Estimating malaria incidence from routine health facility-based surveillance data in Uganda
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Malaria Journal Open Access
RESEARCH
Estimating malaria incidence from routine health facility‑based surveillance data in Uganda Adrienne Epstein1* , Jane Frances Namuganga2, Emmanuel Victor Kamya2, Joaniter I. Nankabirwa2,3, Samir Bhatt4, Isabel Rodriguez‑Barraquer1, Sarah G. Staedke5, Moses R. Kamya2,3, Grant Dorsey1 and Bryan Greenhouse1,6
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 denomi‑ nator 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 denomi‑ nator 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 esti‑ mate 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
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