Factors affecting integration of an early warning system for antimalarial drug resistance within a routine surveillance system in a pre-elimination setting in Sub-Saharan Africa
Issued Date
2025-06-01
Resource Type
eISSN
19326203
Scopus ID
2-s2.0-105007453451
Journal Title
Plos One
Volume
20
Issue
6 June
Rights Holder(s)
SCOPUS
Bibliographic Citation
Plos One Vol.20 No.6 June (2025)
Suggested Citation
Kagoro F.M., Allen E., Raman J., Mabuza A., Magagula R., Kok G., Malatje G., Guerin P.J., Dhorda M., Maude R.J., Barnes K.I. Factors affecting integration of an early warning system for antimalarial drug resistance within a routine surveillance system in a pre-elimination setting in Sub-Saharan Africa. Plos One Vol.20 No.6 June (2025). doi:10.1371/journal.pone.0305885 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/110694
Title
Factors affecting integration of an early warning system for antimalarial drug resistance within a routine surveillance system in a pre-elimination setting in Sub-Saharan Africa
Author's Affiliation
Mpumalanga Provincial Malaria Elimination Programme
National Institute for Communicable Disease
The Open University
WorldWide Antimalarial Resistance Network
University of Cape Town
Infectious Diseases Data Observatory
Faculty of Health Sciences
The University of Hong Kong Li Ka Shing Faculty of Medicine
Nuffield Department of Medicine
University of the Witwatersrand Faculty of Health Sciences
Mahidol Oxford Tropical Medicine Research Unit
National Institute for Communicable Disease
The Open University
WorldWide Antimalarial Resistance Network
University of Cape Town
Infectious Diseases Data Observatory
Faculty of Health Sciences
The University of Hong Kong Li Ka Shing Faculty of Medicine
Nuffield Department of Medicine
University of the Witwatersrand Faculty of Health Sciences
Mahidol Oxford Tropical Medicine Research Unit
Corresponding Author(s)
Other Contributor(s)
Abstract
To address the current threat of antimalarial resistance, countries need innovative solutions for timely and informed decision-making. Integrating molecular surveillance for drug-resistant malaria into routine malaria surveillance in pre-elimination contexts offers a potential early warning mechanism for further investigation and response. However, there is limited evidence on what influences the performance of such a system in resource-limited settings. From March 2018 to February 2020, a sequential mixed-methods study was conducted in primary healthcare facilities in a South African pre-elimination setting to explore factors influencing the flow, quality and linkage of malaria case notification and molecular resistance marker data. Using a process-oriented framework, we undertook monthly and quarterly data linkage and consistency analyses at different levels of the health system, as well as a survey, focus group discussions and interviews to identify potential barriers to, and enhancers of, the roll-out and uptake of this integrated information system. Over two years, 4,787 confirmed malaria cases were notified from 42 primary healthcare facilities in the Nkomazi sub-district, Mpumalanga, South Africa. Of the notified cases, 78.5% (n = 3,758) were investigated, and 55.1% (n = 2,636) were successfully linked to their Plasmodium falciparum molecular resistance marker profiles. Five tangible processes—malaria case detection and notification, sample collection, case investigation, analysis and reporting—were identified within the process-oriented logic model. Workload, training, ease of use, supervision, leadership, and resources were recognized as cross-cutting influencers affecting the program’s performance. Approaching malaria elimination, linking molecular markers of antimalarial resistance to routine malaria surveillance is feasible. However, cross-cutting barriers inherent in the healthcare system can influence its success in a resource-limited setting.