3.3. The analytic results of the malaria case reports from early 2017 up to now
3.3.1. Demographic characteristics of the study subjects
Table 3.9 Demographic characteristics of the study subjects
| No. | Variable | Phu Yen | Khanh Hoa | Gia Lai | Dak Lak | Dak Nong | Binh Thuan | Da Nang | Total |
| 1 | Age group | Under 5 | 0 | 5 (7,25%) | 2 (1,11%) | 2
(0,84%) | 1 (0,68%) | 0 | 0 | 10 (1,35%) |
| From 5 to under 15 | 4 (11,76%) | 13 (18,84%) | 18 (10,00%) | 18 (7,53%) | 6 (4,08%) | 5 (7,35%) | 0 | 64 (8,66%) |
| 15 and above | 30 (88,24%) | 51 (73,91%) | 160 (88,89%) | 219 (91,63%) | 140 (95,28) | 63 (92,65%) | 2 (100%) | 665 (89,99%) |
| 2 | Age | Mean ± SD | 33,59 ±15,64 | 31,03±19,03 | 27,04±11,64 | 28,81±11,24 | 31,23±12,16 | 32,37±12,56 | 32,5 | 29,62±12,89 |
| (Min-Max) | 12 - 77 | 8th - 70 | 6th - 76 | 2 - 75 | 3-61 | 9-60 | 16-49 | 6th - 77 |
| 3 | Gender | Male | 30 (88,24%) | 54 (78,26%) | 158 (87,78%) | 211 (88,28%) | 129 (87,76%) | 64 (94,12%) | 2 (100%) | 648 (87,69%) |
| Female | 4 (11,76%) | 15 (21,74%) | 22 (11,72%) | 27 (11,3%) | 18 (12,24%) | 4 (5,88%) | 0 | 87 (12,18%) |
| Pregnant women | 0 | 0 | 0 | 1 (0,42%) | 0 | 0 | 0 | 1 (0,13%) |
| 4 | Ethnic group | Kinh | 21
(61,76%) | 24
(34,78%) | 53
(29,44%) | 87 (36,40%) | 53 (36,05%) | 29 (42,65%) | 2 (100%) | 269 (36,40%) |
| E De | 5
(14,71%) | 4
(5,80%) | 0 | 51
(21,34%) | 6 (4,08%) | 0 | 0 | 66 (8,93%) |
| RagLai | 2
(5,88%) | 35
(50,72%) | 0 | 0 | 0 | 17 (25,00%) | 0 | 54 (7,3%) |
| Gia Rai | 0 | 0 | 102
(56,67%) | 12
(5,02%) | 0 | 6 (8,82%) | 0 | 120 (16,24%) |
| H' Mong | 2
(5,88%) | 0 | 0 | 20
(8,37%) | 30 (20,41%) | 0 | 0 | 52 (7,04%) |
| Others | 4 (11,77%) | 6 (8,70%) | 25 (13,89%) | 69 (28,87%) | 58 (39,46%) | 16 (23,53%) | 0 | 178 (24,09%) |
| 5 | Occupation | Farmer | 26 (76,47%) | 16 (23,19) | 113
(62,78%) | 176
(73,64%) | 115
(78,23) | 43 (63,24%) | 2 (100%) | 491 (66,44%) |
| Forest-related jobs | 0 | 36 (52,17%) | 13
(7,22%) | 15
(6,28%) | 11
(7,48) | 10 (14,71%) | 0 | 85 (11,5%) |
| Others | 8 (23,53%) | 17 (24,64%) | 54 (30,00%) | 48 (20,08%) | 21 (14,29%) | 15 (22,05%) | 0 | 163 (22,06%) |
Remarks: The data in Table 3.9 showed some of the demographic characteristics of all MPs being recorded in 7 surveyed provinces. Of 739 reported MPs, those in the age group of 15 and above accounted for the highest percentage at 89.99%, followed by the age group 5 to under 15 with 8.66%, and the lowest belonged the age group under 5 with 1.35%. The average age of malaria cases was 30, the youngest age was 6 months, the oldest was 77. The male MPs dominates with a notable proportion of 87.69% while the female 12.18% and oÂnly oÂne case of pregnant MP, accounting for 0.13%. There were about 20 different ethnic groups recorded, but the majority were Kinh (36,40%), Gia Rai (16,24%), E De (8,93%), H’Mong (7,04%) and Raglai (7,3%); the others such as Tay, Nung, Dao, Thai, etc. accounted for a very low proportion of the total. Their occupations were also diversified, mainly jobs relating to agriculture (66.44%) and forestry (11.5%), and the rest 22.06% belonged other careers such as traders, foresters, students and so oÂn.
3.3.2. Epidemiological characteristics of the study subjects
Table 3.10. Epidemiological characteristics of the study subjects
| No. | Variable | Phu Yen | Khanh Hoa | Gia Lai | Dak Lak | Dak Nong | Binh Thuan | Da Nang | Total |
| 1 | Were they in malaria-endemic areas? | Yes | 33 (97,06%) | 68 (98,55%) | 180 (100%) | 235 (98,33%) | 147 (100%) | 67 (98,53%) | 2 (100%) | 732 (99,05%) |
| No | 1 (2,94%) | 1 (1,45%) | 0 | 4 (1,67%) | 0 | 1 (1,47%) | 0 | 7 (0,95%) |
| 2 | Where were they 14 days before getting a fever? | At home | 4 (11,76%) | 27 (39,13%) | 20 (11,11%) | 34 (14,23%) | 7
(4,76%) | 11 (16,18%) | 0 | 103 (13,94%) |
| In mountain fields | 16 (47,07%) | 34 (49,27%) | 75 (41,67%) | 91 (38,08%) | 46
(31,29) | 19 (27,93%) | 0 | 281 (38,02%) |
| In forests | 2 (5,88%) | 6 (8,70%) | 70 (38,89%) | 84 (35,14%) | 58
(39,46) | 33 (48,53%) | 0 | 253 (34,24%) |
| Crossing borders | 0 | 1 (1,45%) | 6 (3,33%) | 13 (5,44%) | 12 (8,16) | 0 | 0 | 32 (4,33%) |
| Somewhere outside their communes | 12 (35,29%) | 1 (1,45%) | 9 (5,00%) | 17 (7,11%) | 24 (16,33) | 5 (7,35%) | 2 | 70 (9,47%) |
| 3 | Have they infected with malaria before? | Yes | 6 (17,65%) | 7 (10,14%) | 40 (22,22%) | 57 (23,85%) | 31 (21,09%) | 14 (20,59%) | 0 | 155 (20,97%) |
| No | 28 (82,35%) | 62 (89,86%) | 140 (77,78%) | 182 (76,15%) | 116 (78,91%) | 54 (79,41%) | 2 (100%) | 584 (79,03%) |
| 4 | Is there anyone in their houses be infected with malaria? | Yes | 0 | 2 (2,9%) | 11 (6,11%) | 14 (5,86%) | 5 (3,4%) | 3 (4,41%) | 0 | 35 (4,74%) |
| No | 34 (100%) | 67 (97,1%) | 169 (93,89%) | 225 (94,14%) | 142 (96,6%) | 65 (95,59%) | 2 (100%) | 704 (95,26%) |
| 5 | Is there anyone around be infected with malaria? | Yes | 2 (5,88%) | 1 (1,45%) | 26 (14,44%) | 35 (14,64%) | 2 (1,36%) | 14 (20,59%) | 0 | 80 (10,83%) |
| No | 32 (94,12%) | 68 (98,55%) | 154 (85,56%) | 204 (85,36%) | 145 (98,64%) | 54 (79,41%) | 2 (100%) | 659 (89,17%) |
Remarks: Among 739 MPs in 7 provinces who were surveyed from the beginning of 2017 up to now, 732 have lived in the malaria-endemic areas, accounting for 99.05%, especially in the provinces of Gia Lai and Dak Nong and Da Nang city, 100% of MPs have lived in the malaria-endemic areas. Regarding the MPs’ residence 14 days before they get a fever, 281 MPs (38.02%) were in the upland fields, and 253 (34.24%) in the forests, 103 (13.94%) at home, 70 (9.47%) in other places outside their communes, and 32 crossed the borders, making up the lowest rate of 4.33%. The distribution of the MPs’ residence 14 days before they get a fever was also different in each province. In Phu Yen province, most MPs were in the mountain fields (47.07%) and elsewhere outside their communes (35.29%). In Khanh Hoa province, MPs were mainly in the upland fields (49.27%) and at home (39.13%). In three Central Highlands provinces, the main places of residence of MPs were mountain fields and forests. The proportion of MPs who used to be infected with malaria was relatively low, accounting for 20.97% while the malaria incidence was of 79.03%. In addition, the rates of malaria infections in the MPs’ family members and in the people living around the MPs’ houses were relatively low, accounting for 4.74% and 10.83%, respectively.
3.3.2. Characteristics of detection and treatment of MPs
Table 3.11. Characteristics of detection and treatment of MPs
| No. | Variable | Phu Yen | Khanh Hoa | Gia Lai | Dak Lak | Dak Nong | Binh Thuan | Da Nang | Total |
| 1 | Time from getting a fever until diagnosis | Mean ± SD | 3,75±2,05 | 3,14±1,92 | 3,44±3,38 | 4,07±3,99 | 3,34±2,55 | 4,72±4,31 | 14 | 3,64±3,32 |
| (Min-Max) | 1-10 | 1-9 | 0-30 | 1-35 | 1-14 | 1-30 | 14 | 0-35 |
| 2 | Symptoms | Fever | 32 (94,12%) | 62 (89,86%) | 152 (84,44%) | 236 (98,74%) | 136 (92,52%) | 64 (98,21%) | 2 (100%) | 684 (92,56%) |
| Chills | 32 (94,12%) | 42 (60,87%) | 168 (93,33%) | 182 (76,15%) | 147 (100%) | 55 (80,88%) | 2 (100%) | 628 (84,98%) |
| Sweating | 28 (82,35%) | 31 (44,93%) | 164 (91,11%) | 137 (57,32%) | 139 (94,56%) | 46 (67,65%) | 2 (100%) | 547 (74,02%) |
| 3 | Testing results | P.f | 17
(50%) | 48 (69,57%) | 124 (68,89%) | 150
(62,76%) | 107
(72,79%) | 30 (44,12%) | 1 (50%) | 447 (64,55%) |
| P.v | 17
(50%) | 18 (26,08%) | 54 (30,00%) | 88 (36,82%) | 40 (27,21%) | 37 (54,41%) | 1 (50%) | 255 (34,51%) |
| P.m | 0 | 3 (4,35%) | 0 | 0 | 0 | 0 | 0 | 3 (0,40%) |
| PH | 0 | 0 | 2 (1,11%) | 1 (0,42%) | 0 | 1 (1,47%) | 0 | 4 (0,54%) |
| 4 | DOT | Yes | 13 (38,24%) | 47 (68,12%) | 157 (87,22%) | 214 (89,54%) | 88 (59,86%) | 63 (92,65%) | 2 | 580 (78,48%) |
| No | 21 (61,76%) | 22 (31,88%) | 23 (12,78%) | 25 (10,46%) | 59 (40,14%) | 5 (7,35%) | 0 | 159 (21,52%) |
| 5 | Current status | Inpatients | 20 (58,82%) | 33
(47,83%) | 52 (28,89%) | 158 (66,11%) | 47 (31,97%) | 25 (36,76%) | 0 | 335 (45,33%) |
| Outpatients | 8
(23,53%) | 27 (39,13%) | 124 (68,69%) | 31 (12,97%) | 16 (10,88%) | 24 (35,30%) | 0 | 230 (31,12%) |
| Discharged patients | 4 (11,76%) | 6 (8,70%) | 4 (2,22%) | 48 (20,08%) | 79 (53,74%) | 18 (26,47%) | 2 (100%) | 161 (21,79%) |
| Transferred patients | 2 (5,88%) | 3 (4,35%) | 0 | 2 (0,84%) | 5 (3,40%) | 1 (1,47%) | 0 | 13 (1,76%) |
Remarks: The results of analyzing the characteristics of detection and treatment of MPs showed that the average time from getting a fever to being diagnosed was 4 days; in the provinces of Phu Yen, Khanh Hoa and Dak Nong, the shortest time from fever to diagnosis was 1 day, the longest was 14 days; in Gia Lai and Dak Lak provinces, the longest time from fever to detection was from 30 to 35 days. Most patients have typical symptoms of malaria including fever, chills and sweating. In terms of the distribution of malaria parasites, there were differences among the provinces. In 7 surveyed provinces, there were totally 739 malaria parasites, of which P.f. accounted for 64.55%, P.v. 34.51%, P.m 0.45% and mixed infections 0.54%. The P.f/P.v rate in Phu Yen, Binh Thuan and Da Nang was 1/1, in Khanh Hoa, Gia Lai, Dak Lak and Dak Nong 2.5/1; 03 species of P.m were all concentrated in Khanh Hoa province. The proportion of MPs participating in DOT in 7 surveyed provinces was 78.48%. In Da Nang city and Khanh Hoa, Binh Thuan, Gia Lai, Dak Lak and Dak Nong provinces, this proportion was relatively high; in Phu Yen province, oÂnly 38.24% of the MPs were involved in DOT and the rest 61.76% were not. As regards the status of MPs as reporting cases of malaria, 45.33% of MPs were given treatments as inpatients, 31.12% as outpatients, 21.79% were discharged and 1.76% were transferred to other hospitals. These proportions were fairly different in the provinces; in Da Nang, 100% of MPs were discharged; in Gia Lai, a higher number of MPs were treated as outpatients (68.69%) than as inpatients (28.89%); meanwhile, MPs as inpatients accounted for higher rates as in Phu Yen (58.82%), Khanh Hoa (47.83%) and Dak Lak (66.11%). In Binh Thuan, the rates of inpatients and outpatients were similar (about 36%); particularly, in Dak Nong, the highest rate of discharged MPs (53.74%) was recorded at the time of making the malaria case report.
IV. Conclusions
4.1. Assessment of the Information - Reporting (IR) situation of malaria cases at health-care levels in some provinces of Central Vietnam
Human resources for IR at health-care levels in 6 surveyed provinces, including Quang Binh, Phu Yen, Khanh Hoa, Gia Lai, Dak Lak and Dak Nong, have relatively ensured the quality of statistical reporting.
- The office informatics standard of the staff in charge of malariology, especially at district and commune levels, is very good. The health stations are all equipped with computers of stable configuration which are connected to the internet to guarantee that information can be send quickly and accurately.
- As regards the reporting of malaria case under the Decision No.741, there were 5 over 6 provinces implemented this activity from January 2017 to May 2017 and oÂnly Quang Binh province has not conducted yet.
- The frequency of sending reports in 6 surveyed provinces was 75.77%. Three provinces completely fulfilled their reporting, including Phu Yen, Dak Lak and Dak Nong. No reports have been sent by Quang Binh province. The reporting rates in Khanh Hoa and Gia Lai province were 70% and 60%, respectively. The information in the reports was relatively adequate.
- Case reports were made mainly at commune health stations and district health centers. These health-care facilities carried out the reporting relatively well within prescribed time (before 48 hours); if cases were found oÂn Saturdays and Sundays, the reporting time would be slower than the prescribed time. Most cases detected in hospitals (province and district) have been reported late against prescribed time.
- The main method for rapidly providing information of malaria cases to the higher levels was sending an email with attached MS Word file. Some medical stations in Krong Pa district employed direct calls or sent written reports to district health staff.
4.2. Comments and suggestions oÂn improving the quality of IR health workers' reports
- Reducing some of the contents of the case report (form 1)
- Supporting an application or a tool for data input to facilitate the process of making reports.
- Regulating how to enter a patient’s code so as to make it more convenient for health workers.
- Sending a photo of the report to the higher levels via some free applications oÂn smartphones in case email cannot be sent.
V. Recommendations
- With the above-mentioned favorable conditions as well as challenges/difficulties, the monitoring mission team would like to propose some solutions of applying information technology in IR as follows:
- Immediate solution: In addition to written reports sent by post for archives, inspection and comparison, it is probably to quickly send a case report to the upper levels via email or through the free application Zalo running oÂn smartphones.
- Medium-term solution: To build a small oÂnline module oÂn the computer, which allows quick entry of case information (form 1) to send to a common database via internet connection. It is possible for the upper level to view the report of the lower level at this database. Estimated construction costs for this application are from VND 200 - 300 million.
- Long-term solution: To develop a malaria management software that can link the databases of NIMPE, IMPE Ho Chi Minh and IMPE Quy Nhon and connect to the Ministry of Health's database. The information technology platform should be based oÂn the HDR-2 standard (currently used by WHO and CDC USA).
- To shorten some of the contents in Form 1 (Decision No. 741) in order to simplify the report form, creating more favorable conditions for report writers.
- To organize a workshop oÂn seeking mechanisms for information exchange of malaria cases between hospitals (province and district) and provincial preventive medicine centers/provincial centres for malaria control and district health centers in order to rapidly report malaria cases within the prescribed time.
- To hold workshops oÂn finding measures to promote the reporting of malaria cases in accordance with the real time, including weekends and holidays.
- In the coming time, it is necessary that the Provincial Centre of Malariology and Endocrinology of Quang Binh soon disseminates the prescribed forms according to the Decision No.741/QD-BYT dated 02 March 2016 oÂn "Guidelines for surveillance and control of malaria" among provincial health-care facilities.