Monitoring COVID-19 occurrence in a resource-limited setting - COVID-19 sentinel surveillance in Malawi

Sep 30, 2026

Routine COVID-19 surveillance in Malawi based on retrospective reporting could not steer timely actions during the rapidly evolving pandemic. An active sentinel surveillance system was implemented from July to December 2022 to track real-time infection changes and support the COVID-19 response. Symptomatic and asymptomatic participants with SARS-CoV-2 were enrolled at selected health facilities, and individuals aged 5+ at Points of Entry. Across 9,305 participants, higher SARS-CoV-2 RT-PCR positivity occurred at health facilities than at entry sites, and positivity trends followed similar patterns between groups.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages14

Reading Time35 min

AccessFree to download

Abstract

Introduction

Surveillance need and challenges in Malawi

Surveillance approach and testing strategy

OPEN ACCESS Citation: Ulaya G, Kabaghe A, Saussier C, MacLachlan E, Smith-Sreen J, Katumbi C, et al. (2026) Monitoring COVID-19 occurrence in a resource-limited setting – COVID-19 sentinel surveillance in Malawi. PLOS Glob Public Health 6(1): e0004158. [https://doi](https://doi). org/10.1371/journal.pgph.0004158 Editor: Julia Robinson, PLOS: Public Library of Science, UNITED STATES OF AMERICA Received: December 20, 2024 Accepted: December 12, 2025 Published: January 8, 2026 Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Data availability statement: The dataset was and is still being stored at the Birth Defect Surveillance Server. The server is housed at the Public Health Institute of Malawi (PHIM) . The data that support the findings of this study are RESEARCH ARTICLE Monitoring COVID-19 occurrence in a resourcelimited setting – COVID-19 sentinel surveillance in Malawi Godwin Ulaya1*, Alinune Kabaghe2, Christel Saussier1, Ellen MacLachlan3, Joshua Smith-Sreen4, Chaplain Katumbi1, George Bello1, Terence Tafatatha2, Limbikani Chaponda5, Bernard Mvula5, Matthews Kagoli5, Benson Chilima5, Joseph Bitilinyu-Bangoh5, Laphiod Chisuwo5, Yusuf Babaye1, Moses Chitenje1, Barbara Bighignoli1, Fred Bangara2, Ireen Namakhoma1, Annie Chauma-Mwale5, Gabrielle O’Malley3, Kelsey Mirkovic6, Nellie Wadonda-Kabondo2 1 International Training and Education Center for Health (I-TECH) Malawi, University of Washington, Lilongwe, Malawi, 2 Division of HIV and TB, US Centers for Disease Control and Prevention Lilongwe, Lilongwe, Malawi, 3 International Training and Education Center for Health (I-TECH), University of Washington, Seattle, Washington, United States of America, 4 Alpert Medical School of Brown University, Providence, Rhode Island, United States of America, 5 Public Health Institute of Malawi (PHIM), Lilongwe, Malawi, 6 Department of Rare Disease, Amgen Biotechnology Research, Minneapolis, Minnesota, United States of America * [godwin.ulaya@gmail.com](godwin.ulaya@gmail.com) Abstract The routine COVID-19 surveillance in Malawi that relied on retrospective reporting could not efficiently steer timely measures to the rapidly evolving pandemic. To monitor real-time changes in infections and inform the COVID-19 response, we implemented an active sentinel surveillance system from July to December 2022. Symptomatic and asymptomatic patients with SARS-CoV-2 in selected health facilities (HFs) and anyone aged ≥5 years entering at Point of Entry (PoEs) sites were eligible to participate. Self-reported epidemiological and clinical data, and nasopharyngeal specimens were collected from 9,305 participants. A higher overall SARSCoV-2 RT-PCR positivity rate was observed at HFs, 8.9% among symptomatic and 6.5% among asymptomatic patients, versus 3.5% at PoEs. The positivity trends among symptomatic and asymptomatic patient groups showed a similar pattern throughout the period. This active surveillance complemented routine surveillance, especially during a low incidence period and highlighted the need to target both symptomatic and asymptomatic populations. Introduction SARS-CoV-2 infection was first confirmed in Malawi on 2nd April 2020 [ 1] . The Government of Malawi subsequently activated a national Public Health Emergency Operations Center to coordinate the multisectoral response to the COVID-19 pandemic PLOS Global Public Health | [https://doi.org/10.1371/journal.pgph.0004158](https://doi.org/10.1371/journal.pgph.0004158) January 8, 2026 1 / 14 not publicly available, but can be made available upon request and with permission of the Public Health Institute of Malawi (PHIM) . Email: [malawipheoc@health.gov.mw](malawipheoc@health.gov.mw Website:)[ Website:](malawipheoc@health.gov.mw Website:) [

FAQs

Why was active sentinel surveillance implemented in Malawi?

Routine retrospective surveillance could not efficiently guide timely measures as the pandemic evolved. Active sentinel surveillance was used to monitor real-time infection changes and inform the COVID-19 response.

What populations and sites were included in the sentinel surveillance?

The study enrolled symptomatic and asymptomatic patients with SARS-CoV-2 at selected health facilities, and anyone aged 5 years and older entering at Points of Entry sites.

What did the RT-PCR positivity results show across locations?

Overall SARS-CoV-2 RT-PCR positivity was higher at health facilities than at Points of Entry. Positivity rates were 8.9% among symptomatic and 6.5% among asymptomatic patients at health facilities versus 3.5% at Points of Entry.

Sep 30, 2026

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