WHO Publication on using mobile phone and web-based technology to facilitate response to malaria in real-time.

1. April - June 2011
Containment
The Quarterly Newsletter of the Containment of Artemisinin-Tolerent Malaria Parasites in South-East Asia Project

2. Surveillance of Day-3 Falciparum Malaria
Positives in Real-Time
Malaria Consortium, through
the Containment Project, is pilot- Location on Google Earth
ing a Day-3 positive alert system
in western Cambodia’s Ta Sanh
district, using mobile phone
and web-based technology to
facilitate response to malaria
in real-time. CONTAINMENT’s
Sonny Inbaraj reports.
EFFECTIVE containment of
multi-drug resistant falciparum
malaria depends on timely acquisi-
tion of information on new cases,
their location and frequency. This
is to plan interventions and focus
attention on speci c locations to
Source: WHO/Sonny Krishnan
prevent an upsurge in transmis-
sion. Diagram showing how a text message from the Ta Sanh Health Centre gets disseminated with
FrontlineSMS.
Response in western Cambodia’s
Ta Sanh district involves combining skills of VMWs in other villages “Immediately after a villager tests
the process of positive diagnoses in the Containment Project. The positive for falciparum malaria in a
through microscopy of Day 3 posi- VMWs were also trained to carry rapid diagnostic test (RDT), I pre-
tives at the Ta Sanh health centre out a three-day directly observed pare the blood slides. Then I give
from blood slides sent by Village treatment (DOT) of Pf cases with the drugs, which the villager has to
Malaria Workers, to an alert system the co-formulated ACT dihydroar- take in front of me,” says Khea.
using mobile phone and web-based temisinin - piperaquine.
technology to help pinpoint poten- “On Day 2 and Day 3, I’ll go to
tial outbreaks of malaria and target Chou Khea, a 21-year-old Village the villager’s house and make sure
interventions to foci where parasite Malaria Worker, trained by MCC in that the drugs are again taken in
reservoirs are likely to be present. Ta Sanh district’s remote Ou Non- my presence,” she adds. “After 72
oung village tells CONTAINMENT hours from the rst intake of the
The proportion of patients who how she carries out DOT. anti-malaria drugs, I’ll be at the
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 con rma-
tion 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
Containment Project partnered the
USAID-funded University Research
Co., LLC (URC) to train these VMWs
to prepare blood slides on Days
Zero and 3, from those who tested
positive for falciparum malaria. A
similar partnership was entered
into with the public health and
development NGO Family Health Photo: WHO/MERG
International (FHI) to upgrade the A validation of the SMS sent from the Ta Sanh Health Centre, from the database.
4 Containment April - June 2011

3. “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 con-
taining any validation errors found,
or to con rm that the data has been
accepted,” he adds.
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 visu-
alisation of the terrain and helps
CNM, WHO and the USAID-funded
Cambodia Malaria Prevention and
Photo: Malaria Consortium Control Project (MCC) to plan coor-
Day 3 positives, in the Access database, mapped in real-time on Google Earth. dinated interventions in terms of
case follow-up on Day Zero and Day
3 and carry out epidemiological and
villager’s house again to take his immediately sends out an SMS on entomological investigations.
or her blood sample for preparing a mobile phone, using a dedicated
another blood slide.” number, to a database indicating “All this happens in real-time
the village code and the sex of the and alert text messages are sent
Chou Khea then takes the Day patient. out simultaneously to the opera-
Zero and Day 3 slides, together tional district malaria supervisor,
with the used RDT, to the Ta Sanh Malaria Consortium pioneered the provincial health department,
Health Centre 30-kilometres away the use of this alert system in Ta CNM and the administrators of the
from her village. Sanh, with support from Cambodia’s database,” Mellor points out.
National Centre for Parasitology,
“I usually take a motor-dop Entomology and Malaria Control There are plans to upscale this
(motorcycle taxi) to the health (CNM) and the World Health Organ- mobile phone and web-based alert
centre. But most of the motor-dop ization’s Malaria Containment system with InSTEDD, an innova-
drivers are reluctant to use the track Project funded by the Bill & Melinda tive humanitarian technology NGO,
to health centre in the rainy season Gates Foundation. to map all Day Zero cases. Malaria
because of the slippery mud. Also Consortium and CNM are also in
many of them M a l a r i a direct talks with Mobitel, one of
are scared of
the wild animals
There are plans to up- C o n s o r t i u m ’s
Information Sys-
Cambodia’s main telecommunica-
tion carriers.
and land-mines scale this mobile phone tems Manager
in the area,” she Steve Mellor “We are in negotiations with
tells CONTAIN- and web-based alert explains the use Mobitel for a free number and also
MENT with system of cellular text free SIM cards to be distributed
concern. “I hope messaging (SMS) to health centre staff and village
to have my own with InSTEDD, an in- as a viable tool to malaria workers,” Mellor reveals.
motorcycle soon,
so that I’ll be
novative humanitarian send alerts and
map Day 3 posi-
“After all, this is for a public
good.”
able to transport technology NGO, to tives in real-time
the slides and on Google Earth. Besides plans to map all Day Zero
RDTs faster,” map all Day Zero cases, Malaria Consortium is also
she adds with a cases… “We use exploring the possibility of sending
smile. FrontlineSMS, alert messages in Khmer script.
an open-source
At the Ta Sanh Health Centre, software, that enables users to “This will be a breakthrough and
the Day 3 slides are examined by a send and receive text messages we hope this will help facilitate a
microscopist and if asexual malaria with groups of people through quick response mechanism from
parasites are seen they are graded mobile phones,” Mellor tells CON- CNM and other partners,” says
as positive. The microscopist TAINMENT. Mellor.
April - June 2011 Containment 5