OBJECTIVE
This paper evaluates the effectiveness of “active
fever surveillance” during malaria outbreak (from
December 2006 to June 2007) in western Jamaica.
INTRODUCTION
Malaria, major leading cause of morbidity and
mortality in third world countries has been
successfully eliminated from Jamaica since 1965.
This, however, is being constantly challenged by (1)
lack of sustained vector control activities (2)
increased movement of global travellers to and from
endemic countries to Jamaica given that the presence
of vector “anopheles mosquitoes” that transmit
malaria parasites. On December 2006 the first locally
transmitted case of malaria was identified in
Kingston, the capital city of Jamaica. Due to the
impending threat to the country’s economy, such as
travel advisory as Jamaica’s main foreign income
comes from tourism especially in the western
Jamaica, and to health care system. The Ministry of
Health (MoH) stepped up the prevention and control
of malaria program. The objectives of the program
are (a) early detection of cases and (b) prompt
treatment of cases identified.
METHODS
Active fever surveillance is being used to screen
malaria (a) at all sentinel sites (b) official ports (air
and sea) and (c) private hospitals in the western
Jamaica as fever is the most common presentation in
all laboratory confirmed malaria cases identified in
Jamaica. In western Jamaica there are a total of four
health departments with twenty (20) sentinel sites
including four government hospitals and fourteen
(14) primary health care health centers with a total
population of 452,724. The data of daily line listing
on fever cases which are fitted into the fever case
definition (fever is being defined as a person
presenting with acute onset of fever with temperature
38C or 100.4F) are collected from all sites and
analysed at local health departments and reported to
Ministry of Health. The screening of visitors and
returning residents from malarious endemic countries
is also carried out at all officials’ ports including one
major international airport and selected seaports. In
addition, once a confirmed case of malaria is
identified, house to house visits were also made to
the area where the case came from and active fever
surveillance was done and these activities were led
by a multidisciplinary health team.
RESULTS
Active Fever Surveillance – Approximately more than
(350) fever cases were line listed and (278) of (350
) are being diagnosed as suspected malaria during the
period. All were tested negative for malaria parasites.
Port Health (Airport and Seaport) – A total of 2759
visitors were listed to have come from malarious
endemic countries during the period (Dec 06 – June
07). Of 2570 visitors only 2 persons were found to
have fever and tested for malaria and came back
negative for malaria parasites in their blood.
House to house active fever surveillance – A total of
approximately (1205) homes were visited by health
teams and (65) fever cases were identified and tested
and all came back negative for malaria parasites.
CONCLUSION
Case detection (quality) – There is major shortcoming
on the collection of “fever” cases, as the exact
temperature reading is not documented on the
patients’ record. Moreover some patients took anti
pyrexia medication prior to visiting health institutions
thus their exact temperature reading could not be
ascertain and could not be counted as “fever case” as
they did not fit in fever case definition.
Frequency of data reporting – At the beginning of
outbreak all sentinel sites, especially government
facilities reported their data to local health
departments daily. However as time progressed,
frequency became less and less and at some point
some sites stopped reporting. Data from all private
physicians’ offices were not collected.
House to house active fever surveillance – Although
this task took a great deal of human and material
resources it helped the health team to carry out
multiple activities such as environmental health
assessment and mass health education at the
community level.
Port Health – The strengthening of existing port
health surveillance at major international airport and
sea port was of a great success as majority of visitors
were screened and interviewed at the point of entry to
prevent importation of malaria.