Abstract
BackgroundEarly detection of febrile illnesses at community level is essential for improved malaria case management and control. Currently, mobile phone-based technology has been commonly used to collect and transfer health information and services in different settings. This study assessed the applicability of mobile phone-based technology in real-time reporting of fever cases and management of malaria by village health workers (VHWs) in north-eastern Tanzania.MethodsThe community mobile phone-based disease surveillance and treatment for malaria (ComDSTM) platform, combined with mobile phones and web applications, was developed and implemented in three villages and one dispensary in Muheza district from November 2013 to October 2014. A baseline census was conducted in May 2013. The data were uploaded on a web-based database and updated during follow-up home visits by VHWs. Active and passive case detection (ACD, PCD) of febrile cases were done by VHWs and cases found positive by malaria rapid diagnostic test (RDT) were given the first dose of artemether–lumefantrine (AL) at the dispensary. Each patient was visited at home by VHWs daily for the first 3 days to supervise intake of anti-malarial and on day 7 to monitor the recovery process. The data were captured and transmitted to the database using mobile phones.ResultsThe baseline population in the three villages was 2934 in 678 households. A total of 1907 febrile cases were recorded by VHWs and 1828 (95.9%) were captured using mobile phones. At the dispensary, 1778 (93.2%) febrile cases were registered and of these, 84.2% were captured through PCD. Positivity rates were 48.2 and 45.8% by RDT and microscopy, respectively. Nine cases had treatment failure reported on day 7 post-treatment and adherence to treatment was 98%. One patient with severe febrile illness was referred to Muheza district hospital.ConclusionThe study showed that mobile phone-based technology can be successfully used by VHWs in surveillance and timely reporting of fever episodes and monitoring of treatment failure in remote areas. Further optimization and scaling-up will be required to utilize the tools for improved malaria case management and drug resistance surveillance.
Highlights
Detection of febrile illnesses at community level is essential for improved malaria case management and control
Another study conducted in Zanzibar utilized mobile phones in surveillance of malaria and revealed that mobile phones are among the tools that can help accelerate malaria elimination by improving coordination, timing, coverage, and responses [14]
Apart from the WHO recommendations to consider active case surveillance in areas with low malaria transmission [19], these findings suggest that active case detection (ACD) might not be suitable and cost-effective for surveillance of symptomatic cases in the study villages and possibly other areas with similar malaria transmission intensity
Summary
Detection of febrile illnesses at community level is essential for improved malaria case management and control. This study assessed the applicability of mobile phone-based technology in real-time reporting of fever cases and management of malaria by village health workers (VHWs) in north-eastern Tanzania. Current therapy is losing effectiveness because malaria pathogens are increasingly becoming tolerant/resistant to drugs [3, 4] and other vector control strategies are compromised by the rapidly emerging insecticide resistance among mosquito populations [5]. Detecting pathogens that are drug-resistant or associated with severe disease in real-time as they emerge in the population and transferring them to a laboratory setting is essential for proper patient care, informing policy and developing new drugs that combat resistance. Detecting severe disease in early stages is expected to improve therapeutic options and dramatically reduce mortality
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