Evaluation of the “1–3–7” surveillance and response approach for malaria elimination and challenges faced in its initial phase of implementation: Farta district, Ethiopia

Abstract

Ethiopia implemented the "1–3–7" surveillance and response approach for malaria elimination in selected districts. Evaluating its progress is crucial to ensure alignment with the national malaria elimination plan. This study assesses the approach's implementation and investigates challenges faced during its initial phase in the Farta district, northwest Ethiopia. A concurrent mixed-methods design was employed, combining a review of malaria elimination reports from April 2nd to December 24th, 2023, with interviews of 22 key stakeholders. Data were extracted from the district’s malaria surveillance database, and qualitative data were collected to explore the experiences and challenges of local health staff. The CDC’s guidelines for evaluating surveillance systems were used to assess the approach’s attributes. A total of 199 malaria cases were reported, with 85.4% notified within one day. Of the 180 eligible cases, 86.7% were investigated within three days. Asymptomatic testing of 1,590 individuals identified 31 additional cases, yielding a 1.9% positivity rate. However, there were significant gaps in timeliness, completeness, and understanding of the approach, with only 31.8% of key players demonstrating adequate knowledge. Common challenges included security issues, insufficient antimalarial supplies, and a lack of dedicated staff. The implementation of the "1–3–7" surveillance approach in the Farta district did not fully align with national malaria elimination guidelines. Addressing security, improving capacity-building, ensuring antimalarial supply, and strengthening advocacy and community mobilization are critical for success.