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Community Malaria Workers Use SMS to Report in Real-Time

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Malaria Consortium’s Ngor Pengby demonstrating how to charge a mobile phone using a solar panel. This project is in collaboration with Mobitel.Photo by WHO/Moeun Chhean Nariddh

Moeun Chhean Nariddh reports on a mobile phone-based frontline reporting system for detected malaria cases, implemented in Kampot province.

From her house in Snay Anchit Village, about five kilometers from the health center in Kampot provonce’s Chum Kiri district, 20-year-old village malaria worker Kong Lida can clearly hear the noise of a generator roaring in the distance. This generator is an important source of power where Lida and other villagers have their car batteries charged everyday so that their houses can be lit up at night from electric lamps and at the same time charge up their mobile phones.

But soon Lida and other village malaria workers in her village and other communes will not need to pay the generator owner to have their car batteries charged anymore. Now, all these VMWs will get their power from a ubiquitous source of energy – namely solar power.

As part of the country’s malaria elimination strategy, the National Center for Parasitology, Entomology and Malaria Control or CNM, with technical support from Malaria Consortium (MC) and WHO, has launched a pilot program to train VMWs in Kampot, Siem Reap and Kampong Cham provinces on how to send simple mobile phone text messages (SMS) to report in real time on detected malaria cases. These SMS messages also support the paper reporting that feeds into the health information system from the health centers.

CNM and MC also provide each of the VMWs with a solar panel and a lamp together with a mobile phone and a charger since there is no electricity in their villages.

The SMS from a village malaria worker in Khmer script. Photo by Malaria Consortium/Steve Mellor

Cambodia is currently seeing a revolution in communications with the roll-out of affordable wireless services to much of the rural population. The potential of approaches based on mobile phones and web-based technology to address the gaps in field data collection for malaria is now widely recognized.

“I think using a mobile phone is good, because I can report immediately when I come across a malaria case,” said village malaria worker Lida. Previously, the VMWs would record the data in a logbook which they would then report to the health centers at the end of every month before it was sent to the operational district hospitals and finally to CNM.

InSTEDD, an innovative humanitarian technology NGO, designed the system, utilizing SMS messages in Khmer script that interact with mapping software to generate maps on the World Wide Web for the locations of malaria cases reported by the VMWs. These malaria cases are also known as Day Zero cases, to indicate the locations of the patients before they are given appropriate and effective treatment.

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Radio Program in Chantaburi Offers Life-Saving Advice on Malaria Prevention

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The ‘Love Your Health’ radio program hosted by the head of the Malaria Clinic in Khaeng Harng Maew District, Chanthaburi is a community favourite. CONTAINMENT’s Nat Sumon tells why.

Anukoon Charunthup, the presenter of “Rak Sukaphab” or “Love Your Health”. Pix by WHO/Nat Sumon

If you live in Khaeng Harng Maew district, Chanthaburi, where there is only one strong radio frequency, your favorite entertainment channel would definitely be the local radio network FM95.75.

Among the variety of programs carried by FM95.75, the most popular slot seems to be a one-hour health program every Wednesday called “Rak Sukaphab” or “Love Your Health”.  Undoubtedly the listening audience, attracted by the easy-listening music, tune in faithfully every Wednesday to the health program that has helpful tips on how to lead a healthy lifestyle.

“Love Your Health” also has a call-in facility that allows listeners to interact with the presenter Anukoon Charunthup, who is also head of the Malaria Clinic in Khaeng Harng Maew District, Chanthaburi. The program allows listeners to phone in to ask any health-related questions they might have.   And as an indication of the radio program’s popularity, the station’s phone is always ringing off the hook.

Anukoon tells CONTAINMENT that he began hosting the “Love Your Health” radio program about five years ago when the local radio network was just launched.

“Chantaburi is no stranger to vector-borne diseases,” he says. “The health topics that I cover in my radio program range from malaria, dengue and other mosquito-borne diseases.”

Anukoon’s radio program is important for Khaeng Harng Maew residents especially during the rainy season. “It’s the rainy season when diseases like malaria and dengue are rife and I use the radio program to disseminate preventive messages and tips on how listeners will be able to protect themselves from falling sick,” he adds.

But there is a humourous side to Anukoon, too. He tells CONTAINMENT that malaria is also known as “khai-mae-yai-bua” in Thai, which means “fever that pisses your mother-in-law off!”

Anukoon explains. “When you have malaria, you can’t work to feed your family, and that’s when the mother-in-law becomes cross because her daughter and grandchildren would have to go hungry.”

The Malaria Clinic head in Khaeng Harng Maew District made it clear that the most vulnerable group to malaria are male wage earners.

“Because of this, my program gives advice on where these workers would be able to get mosquito repellents and insecticide-treated bed nets to prevent themselves from getting malaria,” adds Anukoon. The “Love Your Health” radio call-in program also tells these workers where the locations of the malaria clinics are and assures them that diagnosis and treatment is free of charge.

Though Anukoon believes that local people are very acquainted with malaria, its symptoms, and vector control and prevention measures, he, however, tells CONTAINMENT that they need to be reminded of the dangers of malaria during the rainy season.

Anukoon has been presenting “Love Your Health” for about five years and is now building up the capacity of his staff to co-host the show to add diversity to the radio program and also fill in as main presenters when he has to travel outside the district for meetings and workshops.

“My hope is that by building up the capacity of my staff as presenters, they would in turn be able to start their own malaria radio shows if they are promoted and transferred out of the district,” he explains.

But wearing two hats at one time can be tiring for Anukoon. “I frequently get calls from listeners asking me where I was in the previous week, for instance, because they didn’t hear my voice on radio,” he explains.

But the rewards are always gratifying. “Every week I get e-mails and calls from listeners telling me how much they enjoyed my show and how useful the health messages were to them,” says Anukoon. “That’s enough to keep me going.”

Written by malariacontainment

July 21, 2011 at 11:22 am

Responding to Day 3 Falciparum Malaria Positives in Real-Time

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Malaria Consortium, with the support of the Bill & Melinda Gates Foundation-funded Containment Project, is pioneering a Day 3 positive alert system in Ta Sanh district, western Cambodia, using mobile phone and web-based technology to facilitate response in real-time. CONTAINMENT’s Sonny Inbaraj reports.

Diagram showing how a text message from the Ta Sanh Health Centre gets disseminated with FrontlineSMS. Source:WHO/Sonny Krishnan

EFFECTIVE containment of multi-drug resistant falciparum malaria depends on timely acquisition of information on new cases, their location and frequency. This is to plan interventions and focus attention on specific locations to prevent an upsurge in transmission.

Response in western Cambodia’s Ta Sanh district involves combining the process of positive diagnoses through microscopy of Day 3 positives at the Ta Sanh health centre from blood slides sent by Village Malaria Workers, to an alert system using mobile phone and web-based technology to help pinpoint potential outbreaks of malaria and target interventions to foci where parasite reservoirs are likely to be present.

The proportion of patients who still carry malaria parasites on the third day of treatment is currently the best measure available of slow parasite clearance and can be used as a warning system for confirmation of artemisinin resistance.

In Ta Sanh, the Village Malaria Workers or VMWs play a crucial role in the early detection and treatment of the killer falciparum malaria. In September 2010 the USAID-funded Cambodia Malaria Prevention and Control Project (MCC), implemented by University Research Co., LLC (URC), trained these VMWs to prepare blood slides from those who tested positive for falciparum malaria from rapid diagnostic tests. They were also trained to carry out a three-day directly observed treatment (DOT) of the Pf cases with the co-formulated ACT dihydroartemisinin – piperaquine.

Chou Khea, a 21-year-old Village Malaria Worker, trained by MCC in Ta Sanh district’s remote Ou Nonoung village tells CONTAINMENT how she carries out DOT.

“Immediately after a villager tests positive for falciparum malaria in a rapid diagnostic test (RDT), I prepare the blood slides. Then I give the drugs, which the villager has to take in front of me,” says Khea.

“On Day 2 and Day 3, I’ll go to the villager’s house and make sure that the drugs are again taken in my presence,” she adds. “After 72 hours from the first intake of the anti-malaria drugs, I’ll be at the villager’s house again to take his or her blood sample for preparing another blood slide.”

Chou Khea then takes the Day Zero and Day 3 slides, together with the used RDT, to the Ta Sanh Health Centre 30-kilometres away from her village.

“I usually take a motor-dop (motorcycle taxi) to the health centre. But most of the motor-dop drivers are reluctant to use the track to health centre in the rainy season because of the slippery mud. Also many of them are scared of the wild animals and land-mines in the area,” she tells CONTAINMENT with concern. “I hope to have my own motorcycle soon, so that I’ll be able to transport the slides and RDTs faster,” she adds with a smile.

A validation, from the database, of the SMS sent from the Ta Sanh Health Centre. Pix WHO/MERG

At the Ta Sanh Health Centre, the Day 3 slides are examined by a microscopist and if asexual malaria parasites are seen they are graded as positive. The microscopist immediately sends out an SMS on a mobile phone, using a dedicated number, to a database indicating the village code and the sex of the patient.

Malaria Consortium pioneered the use of this alert system in Ta Sanh, with support from Cambodia’s National Centre for Parasitology, Entomology and Malaria Control (CNM) and the World Health Organization’s Malaria Containment Project funded by the Bill & Melinda Gates Foundation.

Malaria Consortium’s Information Systems Manager Steve Mellor explains the use of cellular text messaging (SMS) as a viable tool to send alerts and map Day 3 positives in real-time on Google Earth.

“We use FrontlineSMS, an open-source software, that enables users to send and receive text messages with groups of people through mobile phones,” Mellor tells CONTAINMENT.

“FrontlineSMS interfaces with an MS Access database system that was developed to host the SMS data and to provide validation on the data received and to send an automatic reply to the sender containing any validation errors found, or to confirm that the data has been accepted,” he adds.

There are plans to upscale this mobile phone and web-based alert system with InSTEDD, an innovative humanitarian technology NGO, to map all Day Zero cases…

Day 3 positives, in the Access database, mapped in real-time on Google Earth. Pix/Malaria Consortium

In the Access database, a script interfaces with Google Earth and maps out the locations of the Day 3 positives based on the village code. The mapping on Google Earth is essential as it gives a clear visualisation of the terrain and helps CNM, WHO and the USAID-funded Cambodia Malaria Prevention and Control Project (MCC) to plan coordinated interventions in terms of case follow-up on Day Zero and Day 3 and carry out epidemiological and entomological investigations.

“All this happens in real-time and alert text messages are sent out simultaneously to the operational district malaria supervisor, the provincial health department, CNM and the administrators of the database,” Mellor points out.

There are plans to upscale this mobile phone and web-based alert system with InSTEDD, an innovative humanitarian technology NGO, to map all Day Zero cases. Malaria Consortium and CNM are also in direct talks with Mobitel, one of Cambodia’s main telecommunication carriers.

“We are in negotiations with Mobitel for a free number and also free SIM cards to be distributed to health centre staff and village malaria workers,” Mellor reveals. “After all, this is for a public good.”

Besides plans to map all Day Zero cases, Malaria Consortium is also exploring the possibility of sending alert messages in Khmer script.

“This will be a breakthrough and we hope this will help facilitate a quick response mechanism from CNM and other partners,” says Mellor.

Malaria Surveillance Using Mobile Phone Technology

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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.

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Written by malariacontainment

September 28, 2010 at 10:51 am