Enhancing SARS-CoV-2 surveillance in Malawi using telephone syndromic surveillance from July 2020 to April 2022.
Godfrey Woelk, Thulani Maphosa, Rhoderick Machekano, Annie Chauma-Mwale, Lucky Makonokaya, Suzgo B Zimba, Rachel Kanyenda Chamanga, Rose Nyirenda, Andrew Auld, Evelyn Kim, Veena Sampathkumar, Allan Ahimbisibwe, Louiser Kalitera, Lindsay Kim, Alice Maida
Author Information
Godfrey Woelk: Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USA.
Thulani Maphosa: Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi tmaphosa@pedaids.org. ORCID
Rhoderick Machekano: Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia, USA.
Annie Chauma-Mwale: Public Health Institute of Malawi, Ministry of Health, Lilongwe, Malawi.
Lucky Makonokaya: Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi.
Suzgo B Zimba: Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi.
Rachel Kanyenda Chamanga: Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi.
Rose Nyirenda: Ministry of Health Department of HIV and AIDS, Lilongwe, Central Region, Malawi.
Andrew Auld: US Centers for Disease Control and Prevention, Division of Global HIV and TB, Lilongwe, Malawi.
Evelyn Kim: US Centers for Disease Control and Prevention, Division of Global HIV and TB, Lilongwe, Malawi.
Veena Sampathkumar: Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi.
Allan Ahimbisibwe: Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi.
Louiser Kalitera: Elizabeth Glaser Pediatric AIDS Foundation, Lilongwe, Malawi.
Lindsay Kim: US Centers for Disease Control and Prevention, Division of Global HIV and TB, Lilongwe, Malawi.
Alice Maida: US Centers for Disease Control and Prevention, Division of Global HIV and TB, Lilongwe, Malawi.
INTRODUCTION: Monitoring the SARS-CoV-2 pandemic in low-resource countries such as Malawi requires cost-effective surveillance strategies. This study explored the potential utility of phone-based syndromic surveillance in terms of its reach, monitoring trends in reported SARS-CoV-2-like/influenza-like symptoms (CLS/ILS), SARS-CoV-2 testing and mortality. METHODS: Mobile phone-based interviews were conducted between 1 July 2020 and 30 April 2022, using a structured questionnaire. Randomly digital dialled numbers were used to reach individuals aged ���18 years who spoke Chichewa or English. Verbal consent was obtained, and trained research assistants with clinical and nursing backgrounds collected information on age, sex, region of residence, reported CLS/ILS in the preceding 2���weeks, SARS-CoV-2 testing and history of household illness and death. Data were captured on tablets using the Open Data Kit database. We performed a descriptive analysis and presented the frequencies and proportions with graphical representations over time. FINDINGS: Among 356���525 active phone numbers, 138���751 (38.9%) answered calls, of which 104���360 (75.2%) were eligible, 101���617 (97.4%) consented to participate, and 100���160 (98.6%) completed the interview. Most survey respondents were aged 25-54 years (72.7%) and male (65.1%). The regional distribution of the respondents mirrored the regional population distribution, with 45% (44%) in the southern region, 41% (43%) in the central region and 14% (13%) in the northern region. The reported SARS-CoV2 positivity rate was 11.5% (107/934). Of the 7298 patients who reported CLS/ILS, 934 (12.8%) reported having undergone COVID-19 testing. Of the reported household deaths, 47.2% (982 individuals) experienced CLS/ILS 2���weeks before their death. CONCLUSION: Telephonic surveillance indicated that the number of SARS-CoV-2 cases was at least twice as high as the number of confirmed cases in Malawi. Our findings also suggest a substantial under-reporting of SARS-CoV-2-related deaths. Telephonic surveillance has proven feasible in Malawi, achieving the ability to characterise SARS-CoV-2 morbidity and mortality trends in low-resource settings.
