Toward reliable reporting for lymphatic filariasis elimination efforts

Large-scale disease elimination programs depend critically on the accuracy of data reported back from local implementation sites. WHO and some of its partners recently developed a data quality assessment (DQA) tool specific to efforts to combat neglected tropical diseases (NTDs). A study published in PLOS Neglected Tropical Diseases applying the tool to the lymphatic filariasis program in Ghana finds problems with the routinely reported data and suggests ways toward improving their accuracy.

Regular administration of preventive chemotherapy (PC) to at-risk populations is a key step toward elimination of lymphatic filariasis—commonly known as elephantiasis—an NTD still affecting an estimated 40 million people and one of the leading causes of disability worldwide. With funding support from the University of Ghana, Dziedzom de Souza and colleagues from the Noguchi Memorial Institute for Medical Research and the School of Public Health in Accra, Ghana, applied the NTD-DQA tool to retrospectively evaluate the quality of data reported for Ghana's lymphatic filariasis program in 2010.

The tool includes a comparison between locally collected data and those reported at the district or country level, as well as the analysis of interviews with data handlers involved in program implementation at the local level. Results of the assessment provide a measure of accuracy of the reported data as well as a plan on how to improve accurate reporting based on a detailed understanding of the local circumstances.

Assessing three implementation sites in Ghana, the researchers compared routinely reported results with recounted values for five different indicators, including number of; tablets received, tablets used, tablets remaining, population treated, and PC coverage. The researchers found that over 60% of the data reported were of low accuracy (i.e., had a higher than 10% difference between the collected and reported data). The only consistent indicator that was accurately reported across the sites was the number of tablets received.

The second part of the assessment, based on the individual interviews, exposed challenges and limitations of the existing data management information systems. The weakest functional area across the sites, the researchers found, was 'data management processes', but the strongest functional areas (such as 'indicator definitions and reporting guidelines', or 'data collection and reporting forms and tools') differed between implementation sites, suggesting that sites can learn from one another.

The present study was a pilot assessment that found the DQA to be "a very useful monitoring and evaluation tool that can be used to elucidate and address data quality issues" for Ghana's NTD programs. As a particularly concerning result, the researchers highlight the overestimation of PC coverage, the core indicator for program performance that affects decisions about continuation or stoppage of the program. They also mention that similar reporting inaccuracies have been found in other countries.

The researchers conclude that "while the results from this study are informative, a more complete assessment of [Ghana's] LF Control Programme (involving the Ministry of Health, the NTD programme and other NTD partners in the country) must be undertaken in order to establish appropriate programmatic responses". They hope that"this study will serve as a starting point to gather support towards a more complete evaluation of country NTD programmes".