A mobile phone application for malaria case-based reporting to advance malaria surveillance in Myanmar: a mixed methods evaluation

Abstract

Background To achieve malaria elimination in the Greater Mekong Subregion, including Myanmar, it is necessary to ensure all malaria cases are detected, treated, and reported in a timely manner. Mobile phone-based applications for malaria reporting, case management, and surveillance implemented at a community-level may overcome reporting limitations associated with current paper-based reporting (PBR), but their effectiveness in this context is unknown. Methods A mixed methods evaluation study was undertaken to determine the effectiveness of a national Malaria Case-Based Reporting (MCBR) mobile phone application in improving malaria case reporting compared to the existing PBR reporting system in Myanmar. Methods included secondary analysis of malaria case report data, questionnaires, focus group discussions and field observations of community volunteers, interviews and direct observations of malaria programme stakeholders, and cost analysis. Using a combination of these approaches the following areas were investigated: data quality and completeness, data access and usage, capacity for timely reporting, the acceptability, functionality, and ease of use of the application and facilitators and barriers to its use, and the relative cost of MCBR compared to the PBR system. Results Compared to PBR, MCBR enabled more accurate and complete data to be reported in a much timelier manner, with 63% of MCBR users reporting they transmit rapid diagnostic test outcomes within 24 h, compared to 0% of PBR users. MCBR was favoured by integrated community malaria volunteers and their supervisors because of its efficiency. However, several technical and operational challenges associated with internet coverage, data transmission, and e-literacy were identified and stakeholders reported not being confident to rely solely on MCBR data for programmatic decision-making. Conclusions Implementation of MCBR provided timely and accurate data for malaria surveillance. Findings from this evaluation study will enable the optimization of an application-based reporting system for malaria monitoring and surveillance in the Greater Mekong Subregion and advance systems to track progress towards, and certify, the achievement of malaria elimination targets.

Sustainability of a Mobile Phone Application-Based Data Reporting System in Myanmar’s Malaria Elimination Program: A Qualitative Study

“…Emergent themes were also captured and incorporated into the thematic framework during analysis. The qualitative ndings from FGDs and interviews were triangulated for comprehensive narrative synthesis [13].…”

“…Both ICMVs and stakeholders believed that MCBR would ful l the purposes they want to achieve with malaria case reporting, especially regarding its timeliness, simplicity, ease of use, and requiring no physical transportation for reporting unlike PBR; in addition, they stated that their use of this modern technology improved their social status. However, they also reported many challenges in using MCBR, such as dependence on internet access, software errors, and data synchronization problems [13]. Among ICMVs, this induced anxiety around their work performance and that of the system, leading some users to feel unsatis ed.…”

“…In township-level eld o ces, the paper-based data is entered manually into Microsoft Access, and the electronic data is forwarded to the higher levels by uploading onto Google Drive (Fig. 1) [13]. This lengthy chain of reporting through the PBR system may hinder timely and localised implementation of malaria elimination interventions [13].…”

“…1) [13]. This lengthy chain of reporting through the PBR system may hinder timely and localised implementation of malaria elimination interventions [13].…”

“…MCBR was rolled out in 2018, and by the end of the year more than 1,500 ICMVs managed by Myanmar's National Malaria Control Programme (NMCP) and its implementing partners (IPs) were using it [13]. MCBR was initially found to be superior to the conventional PBR, because it enabled more accurate and complete data to be reported in a much timelier manner, and was favoured by ICMVs and their supervisors because of its e ciency [13]. However, challenges to its longterm sustainability (i.e., meeting current healthcare needs without compromising future utility [15]) and wide-scale national application need to be identi ed and resolved.…”