Abstract
Morbidity burden of lymphatic filariasis (LF) relies on the information from the Mass Drug Administration (MDA) programme where Community Health Volunteers (CHVs) passively report cases identified. Consequently, the exact prevalence of morbidity cases is not always accurate. The use of mobile phone technology to report morbidity cases was piloted in Ghana using a text-based short messaging service (SMS) tool by CHVs. Though successful, illiterate CHVs could not effectively use the SMS tool. The aim of this study was to evaluate the use of a mobile phone-based Interactive Voice Response System (mIVRS) by CHVs in reporting LF morbidity cases and acute dermatolymphangioadenitis (ADLA) attacks in Ghana. The mIVRS was designed as a surveillance tool to capture LF data in Kassena Nankana Districts of Ghana. One hundred CHVs were trained to identify and report lymphedema and hydrocele cases as well as ADLA attacks by calling a hotline linked to the mIVRS. The system asked a series of questions about the disease condition. The ability of the CHV to report accurately was assessed and the data from the mIVRS were compared with the paper records from the CHVs and existing MDA programme records from the same communities and period. Higher numbers of lymphedema and hydrocele cases were recorded by the CHVs using the mIVRS (n = 590 and n = 103) compared to the paper-based reporting (n = 417 and n = 76) and the MDA records (n = 154 and n = 84). Female CHVs, CHVs above 40 years, and CHVs with higher educational levels were better at paper-based reporting (P = 0.007, P = 0.001, P = 0.049 respectively). The system, when fully developed and linked to national databases, may help to overcome underreporting of morbidity cases and ADLA attacks in endemic communities. The system has the potential to be further expanded to other diseases.
Highlights
The northern savannah and coastal regions of Ghana are endemic for lymphatic filariasis (LF) [1] a disease caused by the mosquito-borne parasitic nematode Wuchereria bancrofti
The mobile phone-based Interactive Voice Response System (mIVRS) was fully functional throughout the 12-month period, allowing the Community Health Volunteers (CHVs) to record all cases of lymphedema and hydrocele in their respective communities using their mobile phones
Despite the limited publications on the practice of mIVRS as a surveillance tool [25, 26], our study has demonstrated how mobile phones can be used for disease monitoring of LF cases in rural communities, collecting LF and acute dermatolymphangioadenitis (ADLA) data by CHVs
Summary
The northern savannah and coastal regions of Ghana are endemic for lymphatic filariasis (LF) [1] a disease caused by the mosquito-borne parasitic nematode Wuchereria bancrofti. Affecting approximately 56 million people worldwide, LF can cause long term chronic morbidities including lymphedema (LE), hydrocele, and acute dermatolymphangioadenitis (ADLA) [1]. From the data generated by the mIVRS, even though patients of 40–49 years old were mostly affected with both disease conditions, the difference was not statistically significant compared to the other age groups (p = 0.289). The differences between the number of cases identified from both Kasena Nankana West and Municipal were not statistically significant (Table 1). Paper reports of patients with LF morbidity. Even though 1001 morbidity cases of paper reports were captured by the CHVs, only 696 of the reports were completed without errors (completion rate of 69.5%). Of the 696 complete paper reports 85.1% (n = 592) were lymphedema cases, 11.3% (n = 79) were hydrocele cases and 3.6% (n = 25) patients had both conditions. A summary of the cases found in the study subdistricts can be found in S1 Fig
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