Fighting Malaria Together Newsletter - December 2010

Using SMS to track malaria in Zambia

Health care workers armed with rapid diagnostic tests and cell phones are using text messaging to detect and prevent potential malaria outbreaks in Zambia. By Aniset Kamanga, The Malaria Institute at Macha.

In 2008, researchers at the Malaria Institute at Macha launched a pilot project to train health care workers to use short message service (SMS) messaging to help quickly detect and prevent potential malaria outbreaks in Zambia. It was the first time SMS messaging had been used in the country or anywhere to fight malaria.

Because of Zambia’s strong malaria control program, cases of malaria had greatly decreased across the country, but the potential for outbreaks still existed—particularly after the rainy season and during the long dry period before the rains. Malaria was becoming more local and more focal and it quickly became evident that a new way to monitor transmission was needed, so, if a few malaria cases popped up in a region, that region could be monitored to ensure that those few cases didn’t turn into a full-blown epidemic.

Prior to 2008, data on local malaria transmission could take up to four to five months to reach the center of the Ministry of Health (MoH), where deployment of resources must come from. The SMS messaging project was developed to help data reach the MoH quicker, so they could intervene and respond rapidly. Health care workers trained to use rapid diagnostics tests (RDTs) were given a small incentive—in the form of additional mobile phone talk time—in order to send in test results using their personal phones. The project went quite smoothly.  Our team initially encountered some challenges in motivating the health care workers to send the data in a timely manner—particularly during peak farming seasons—but that was resolved by providing only half of the incentive up front, and paying the rest once the data were received. We are now making use of the data being collected to implement a second project, to determine whether if one person tests positive for malaria in a household, other household members will become more likely to be asymptomatic carriers of the disease than households where no malaria case was reported. When we receive information of a positive RDT result through SMS during the low transmission season, we go back and test everyone in that household. Results from this second phase have just been published in an academic journal (http://www.malariajournal.com/content/9/1/265).

Using the SMS system to target homesteads that may be reservoirs of asymptomatic carriers is only one of many potentially useful applications of the malaria information collected. We’re happy that the model is working so well in Macha, and are looking forward to using it to help planners and decision-makers guide resources where they are needed the most.