Quality improvement interventions and indicators.

Background
Reporting malaria deaths is critical for assessing prevention and case management interventions. In Uganda, malaria mortality is recorded in inpatient registers and reported through weekly and monthly surveillance reports. During a data quality assessment in Namutumba District in October 2022, we found more malaria deaths in health facility registers than were reported. We conducted a continuous quality improvement initiative to improve the accuracy of reported malaria deaths in Namutumba District.
Methods
We purposively selected 2 high-level health centers (HC) in Namutumba District that reported malaria deaths during September 2021–October 2022. We formed quality improvement teams (QIT) comprising clinical and statistical staff at the HC. We conducted brainstorming sessions with QITs to identify challenges with reporting malaria deaths, prioritized areas for improvement, and conducted root cause analysis. Using the plan, do, study, act (PDSA) cycle, we identified change ideas to address root causes.
Interventions
Challenges included knowledge gaps on malaria death definitions, lack of consequences for failing to document deaths, and unclear guidance on how to document deaths. Sustainable interventions identified included continuous medical education on malaria death definition, one-on-one mentorship of staff on documentation in inpatient registers, and weekly verification of inpatient register data, all implemented during November 2022–February 2023.
Results
Of the 36 malaria deaths that occurred during the baseline period (September 2021–October 2022), 25 (69%) were included in the weekly report, and four (11%) in the monthly report. Following the intervention implementation, all 7 malaria deaths recorded at the 2 health facilities during November 2022–February 2023 were reported in the weekly and monthly reports.
Conclusion
Continuous medical education, supervision and mentoring of HC staff, and clear and comprehensive guidance on documenting malaria deaths contributed to the improvement in malaria death reporting for HCs in Namutumba District. Consistence in implementation of these improvement activities could enable accurate planning and resource allocation for malaria control strategies.