Participatory surveillance improved rabies case detection in urban Malawi

A retrospective analysis of a six-month surveillance pilot in Lilongwe tracked 610 suspected rabies reports through investigation and classification. Participatory surveillance retained reports more consistently and detected more confirmed or probable cases than passive surveillance, although most reports overall were lost before the pathway was complete.

Only 24.6% of 610 reports completed surveillance classification.
Participatory surveillance classified all 46 reports in its pathway.
It identified all nine laboratory-confirmed cases during the pilot.
Most report losses occurred before traceability was established.

Researchers retrospectively analysed programme records from a participatory rabies surveillance pilot in urban Lilongwe, Malawi, conducted from January to June 2020. They compared retention, case ascertainment and diagnostic yield with passive surveillance during the pilot, and with routine diagnostic records from matching periods in 2015–2019.

Of 610 suspected reports, 393 (64.4%) could not be traced; another 67 of 217 traceable reports did not progress to investigation and classification. Only 150 reports (24.6%) completed the pathway. All 46 participatory reports were classified, compared with 104 of 564 passive reports (18.4%). Confirmed or probable rabies was found in 13 of 46 participatory reports (28.3%) and 7 of 104 passive reports (6.7%; odds ratio 5.39, 95% CI 1.82–17.39). Participatory surveillance identified 13 of 20 confirmed or probable cases, including all nine laboratory-confirmed cases detected during the study period.

Compared with historical routine surveillance, the programme was associated with 2.4 times as many laboratory-confirmed detections and 4.8 times the overall case ascertainment. Among investigated bite exposures, 136 of 141 people initiated post-exposure prophylaxis; 16 exposures were linked to confirmed or probable rabies. These retrospective findings from one urban pilot suggest participatory reporting may reduce surveillance attrition, but do not establish performance in other settings.

In practice

For public health teams managing rabies surveillance in endemic settings, the Lilongwe pilot suggests that participatory reporting can improve retention and case ascertainment compared with passive surveillance. It identified all nine laboratory-confirmed cases detected during the six-month study, while only 24.6% of reports overall completed the surveillance pathway. The evidence is retrospective and comes from one urban programme, so it does not establish effectiveness elsewhere or justify changes to post-exposure prophylaxis practice.

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Source

BMC Public Health: Where are rabies cases lost along the surveillance pathway? A comparative evaluation of participatory and passive rabies surveillance in urban Lilongwe, Malawi ↗

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