Abstract
BackgroundSurveillance with timely follow-up of diagnosed cases is a key component of the malaria elimination strategy in South Africa. The strategy requires each malaria case to be reported within 24 hours, and a case should be followed up within 48 hours. However, reporting delays are common in rural parts of the country.MethodsA technical framework was implemented and for eight months a nurse was hired to use a smartphone to report malaria cases to the provincial malaria control programme, from selected primary health care clinics in a rural, malaria-endemic area in South Africa. In addition, a short text message (SMS) notification was sent to the local malaria case investigator for each positive case. The objective was to assess whether reporting over the smartphone led to timelier notification and follow-up of the cases. An evaluation on the simplicity, flexibility, stability, acceptability, and usability of the framework was conducted.ResultsUsing mobile reporting, 18 of 23 cases had basic information entered into the provincial malaria information system within 24 hours. For the study period, the complete case information was entered two to three weeks earlier with the mobile reporting than from other clinics. A major improvement was seen in the number of positive cases being followed up within 48 hours. In 2011/2012, only one case out of 22 reported from the same study clinics was followed up within this timeframe. During the study period in 2012/2013, 15 cases out of 23 were followed up within two days. For the other clinics in the area, only a small improvement was seen between the two periods, in the proportion of cases that was followed up within 48 hours.ConclusionsSMS notification for each diagnosed malaria case improved the timeliness of data transmission, was acceptable to users and was technically feasible in this rural area. For the malaria case investigations, time to follow-up improved compared to other clinics. Although malaria case numbers in the study were small, the results of the qualitative and quantitative evaluations are convincing and consideration should be given to larger-scale use within the national malaria control programme.
Highlights
Surveillance with timely follow-up of diagnosed cases is a key component of the malaria elimination strategy in South Africa
In order to establish whether mobile phone reporting could assist in all malaria cases being notified within the required time frame, a mobile phone technical framework was implemented and a nurse was hired to send reports over a smartphone from selected primary health care clinics in a malaria-endemic area in South Africa for eight months
The work was done in close collaboration with the Mpumalanga Malaria Control Programme, which normally receives the paper-based reports from the clinics included in the study
Summary
South Africa’s successful malaria control programme, which included the introduction of artemisinin-containing combination treatment (ACT), an effective residual indoor insecticide spraying programme, together with the adoption of regional malaria control strategies in South Africa, Mozambique and Swaziland, produced a decline in contacts of a confirmed malaria case. This is because the reduction in numbers of infected people shrinks the reservoir of malaria parasites available for transmission. Despite a decreasing number of malaria cases, response to notification and follow-up of each case is extremely important to break the chain of transmission through treatment of identified parasitaemic persons, and reach the target for elimination. 16 died from their malaria infection (personal communication with Provincial Malaria Programme)
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