Anticipation and response: pandemic influenza in Malawi, 2009

Sambala, Evanson Z.; Manderson, Lenore

As we have argued, scarce resources limited the capacity of the government to strengthen the health system to ensure that responsibilities and infrastructure were adequately supported. A number of important weaknesses were identified in the robustness of influenza surveillance systems intended to send early signals for health service response, including the lack of efficient and timely decision-making among policymakers to guide public health policy on influenza. The WHO recommends reinforcement of routine surveillance capacity both from an epidemiological and virological standpoint to monitor influenza. This requires collection of sickness reports combined with laboratory and clinical investigations as valuable indicators of the occurrence of influenza. It is essential to monitor for influenza-like illnesses (ILI), including severe acute respiratory infections (SARI) during influenza season and non-season periods. Unless these ILI and SARI are characterised and monitored, policymakers will not be well informed on the burden of respiratory diseases in order to prioritise resources and plan public health interventions to mitigate influenza infections. Institutions within existing systems, such as hospitals and laboratories, need to document and assess influenza data. This can be undertaken using surveillance techniques such as reporting ILI or SARI, and absenteeism in work place and schools.