Timelier notification and action with mobile phones–towards malaria elimination in South Africa

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.

Four steps to precision public health

“…Work towards malaria elimination in South Africa, for example, has depended largely on paper reporting forms, which are collected and entered manually each week by dozens of subdistricts, and eventually analysed at the province level. This process would be much faster if field workers filed reports from mobile phones 5 .…”

Evaluating Response Time in Zanzibar’s Malaria Elimination Case-Based Surveillance–Response System

“…This challenge, however, is not unique to Zanzibar and has been identified in other settings. 12,31 Incidentally, the districts in which case investigation was completed within 48 hours had some of the lowest numbers of reported cases, which could explain a faster response time. Furthermore, the IQR of response time in these districts .987 (6.697-9.526)** 7.870 (6.579-9.414)** CI = confidence interval; IRR = incidence rate ratios.…”

“…26,27 A few other studies went beyond simple measures and investigated the relationship of timeliness with health system and surveillance-response system factors, geographic factors, and epidemiological factors. 28,29 To our knowledge, very few studies have investigated timeliness of malaria surveillance in a malaria eliminating country [30][31][32] or in a subnational elimination program. 33 These studies investigated the association of timeliness with health system factors and compared timeliness before and after the introduction of web-based and mobile phone-based reporting systems or the initiation of an elimination program.…”

Survey of the perceptions of key stakeholders on the attributes of the South African Notifiable Diseases Surveillance System

“…This is because the latter has a high penetration in the South African population. In 2015 there have been some encouraging developments with regard to malaria surveillance [36] that could be built upon. The 2014–2016 EVD outbreak and the current Zika virus outbreak provide a window of opportunity that should be used to strengthen the NDSS system.…”