their guardians had to give consent.

#How Many Participants Were Involved?

Across all seven sentinel sites, nearly 10,000 individuals were screened. A small percentage refused to participate or were not eligible, leaving over 9,300 participants who provided the necessary samples and answered the questions. This is quite impressive, considering it was during a pandemic!

#Gathering Data

Before kicking off the surveillance, all staff involved received training. Each site had a designated surveillance assistant responsible for data entry and quality control. Participants answered questions using a digital platform available in multiple languages.

The data gathered included information on socio-demographics, prior exposure to COVID-19, symptoms, travel history, and Vaccination Status. A nasopharyngeal specimen was taken from every participant to test for the virus. The tests were conducted fairly quickly, so results were available shortly after collection.

#Analyzing the Data

After gathering the data, it was sent to a secure server for analysis. The information was cleaned and analyzed using software, looking for patterns and insights. Researchers looked at various demographic and behavioral factors that might influence the Positivity Rates of COVID-19, making sure to factor in potential confounders.

To ensure the reliability of the study, researchers put protocols in place for checking the consistency of the data weekly. They also generated tables and graphs to track trends over time.

#Ethical Considerations

Before starting the study, ethical approvals were obtained to ensure the rights of participants were protected. Everyone involved provided informed consent. It's essential to uphold ethics, especially when it comes to public health studies.

#Participant Characteristics

When breaking down participant characteristics, it appeared that many health facility respondents were young adults, particularly those aged 15 to 29. The travelers skewed older, with most aged between 30 and 49. More women participated in health facilities than men, while the opposite was true for border points where more men traveled.

Surprisingly, a significant number of participants reported not being vaccinated against COVID-19. This suggests that many people might have felt healthy enough not to get the vaccine. Among those who had underlying health conditions, HIV was the most commonly reported issue.

#Trends in COVID-19 Positivity Rates

Throughout the surveillance period, the positivity rates varied. The highest rate was observed early on, coinciding with a smaller sample size. As time went on, the positivity rates fluctuated, but the average remained around 8%. Interestingly, both symptomatic and asymptomatic individuals showed similar positivity trends.

#What Do the Numbers Mean?

When examining the relationship between positivity rates and demographic factors, certain trends emerged. For example, those who had partial vaccinations were more likely to test positive than unvaccinated individuals. However, among symptomatic patients, those at specific health facilities had higher positivity rates compared to others.

For asymptomatic participants, travelers who had recently been abroad were less likely to test positive. This might be due to heightened health measures being enforced in other countries, combined with awareness campaigns.

#Let’s Talk About Vaccinations

The study also analyzed the relationship between vaccination status and positivity rates. Interestingly, fully vaccinated travelers were more likely to test positive, which raised some eyebrows. These peculiar trends might be attributed to various factors, including the self-reported nature of vaccination status and the small number of fully vaccinated participants.

It’s a bit like wearing a seatbelt but still driving a little too fast-just because you did one smart thing doesn’t mean you can let your guard down in other areas!

#Limitations of the Study

While this surveillance provided valuable insights, it had its limitations. The results do not represent the entire population, as the focus was on a specific group. Also, certain biases could not be avoided due to the sampling methods, and some important information was left out of the study.

For instance, the survey did not gather data on the severity of cases or details about vaccination behaviors, which could have provided a more complete view of the pandemic.

#Final Thoughts

This COVID-19 active sentinel surveillance was an essential step in complementing routine passive surveillance. The results showed that preventative measures were somewhat effective, as indicated by the lower prevalence rates. However, the ongoing detection of cases among both symptomatic and asymptomatic individuals emphasized the importance of continued monitoring.

The findings also suggest that despite the setbacks, there is a need for enhanced surveillance to catch any new variants and keep an eye on the pandemic's progress. Zooming in on the relationship between vaccinations and protective behaviors is crucial in terms of creating targeted awareness campaigns.

As we move forward, the lessons learned from this study will help shape integrated health surveillance systems in Malawi and might just help other countries facing similar challenges. After all, staying one step ahead of a virus is key, and collaboration and vigilance will play significant roles in public health strategies.