Evaluation of the malaria death notification surveillance system focusing on the electronic malaria death investigation form piloted in Manicaland Province, Zimbabwe, 2023

Introduction: Zimbabwe is accelerating towards malaria elimination by 2030. Investigation of malaria deaths is a requirement. The malaria case management technical working group recommended the development of an electronic malaria death investigation form after noting the challenges of the paper-based one. The form was piloted in Manicaland in 2022. We evaluated it to assess if it could be rolled out to other provinces. We evaluated the electronic malaria death notification surveillance system in Manicaland province, 2023. Methods: A descriptive cross-sectional study using the updated CDC guidelines for evaluating public health surveillance systems was conducted at 11 hospitals in Manicaland. Administered 62 questionnaires among healthcare workers (HCWs). Conducted key informant interviews and reviewed records. We generated frequencies, means, and proportions using Epi Info 7.2.5. Results: The median age for participants was 31 (IQR: 25-39). Their median year in service was 9 (IQR: 2-6). Out of 18 trained nurses, seven had not used the system. No trained doctors had used the system, and 40% of HCWs said the electronic form excluded zero reporting and private sector participation. 80% found the form easy to use, 20% found it confusing, and 50% notified deaths electronically within 24 hours. There were no guidelines. The estimated once-off cost of running the system per district per year was USD 3,000. Conclusion: The system was simple, flexible, acceptable and useful. However, it was poor on timeliness, sensitivity and representativeness and data from the private health facilities.