This community innovation has been accepted at the 2026 DHIS2 Annual Conference as a physical poster.
Conflict impact on malaria indicators, Sudan
Background: Malaria remains a major public health burden in Sudan, accounting for a large share of outpatient visits and hospital admissions across approximately 80% of states. The armed conflict that began in April 2023 severely disrupted an already fragile health system, affecting service delivery, health workforce availability, and routine disease surveillance. Despite the importance of surveillance data for malaria control, the impact of conflict on routine malaria indicators reported through the District Health Information Software 2 (DHIS2) has not been systematically assessed. This study examined the effects of conflict on malaria impact indicators and surveillance data completeness across Sudanese states. Methods: A mixed methods approach combined quantitative analysis of quarterly DHIS2 malaria data from January 2020 to March 2025 across 17 states with qualitative assessment of surveillance system functionality. Quantitative analyses included descriptive time trend analysis and interrupted time series analysis (ITSA) of three malaria impact indicators: reported malaria cases (presumed and confirmed) per 100,000 population, microscopy test positivity rate, and inpatient malaria deaths per 100,000 population. Data completeness was assessed as the proportion of missing quarterly reports per state. ITSA was conducted for 11 states with sufficient post conflict data; six states were excluded due to extensive missing. Qualitative data were collected through semi-structured key informant interviews (n=3) and analyzed using a deductive framework guided by predefined surveillance performance themes. Results: Following April 2023, missing DHIS2 reporting quarters increased substantially across all malaria indicators at the national level. Marked inter state variation was observed: western and southern states (except North Kordofan) experienced persistent post conflict reporting gaps, while northern and eastern states maintained relatively continuous reporting. ITSA demonstrated a statistically significant immediate decline
Primary Author: Khlood Fahti Alnaeem
Keywords:
malaria surveillance, Sudan conflict, DHIS2, data completeness, mixed methods, health system disruption, routine data quality
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