Malaria Surveillance Using Mobile Phone Technology

Besides supporting mobile phone technology, the DTMM module also allows web-based tracking of malaria patients. Pix/Google Earth

THE explosive spread of mobile phone networks across the developing world has created a unique opportunity to significantly transform how countries can tackle global health challenges, including the containment of drug-resistant malaria along the Thai-Cambodian border.

The Disease and Treatment Monitoring of Malaria (DTMM) module, a part of the Better Border Healthcare Program created by the Centre of Excellence for Biomedical and Public Health Informatics at Mahidol University or Biophics, uses mobile and web-based technology to alter treatment-seeking behaviours and facilitate better treatment and care for malaria patients in low-resource settings. It has speeded up detection at the point-of-care, made reporting to decision-makers close to real time, and improved the accuracy of mapping malaria risk locations.

Using the Biophics-designed DTMM module we will know the name (of the patient), the kind of malaria and the follow-up that needs to be done at every level – from the district to the provincial and central levels…

“We can use IT [Information Technology] to help us fill in data in real time and send it to Biophics,” said Dr Wichai Satimai, director of the Bureau of Vector-Borne Diseases, of the usefulness of the system. “Then using the Biophics-designed DTMM module we will know the name (of the patient), the kind of malaria and the follow-up that needs to be done at every level – from the district to the provincial and central levels,” he added.

The DTMM module enables remote data transfer in both textual and geographic format allowing details of registered patients, who visit the malaria clinic, and their treatment history to be examined. Responsible malaria staff at the local treatment sites are provided with mobile phones loaded with the follow-up application; they use the case-follow-up function of the DTMM to update the follow-up status on the schedule date, and capture the locations (GPS coordinates) each time local malaria staff perform routine home visits.

Screen shots of case follow-up on mobile phone. Pix by Biophics

This replaces paper-based case-tracking in the villages, and supersedes routine map-drawing for case locations. The DTMM also sends home-visit-schedule reminder messages directly to responsible local staff.

Dr Wichai said officials down the line had been “happy” with the paper system of registry and follow-up still existing in low-risk areas.

But after recognising the “long term value” for surveillance and reporting in the DTMM module that the Bill & Melinda Gates Foundation fully supported in two high-risk districts — Pong Nam Ron and Borai, respectively located in the provinces of Chantaburi and Trat — the bureau decided to finance expansion of it to other vulnerable pockets along the eastern border out of its own budget.  It was, in Dr Wichai’s words, “an opportunity to strengthen our surveillance system and reporting as well.”

A major problem in the bureau’s vertical control programme is that it may not be accessible to people living in remote communities, and to people-on-the-move who are undocumented migrants from neighbouring countries and hence afraid of authorities.  Dr Wichai said he had asked the Global Fund Against Aids, Tuberculosis and Malaria, Round 10, for 12 non-governmental organisations to become grant recipients because they had experience working with migrants.

Asked about challenges in introducing the DTMM module along the Thai-Cambodian border, Amnat  Khamsiriwatchara, deputy director of Biophics, said infrastructure and computer facilities to connect with the system were “not a big problem”. He pointed out that network coverage and technical support could reach all the data entry sites.

“Most of the challenges we face now are human resources and co-ordination across different levels,” he noted.

In the DTMM module, information can be captured on the phone in areas without a telephone signal, and malaria-control staff can later synchronize information onto a malaria clinic or wherever a signal is available

If the DTMM module was to be used for cross-border surveillance of malaria cases, there should be a mechanism for sharing information first and foremost.  Moreover, the mechanism should clearly define the roles of each country representative acting as the focal point, Mr Amnat said. It must be clear who will be doing what, when, where, and why with the information that is generated.

Collaboration on case investigations will be possible after messages or reports are received. Then the health information system of both countries can be used to support any activities created from this co-operation.  Collaboration in information “and action” were vital for driving this cross-border mechanism successfully, he stressed.

The success of the DTMM module in Thailand’s Saiyok District of Kanchanaburi was “a big chance to prove that informatics (using mobile technology) could be an effective management tool to eliminate drug-resistant malaria,” he said. Features awaiting development and incorporation into this system include:  real-time monitoring and reporting of infected cases, microscopic digitizing imaging, the capturing of infected follow-up locations by using a mobile phone panel, and disease mapping with a geographical information system or GIS.

Anuraj Manibhandu