cressman 2078616 cs2_using mobile technology to help eliminate malaria 2014.12.10
TRANSCRIPT
RTI International
RTI International is a trade name of Research Triangle Institute. www.rti.org1
Using Mobile Technology to Help Eliminate Malaria in Zanzibar
Gordon M. Cressman1, Michael V. McKay1, Abdul-wahid Al-Mafazy2, Mahdi M. Ramsan3, Abdullah S. Ali2, Issa A. Garimo2, Humphrey
Mkali2, Jeremiah J. M. Ngondi3
1. RTI International, Research Triangle Park, USA2. Zanzibar Malaria Elimination Programme, Zanzibar3. RTI International, Dar es Salaam, Tanzania
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Global Burden of Malaria
1. Source: World Health Organization, Global Health Observatory Data Repository
3.3 billionPeople estimated at risk
1.2 billionPeople estimated at high risk
207 millionestimated cases in 2012 (range: 135-287 million)
627 000estimated deaths in 2012 (range: 473 000-789 000)
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Malaria can be eliminated
Malaria-freeEliminating malariaControlling malaria
Malaria-free, Eliminating and Controlling Countries, 20121
1. Source: UCSF Global Health Group, Malaria Elimination Group
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The Case of Zanzibar
East Africa 2 large islands
(Unguja, Pemba) A semi-autonomous
part of the United Republic of Tanzania
1.3 million population 15 minutes by air and
1.5-2 hours by ferry from Dar es Salaam
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Nearing Elimination – for the Third Time
1. Source: Zanzibar Malaria Elimination Program
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Challenges to Elimination Vector resistance to
pyrethroids Short effective life of
long- lasting insecticide-treated bed nets (LLINs)
Resistance to behavior change
Constant ferry and air traffic with mainland Tanzania
An effective and sustained surveillance and rapid response system is essential
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Weekly Aggregate Case Reporting (2008)
Facility sends weekly case
totals via phone and
USSD
Selcom (service
provider) database
Malaria Epidemic Early Detection System (MEEDS)
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Case Alerts and Active Case Detection (2012)
Facility sends case
notification via phone and
USSD
DMSO receives case on tablet and SMS alert on
personal mobile phone
DMSO collects full case details from facility
DMSO gets precise
household position and other data
DMSO collects individual data from household members
Shared cloud database
Coconut SurveillanceMEEDS
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MEEDS Facility Alert
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Coconut Surveillance Active Response
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Collecting Facility Data
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Collecting Household Data
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Testing and Treating Household Members
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Monitoring the ProcessCase notification issued by facility via MEEDS.
DMSO received notification on Coconut Surveillance tablet.
DMSO collected more case information from facility.
DMSO visited household and collected household data.
DMSO collected data from and tested each member of household.
Additional household memberd tested positive and treated.
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Monitoring and Mapping the Data
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Status All 159 government primary
care units use MEEDS All 20 district malaria
surveillance officers use Coconut Surveillance
Used to respond to more than 5,132 new malaria case reports
Rapid Diagnostic Tests administered and data collected from more than 22,350 household members
1,328 new cases, including asymptomatic cases, detected and treated
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Time from Diagnosis to MEEDS Notification
Source: Zanzibar Malaria Elimination Program
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Time from MEEDS Notification to Follow-up
Source: Zanzibar Malaria Elimination Program
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Challenges
Challenge Response
$3,500/month for MEEDS USSD services Replacement interactive SMS system rolling out in January 2015.
Timely reporting by facilities Automated monitoring, analysis, alerts and coaching added. Timeliness improved.
Not used by private clinicsInteractive SMS system rolling out in January 2015 starting with 84 private health facilities.
No connection to Health Management Information System (DHIS2) None to date.
RDT results not checked by microscopy A quality assurance process using microscopy implemented by ZAMEP.
No follow up on ACT treatment provided to secondary cases during household visits
Health information on completion of treatment is provided. There is follow-up, but no follow-up on completion of ACT.
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Technologies
MEEDs– Unstructured
Supplementary Service Data (USSD)
Coconut Surveillance– CouchDB, PouchDB– JSON– Javascript– Backbone.js– D3.js– Leaflet– Android
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More Information
Gordon M. Cressman
Senior Program Director
+1 (919) 541 6363
Jeremiah Ngondi
Senior Epidemiologist
+255 (688) 619 263
Michael McKay
Senior Software Developer
+254 (716) 925 547
More Informationhttp://www.ictedge.org/meedshttp://www.ictedge.org/coconut-surveillance
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Advanced Monitoring and Alerts
Automated monitoring and alerts System errors Delayed response by
DMSO
Automated trend analysis and weekly email updates Identifies locations
that are experiencing changes relative to previous weeks
Bakari, for past 7 days: 8 cases, 1 missing facility after 24hrs, 2 missing household after 48hrsMuharami, for past 7 days: 1 case, 0 missing facility after 24hrs, 0 missing household after 48hrsMgana, EXCELLENT! For past 7 days: 3 cases without any cases overdue.
Humphrey, 70 cases in past 7 days, 8 missing facility after 24hrs, 12 missing household after 48hrs. Med. time: 2 days http://ow.ly/EDZED
Jeremiah, 70 cases in past 7 days, 8 missing facility after 24hrs, 12 missing household after 48hrs. Med. time: 2 days http://ow.ly/EDZED
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Findings
Sample size 3,380 cases
Median time from SMS sent to Case Notification on tablet 1 day
Median time from Case Notification to Complete Facility 6 minutes
Median time from Complete Facility to Complete Household 2 hours
Median time from SMS sent to Complete Household 4 days
Cases without completed facility record 24 hours after facility notification 143 (4%)
Cases without complete household record 48 hours after facility notification 303 (9%)
Cases with complete household record 2,891 (56%)