Key findings and recommendations from assessment of Cambodia’s national malaria surveillance system

Abstract Cambodia is approaching the final stages of malaria elimination, reporting only 1,384 cases in 2023 and aiming to eliminate all species of human malaria by 2025. Given the importance of surveillance in control and elimination efforts the National Center for Parasitology, Entomology, and Malaria Control (CNM) elected to assess its malaria surveillance system to identify strengths and gaps and make recommendations. The WHO Malaria Surveillance System Assessment Toolkit, tailored to Cambodia’s context, was utilized to evaluate a total of 68 indicators across four primary objectives: Performance, Context and Infrastructure, Technical and Process, and Behavior. Data from 2021-2023 and activities which took place in 2023 under the 2021 edition of the Surveillance for Malaria Elimination Guidelines were utilized. Indicators were evaluated through a quantitative survey completed by subnational staff, a field data quality assessment (DQA) at the service delivery level, a national-level DQA, and a national-level desk review including interviews with CNM staff. The assessment demonstrated strong performance of Cambodia’s surveillance system. Of the core indicators assessed, 82% of Performance (14/19), 77% of Context and Infrastructure (8/13), 79% of Technical and Process (4/7), and 100% of Behavior indicators (3/3) were met. Notable successes included the improved completeness and timeliness of reporting and case investigation in the previous three years. Key areas for improvement include revising case investigation and updating case classifications, enhancing data cleaning and verification processes to improve data quality, and upgrading the national malaria information system to include unique patient identifiers and enable interoperability with other national information systems. Cambodia’s surveillance system is strong overall and CNM is committed to addressing identified areas of improvement. Lessons learned from this assessment informed revisions to the national Surveillance for Malaria Elimination Guidelines, implemented in May 2024. Additionally, the results will be used to guide the design of surveillance response-related objectives for Cambodia’s 2026-2035 National Strategic Plan. Competing Interest Statement The authors have declared no competing interest. Funding Statement Funding for routine surveillance activities was provided by the Global Fund to Fight AIDS, Tuberculosis and Malaria. This assessment was supported by the Bill and Melinda Gates Foundation [Grant Number INV-008263]. The findings and conclusions contained within are those of the authors and do not necessarily reflect positions or policies of the Bill & Melinda Gates Foundation. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: As this work was considered to be operational, ethical approval was not deemed to be required and hence, not sought. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability National malaria surveillance data are available at https://mis.cnm.gov.kh/. Additional data available upon reasonable request to the National Center for Parasitology, Entomology and Malaria Control (CNM), Phnom Penh, Cambodia.