Background
The completion of case-based surveillance forms was vital for case identification during COVID-19 surveillance in Malawi. Despite significant efforts, the resulting national data suffered from gaps and inconsistencies which affected its optimal usability. The objectives of this study were to investigate the processes of collecting and reporting COVID-19 data, to explore health workers’ perceptions and understanding of the collection tools and processes, and to identify factors contributing to data quality.
Methods
A total of 75 healthcare professionals directly involved in COVID-19 data collection from the Malawi Ministry of Health in Lilongwe and Blantyre participated in Focus Group Discussions and In-Depth Interviews. We collected participants’ views on the effectiveness of surveillance forms in collecting the intended data, as well as on the data collection processes and training needs. We used MAXQDA for thematic and document analysis.
Results
Form design significantly influenced data quality and, together with challenges in applying case definitions, formed 44% of all issues raised. Concerns regarding processes used in data collection and training gaps comprised 49% of all the issues raised. Language issues (2%) and privacy, ethical, and cultural considerations (4%), although mentioned less frequently, offered compelling evidence for further review.
Conclusions
Our study highlights the integral connection between data quality and the design and utilization of data collection forms. While the forms were deemed to contain the most relevant fields, deficiencies in format, order of fields, and the absence of an addendum with guidelines, resulted in large gaps and errors. Form design needs to be reviewed so that it appropriately fits into the overall processes and systems that capture surveillance data. This study is the first of its kind in Malawi, offering an in-depth view of the perceptions and experiences of health professionals involved in disease surveillance on the tools and processes they use.
Discussion
Data collected through Case Based Surveillance and Response forms and line lists was the source of Malawi's national epidemiological database for COVID-19 and the basis of public health communications and decisions by the Ministry of Health. Efforts to compile data nationally from the point of manually filling in forms and registers were characterized by delays, and poor coordination, and resulted in data with large gaps, and inconsistencies that necessitated great effort to clean and prepare for analysis. This study sought to understand the factors leading to data quality issues by analysing the utilisation of these forms by health professionals. We investigated the design of the data collection tools and processes used by health professionals for COVID-19 surveillance. We conducted focus group discussions and interviews with all types of cadres involved in COVID-10 data collection in Malawi: clinicians, laboratory technicians, health surveillance officers, and environmental health officers. We found that form design and associated processes significantly influenced data quality and limited its effective use in decision-making. Poor form design and challenges in applying case definitions formed 44% of all issues raised, and concerns regarding processes used in data collection and training gaps comprised 49% of the issues raised. Language issues (2%) and privacy, ethical, and cultural considerations (4%), although mentioned less frequently, offered compelling cases for further review of the forms and processes involved. This study is the first of its kind in Malawi, offering an in-depth view of the perceptions and experiences of health professionals involved in disease surveillance of the tools and processes they use. Our study highlights the integral connection between data quality and the design and utilization of data collection formats, pointing to the need for a review and appropriate training and processing.