scholarly journals Malaria Data Analysis Using Routine Surveillance Data, Sunyani Municipality, Ghana, 2020

2021 ◽  
Author(s):  
Abdul Gafaru Mohammed ◽  
Christopher Sunkwa Tamal ◽  
Magdalene Akos Odikro ◽  
Delia Akosua Bandoh ◽  
Charles Lwanga Noora ◽  
...  
Keyword(s):  
Health Management ◽  
Case Fatality ◽  
Surveillance Data ◽  
Health Management Information System ◽  
Malaria Surveillance ◽  
District Health ◽  
Children Under Five ◽  
Under Five ◽  
Routine Surveillance ◽  
Disease Threshold

Abstract Introduction: Malaria is endemic in Ghana, accounting for about 40% of all OPD diagnosis. Data on malaria is routinely collected as part of the IDSR monthly reporting forms. Sunyani municipality recorded 56,540 malaria cases in 2016 with about 35% of the cases occurring in children under five years of age. We analyzed malaria surveillance data to identify the distribution of malaria cases by person, place and time and determine the timeliness and completeness of malaria report submission in the municipality.Methods: We analyzed malaria surveillance data in Sunyani municipality reported between 2015 and 2019 from the District Health Management Information System II. We calculated morbidity and mortality rates of cases by person and estimated proportion of cases by sub-districts. We performed trend analysis and calculated disease threshold levels. We presented the findings using tables and figures.Results: Of 639,361 malaria cases suspected, 93.5% (597,512/639,361) were tested, of which 49.4% (295,458/597,512) was positive. Females accounted for 55.7% (164,436/295,458) of the morbidity. Children <5 years recorded the highest proportion, 29.9% (88,135/295,458) of cases in the municipality. The case fatality rate was 3.7% (18/484) and 1.4% (7/484) for persons under age five and over age five, respectively. Abesim (6,276.03 per 10,000) recorded the highest number of cases, and the least cases were in New Dormaa (1,890.97 per 10,000). The majority of malaria cases were in May and October of each year. Antwi-krom recorded the highest rates of completeness and timeliness of 41.9% and 40.0% respectively. Conclusion: More females were diagnosed with malaria and children <5 years recorded the highest proportion of cases in the municipality. Abesim recorded the highest proportion of malaria cases during the period. High patterns of malaria transmissions occurred during months of high rainfalls. None of the sub-districts met the WHO target for timeliness and completeness of report submission. The NMCP should consider interventions such as SMC among children under five, in the Sunyani municipality.

scholarly journals Malaria Data Analysis Using Routine Surveillance Data, Sunyani Municipality, Ghana, 2020

2021 ◽  
Author(s):  
Abdul Gafaru Mohammed ◽  
Christopher Sunkwa Tamal ◽  
Magdalene Akos Odikro ◽  
Delia Akosua Bandoh ◽  
Charles Lwanga Noora ◽  
...  
Keyword(s):  
Health Management ◽  
Case Fatality ◽  
Surveillance Data ◽  
Health Management Information System ◽  
Malaria Surveillance ◽  
District Health ◽  
Children Under Five ◽  
Under Five ◽  
Routine Surveillance ◽  
Disease Threshold

Abstract IntroductionMalaria is endemic in Ghana, accounting for about 40% of all OPD diagnosis. Data on malaria is routinely collected as part of the IDSR monthly reporting forms. Sunyani municipality recorded 56,540 malaria cases in 2016 with about 35% of the cases occurring in children under five years of age. We analyzed malaria surveillance data to identify the distribution of malaria cases by person, place and time and determine the timeliness and completeness of malaria report submission in the municipality.MethodsWe analyzed malaria surveillance data in Sunyani municipality reported between 2015 and 2019 from the District Health Management Information System II. We calculated morbidity and mortality rates of cases by person and estimated proportion of cases by sub-districts. We performed trend analysis and calculated disease threshold levels. We presented the findings using tables and figures.ResultsOf 639,361 malaria cases suspected, 93.5% (597,512/639,361) were tested, of which 49.4% (295,458/597,512) was positive. Females accounted for 55.7% (164,436/295,458) of the morbidity. Children < 5 years recorded the highest proportion, 29.9% (88,135/295,458) of cases in the municipality. The case fatality rate was 3.7% (18/484) and 1.4% (7/484) for persons under age five and over age five, respectively. Abesim (6,276.03 per 10,000) recorded the highest number of cases, and the least cases were in New Dormaa (1,890.97 per 10,000). The majority of malaria cases were in May and October of each year. Antwi-krom recorded the highest rates of completeness and timeliness of 41.9% and 40.0% respectively.ConclusionMore females were diagnosed with malaria and children < 5 years recorded the highest proportion of cases in the municipality. Abesim recorded the highest proportion of malaria cases during the period. High patterns of malaria transmissions occurred during months of high rainfalls. None of the sub-districts met the WHO target for timeliness and completeness of report submission. The NMCP should consider interventions such as SMC among children under five, in the Sunyani municipality.

scholarly journals Diarrhoeal Diseases in Children under five years Exhibits space-time disparities and priority areas for control interventions in Rwanda

2020 ◽  
Author(s):  
Ladislas NSHIMIYIMANA ◽  
Peris Monchari Onyambu ◽  
Erigene Rutayisire
Keyword(s):  
Health Management ◽  
Geographical Area ◽  
Negative Relationship ◽  
Diarrhoeal Disease ◽  
Health Concern ◽  
Health Management Information System ◽  
Public Attention ◽  
Children Under Five ◽  
Under Five ◽  
Diarrhoeal Diseases

Abstract Background: The Diarrhoeal diseases remain to be a public health concern despite the existence of preventive measures and developing are the most affected. It affects more children under five years compared to the rest of the population. The burden of childhood diarrhoea varies with geographical area and time bound. A part from this variation, the link between climate change and diarrhoea among children under five years has not been well understood. This study aims to determine the trends, spatial temporal and seasonal characteristics of diarrhoea diseases among Rwandan children under five years using routine Health Management Information System (HMIS) data from 2014 to 2018.Methods: This was an ecological study using retrospective data analysis. Incidence were used to examine the trend, and excess hazard was assessed to determine the risk and likelihood for the occurrence of cases. Retrospective Discrete Poisson model was used to identify spatial, temporal and spatial-temporal clusters of diarrhoea. Linear regression was used to assess relationship between climatology variables and the occurrence of diarrhoea. Results: In total, 1,012,827 new diarrhoeal diseases episodes were reported during 2014-2018 with an annual incidence rate of 12,669/100,000 children under five years. Excess risk was noticed in 12/30 (40%) of country’s districts (RR>1). Most significant spatial clusters of diarrhoea were observed in the northern province (RR=1.66, p<001). We found a statistically significant positive and negative relationship between diarrhoeal disease, and temperature and rainfall respectively (p<0.001). Increase in one millimeter of rainfall was associated with decrease of 14 cases of diarrhoea while increase of one degree Celsius of temperature was associated with an increase of 17 diarrhoea cases.Conclusion: More districts were remarked with risk of diarrhoea which require targeted control intervention. Furthermore, significant association between diarrhoea case and climate dynamics was observed. This call for the public attention to climate changes which affect health especially children aged less than five years

scholarly journals Evaluation of surveillance system for pneumonia in children below five years, Tema Metropolis, Ghana, 2012 – 2016

2020 ◽  
Vol 54 (2) ◽  
pp. 11-17
Author(s):  
Dora Dadzie ◽  
Adolphina Addo-Lartey ◽  
Nana Peprah ◽  
Ernest Kenu
Keyword(s):  
Surveillance System ◽  
Laboratory Data ◽  
Case Fatality ◽  
Information Management System ◽  
Case Definition ◽  
Health Staff ◽  
Suspected Case ◽  
Surveillance Systems ◽  
District Health ◽  
Under Five

Background: We evaluated the pneumonia surveillance system in Tema Metropolis to determine whether it is meeting its objectives and to assess its attributes.Design: Descriptive primary and secondary data analysisData Source: We interviewed health staff on the system’s operation and resources. We also extracted 2012-2016 surveillance dataset for under-five pneumonia cases and deaths from the District Health Information Management System for review.Participants: Health staffIntervention: The Centers for Disease Control (CDC) updated guidelines for evaluating surveillance systems was used to assess system attributes. Main outcome measure: state of the pneumonia surveillance system in TemaResults: A suspected case was defined as fast breathing in any child < 5 years old. The case definition was easy to apply, even at the community level. From 2012 to 2016, a total of 3,337 cases and 54 deaths (case fatality rate 1.6%) was recorded from 13 (23.6%) of 55 health facilities. Two epidemics were missed by the district because data were not being analysed. There were no laboratory data on antimicrobial resistance. Although reporting timeliness increased from 28.1% in 2012 to 83% in 2016, data inconsistencies existed between reporting levels.Conclusion: The surveillance system for under-five pneumonia in Tema Metropolis is simple, stable, flexible, timely,but of low sensitivity and acceptability, and only partly meeting its objectives. Major shortcomings are lack of laboratory data, non-use of data and low representativeness.Keywords: Under-five Pneumonia, Surveillance System Evaluation, Tema, GhanaFunding: The study was supported by a grant to author DB by the President’s Malaria Initiative (PMI) -CDC CoAg 6NU2GGH001876

scholarly journals Undernourished children presenting to an urban emergency department of a tertiary hospital in Tanzania: a prospective descriptive study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Prosper J. Bashaka ◽  
Hendry R. Sawe ◽  
Victor Mwafongo ◽  
Juma A. Mfinanga ◽  
Michael S. Runyon ◽  
...  
Keyword(s):  
Emergency Department ◽  
Case Fatality ◽  
Descriptive Study ◽  
High Rate ◽  
World Health ◽  
Mortality Data ◽  
Children Under Five ◽  
Under Five ◽  
Risk Of Death ◽  
Increased Risk

Abstract Background: Childhood undernutrition causes significant morbidity and mortality in low- and middle-income countries (LMICs). In Tanzania, the in-hospital prevalence of undernutrition in children under five years of age is approximated to be 30% with a case fatality rate of 8.8%. In Tanzania, the burden of undernourished children under five years of age presenting to emergency departments (EDs) and their outcomes are unknown. This study describes the clinical profiles and outcomes of this population presenting to the emergency department of Muhimbili National Hospital (ED-MNH), a large, urban hospital in Dar es Salaam, Tanzania. Methods This was a prospective descriptive study of children aged 1–59 months presenting to the ED-MNH over eight weeks in July and August 2016. Enrolment occurred through consecutive sampling. Children less than minus one standard deviation below World Health Organization mean values for Weight for Height/Length, Height for Age, or Weight for Age were recruited. Structured questionnaires were used to document primary outcomes of patient demographics and clinical presentations, and secondary outcomes of 24-h and 30-day mortality. Data was summarised using descriptive statistics and relative risks (RR). Results A total of 449 children were screened, of whom 34.1% (n = 153) met criteria for undernutrition and 95.4% (n = 146) of those children were enrolled. The majority of these children, 56.2% (n = 82), were male and the median age was 19 months (IQR 10–31 months). They presented most frequently with fever 24.7% (n = 36) and cough 24.0% (n = 35). Only 6.7% (n = 9) were diagnosed with acute undernutrition by ED-MNH physicians. Mortality at 24 h and 30 days were 2.9% (n = 4) and 12.3% (n = 18) respectively. A decreased level of consciousness with Glasgow Coma Scale below fifteen on arrival to the ED and tachycardia from initial vital signs were found to be associated with a statistically significant increased risk of death in undernourished children, with mortality rates of 16.1% (n = 23), and 24.6% (n = 35), respectively. Conclusions In an urban ED of a tertiary referral hospital in Tanzania, undernutrition remains under-recognized and is associated with a high rate of in-hospital mortality.

scholarly journals Diarrhoeal Diseases in Children Under Five Years Exhibited Space-Time Disparities and Priority Areas for Control Interventions in Rwanda

2020 ◽  
Author(s):  
LADISLAS NSHIMIYIMANA ◽  
Peris Monchari Onyambu ◽  
Erigene Rutayisire
Keyword(s):  
Geographical Area ◽  
Negative Relationship ◽  
Health Concern ◽  
Maximum Temperature ◽  
Health Management Information System ◽  
Public Attention ◽  
Children Under Five ◽  
Under Five ◽  
Under Five Children ◽  
Diarrhoeal Diseases

Abstract Background: The Diarrhoeal diseases remain to be a public health concern despite the existence of preventive measures and developing are the most affected. It affects more children less than five years compared to the rest of the population. The burden of childhood diarrhoea varies with geographical area and time bound. A part from this variation, the link between climate change and diarrhoea among under-five children has not been well understood. This study aims to determine the trends, spatial temporal and seasonal characteristics of diarrhoea diseases among Rwandan under-five children using routine Health Management Information System (HMIS) data from 2014 to 2018. Methods: Data on cases of diarrhoeal diseases in children under-five years were extracted from HMIS for a period of 5 years. The Rwanda Meteorology Agency provided climatology data including daily minimum and maximum temperature, and daily rainfall. Incidence rate were calculated to examine the trend, and excess hazard was assessed to determine the risk and likelihood for the occurrence of cases. Linear regression was used to assess relationship between climatology variables and the occurrence of diarrhoea. Results: 1,012,827 new diarrhoeal diseases episodes were reported. Excess risk was noticed in 40% of country’s districts. We found a statistically significant positive and negative relationship between diarrhoeal disease, and maximum temperature and mean monthly rainfall respectively (p<0.001). Increase in one millimeter of rainfall was associated with decrease of 14 cases of diarrhoea while increase of one degree Celsius of maximum temperature was associated with an increase of 15 diarrhoea cases. Conclusion: More districts with risk of diarrhoea were remarked which require targeted control intervention. Furthermore, significant association between diarrhoea case and climate dynamics was observed. This call for the public attention to climate changes which affect health especially children aged less than five years. Key words: Diarrhoeal, children under five, spatiotemporal, temperature, rainfall

scholarly journals Effect of Free Healthcare Policy for Children under Five Years Old on the Incidence of Reported Malaria Cases in Burkina Faso by Bayesian Modelling: “Not only the Ears but also the Head of the Hippopotamus”

2020 ◽  
Vol 17 (2) ◽  
pp. 417 ◽  
Author(s):  
Mady Ouédraogo ◽  
Toussaint Rouamba ◽  
Sékou Samadoulougou ◽  
Fati Kirakoya-Samadoulougou
Keyword(s):  
Burkina Faso ◽  
Negative Binomial ◽  
Malaria Incidence ◽  
Fold Increase ◽  
Healthcare Policy ◽  
Data Repository ◽  
Children Under Five ◽  
Under Five ◽  
Routine Surveillance ◽  
Free Healthcare

Burkina Faso has recently implemented an additional strategy, the free healthcare policy, to further improve maternal and child health. This policy targets children under five who bear the brunt of the malaria scourge. The effects of the free-of-charge healthcare were previously assessed in women but not in children. The present study aims at filling this gap by assessing the effect of this policy in children under five with a focus on the induced spatial and temporal changes in malaria morbidity. We used a Bayesian spatiotemporal negative binomial model to investigate the space–time variation in malaria incidence in relation to the implementation of the policy. The analysis relied on malaria routine surveillance data extracted from the national health data repository and spanning the period from January 2013 to December 2018. The model was adjusted for meteorological and contextual confounders. We found that the number of presumed and confirmed malaria cases per 1000 children per month increased between 2013 and 2018. We further found that the implementation of the free healthcare policy was significantly associated with a two-fold increase in the number of tested and confirmed malaria cases compared with the period before the policy rollout. This effect was, however, heterogeneous across the health districts. We attributed the rise in malaria incidence following the policy rollout to an increased use of health services combined with an increased availability of rapid tests and a higher compliance to the “test and treat” policy. The observed heterogeneity in the policy effect was attributed to parallel control interventions, some of which were rolled out at different paces and scales. Our findings call for a sustained and reinforced effort to test all suspected cases so that, alongside an improved case treatment, the true picture of the malaria scourge in children under five emerges clearly (see the hippopotamus almost entirely).

RELATIONSHIP OF PARENTING PATTERNS WITH INCIDENCE OF NUTRITION IN CHILDRENIN SUB-DISTRI BARAN TIMUR MERAL KARIMUN DISTRICTS

2021 ◽  
Vol 10 (2) ◽  
pp. 6-11
Author(s):  
Agung Hadi Pranomo ◽  
Dino Gagah Prihadianto
Keyword(s):  
Nutritional Status ◽  
P Value ◽  
Maternal Knowledge ◽  
District Health ◽  
Chi Square ◽  
Cross Sectional ◽  
Children Under Five ◽  
Under Five ◽  
Good Nutrition ◽  
Nutritional Status Of Children

Background : Based on data from the Karimun District Health Office in 2017, there was 0.9% malnutrition, 4.8% malnutrition, and the prevalence of underweight children was 5.7%. Meanwhile, according to the Center for Data and Information, the Ministry of Health of the Republic of Indonesia in 2017 the nutritional status of children under five to 59 months according to BW / U has 3.7% malnutrition, 14.0% malnutrition, 80.1% good nutrition and 2.1% over nutrition. The purpose of this study was to determine the relationship between maternal knowledge and parenting about the nutritional status of toddlers with the incidence of malnutrition in children under five in Baran Timur Village, Meral District, Karimun Regency. Method : This research used an analytical research design with a cross sectional design approach. Meral Karimun Regency. In this study, the population is all mothers who have toddlers aged 3-59 months who live in Baran Timur Village, Meral District, Karimun Regency as many as 460 people. The data is presented in the form of a cross table then the data is analyzed using the SPSS program (Social Science Program Statistics) through the chi-square statistical test using a significant level of 0.05 Result : from 82 respondents, it is found that 1 respondent (33.3%) with less parenting is malnutrition status, 1 respondent (33.3%) with poor parenting was malnourished and 1 respondent (33.3%) with insufficient parenting was good nutritional status. While 21 respondents (63.6%) with moderate parenting were good nutritional status and 41 respondents (89.1%) with good parenting were good nutritional status obtained a p value of 0.003

scholarly journals Effect of performance-based financing on health service delivery: a case study from Adamawa state, Nigeria

2020 ◽  
Author(s):  
Ryoko Sato ◽  
Abdullahi Belel
Keyword(s):  
Health Service ◽  
Service Delivery ◽  
Health Management ◽  
Intervention Group ◽  
Investment Project ◽  
Health Service Delivery ◽  
Health Management Information System ◽  
District Health ◽  
Performance Based Financing ◽  
Quasi Experimental

Abstract The Nigeria State Health Investment Project (NSHIP) was implemented in three Nigerian states between 2013 and 2018. Under the NSHIP, some local government areas were randomly assigned to Performance-Based Financing (PBF) intervention while others received decentralized facility financing (DFF) for comparison. This article evaluates the effect of PBF compared with DFF on health service delivery indicators in Adamawa state, under this quasi-experimental design, using the difference-in-differences technique. The analysis used health facility monthly data collected by the Health Management Information System through the District Health Information Software 2 (DHIS2). The PBF intervention group significantly increased the quantity of most of its service delivery indicators, such as antenatal care visits and deliveries by skilled personnel compared with the comparison group (DFF) after the introduction of NSHIP, although the baseline level of service delivery between PBF and DFF health facilities was statistically identical prior to the introduction of the intervention. We also conducted robustness check analysis to confirm the effect of PBF. Overall, we found a significant positive effect of PBF on most service delivery outcomes, except full vaccinations and post-natal care. One important policy implication is that we should carefully use PBF for targeted indicators.

scholarly journals STUDI KUALITATIF PELAKSANAAN PEMANTAUAN PERTUMBUHAN ANAK BALITA DI POSYANDU DI KABUPATEN BANDUNG

2019 ◽  
Vol 41 (1) ◽  
pp. 41-54
Author(s):  
Aditianti Aditianti ◽  
Erna Luciasari ◽  
Yurista Permanasari ◽  
Elisa Diana Julianti ◽  
Meda Permana
Keyword(s):  
Focus Group ◽  
Health Service ◽  
Health Workers ◽  
Child Growth ◽  
Growth Monitoring ◽  
Public Health Services ◽  
District Health ◽  
Children Under Five ◽  
Under Five ◽  
Integrated Health

ABSTRACT Integrated health service (Posyandu) is one form of strategic health effort, which provides public health services. One of the posyandu function is as promotion media and growth monitoring of children under five. The purpose of this research was to know the implementation of child growth monitoring at posyandu level in Bandung district. This was an operational studies with qualitative design.Data were collected by depth interview, focus group discussion, and observation. The population of this research were all of  the institution that responsible of nutrition surveillance. There were Regencies District Health Office, Primary Health Center (Puskesmas), and Posyandu, in Bandung District, West Java. This research is operational research with qualitatif design. Colected data used with indepth interview, focus group discusion and observasi. Indepth interview used to offices, health workers from two community health centers, and village officials. Group discussions were conducted on cadres and mothers of underfives children. This research show posyandu activities have been going well but have not implemented monitoring function of child growth. Plot weight were not doing well in KMS, interpretation of child growth were still unsuitable, and counseling had not done well. Repositioning of posyandu is needed as a means of growth monitoring children under five years and efforts to increase knowledge about routine growth monitoring for health workers and cadres. Keyword: growth monitoring, integrated health service, under five years old     Abstrak Pos pelayanan terpadu (Posyandu) merupakan salah satu bentuk upaya kesehatan yang strategis, yang menyediakan layanan kesehatan masyarakat. Salah satu fungsi posyandu adalah sebagai media promosi dan pemantauan pertumbuhan anak umur bawah lima tahun (balita). Penelitian ini bertujuan untuk mengetahui pelaksanaan pemantauan pertumbuhan balita di tingkat posyandu di Kabupaten Bandung, Jawa Barat. Penelitian ini merupakan penelitian operasional dengan desain kualitatif. Pengumpulan data melalui wawancara mendalam, diskusi kelompok terarah. Wawancara mendalam dilakukan kepada petugas di dinas kesehatan kabupaten, tenaga kesehatan dari dua pukesmas terpilih, dan aparat desa. Diskusi kelompok dilakukan pada kader dan ibu balita, dan. Hasil penelitian menunjukkan bahwa kegiatan posyandu sudah berjalan baik namun belum melaksanakan fungsi pemantauan pertumbuhan balita. Masih banyak yang tidak melakukan plot hasil penimbangan pada  KMS (kartu menuju sehat), interpretasi terhadap perubahan berat badan belum dilakukan dengan benar dan konseling yang belum berjalan baik. Perlu dilakukan reposisi posyandu sebagai sarana pemantauan pertumbuhan balita dan upaya untuk meningkatkan pengetahuan tentang pemantauan pertumbuhan secara rutin bagi tenaga kesehatan dan kader. [Penel Gizi Makan 2018, 41(1):41-54] Kata kunci: pemantauan pertumbuhan, pos pelayanan terpadu, bawah lima tahun (balita)

scholarly journals Estimating malaria incidence from routine health facility-based surveillance data in Uganda

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Adrienne Epstein ◽  
Jane Frances Namuganga ◽  
Emmanuel Victor Kamya ◽  
Joaniter I. Nankabirwa ◽  
Samir Bhatt ◽  
...  
Keyword(s):  
Travel Time ◽  
Health Facility ◽  
Health Management ◽  
Malaria Incidence ◽  
Additive Models ◽  
Surveillance Data ◽  
Health Management Information System ◽  
Care Seeking ◽  
Catchment Areas ◽  
Over Time

Abstract Background Accurate measures of malaria incidence are essential to track progress and target high-risk populations. While health management information system (HMIS) data provide counts of malaria cases, quantifying the denominator for incidence using these data is challenging because catchment areas and care-seeking behaviours are not well defined. This study’s aim was to estimate malaria incidence using HMIS data by adjusting the population denominator accounting for travel time to the health facility. Methods Outpatient data from two public health facilities in Uganda (Kihihi and Nagongera) over a 3-year period (2011–2014) were used to model the relationship between travel time from patient village of residence (available for each individual) to the facility and the relative probability of attendance using Poisson generalized additive models. Outputs from the model were used to generate a weighted population denominator for each health facility and estimate malaria incidence. Among children aged 6 months to 11 years, monthly HMIS-derived incidence estimates, with and without population denominators weighted by probability of attendance, were compared with gold standard measures of malaria incidence measured in prospective cohorts. Results A total of 48,898 outpatient visits were recorded across the two sites over the study period. HMIS incidence correlated with cohort incidence over time at both study sites (correlation in Kihihi = 0.64, p < 0.001; correlation in Nagongera = 0.34, p = 0.045). HMIS incidence measures with denominators unweighted by probability of attendance underestimated cohort incidence aggregated over the 3 years in Kihihi (0.5 cases per person-year (PPY) vs 1.7 cases PPY) and Nagongera (0.3 cases PPY vs 3.0 cases PPY). HMIS incidence measures with denominators weighted by probability of attendance were closer to cohort incidence, but remained underestimates (1.1 cases PPY in Kihihi and 1.4 cases PPY in Nagongera). Conclusions Although malaria incidence measured using HMIS underestimated incidence measured in cohorts, even when adjusting for probability of attendance, HMIS surveillance data are a promising and scalable source for tracking relative changes in malaria incidence over time, particularly when the population denominator can be estimated by incorporating information on village of residence.

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