Could text messaging help the fight against malaria?
Recent studies and applications of SMS to efforts against
malaria in afflicted regions of African countries suggest
that it just might.
Basic supplies like bed nets that have been treated
with insecticide are staples in malaria prevention in
areas where the disease is found. Organizations like
Canada's MEDA work to run programs that make these nets
accessible to families in at-risk areas, and one necessity
of these programs is tracking their supplies. Retailers
must be able to update local clinics on supply levels
and to share statistics on net use with organizations
like MEDA, often quickly, in order for the aid programs
to function. And what better vehicle for the rapid transfer
of information than texting?
Texting to track supply stocks ensures that retailers
are always able to provide life-saving nets to families
who need them. It also expedites processes that used
to be paper-based, such as the sharing of statistics
between retailers and groups like MEDA, allowing the
program to function better and more efficiently. This
application of texting is not the end of SMS in malaria
supply tracking, too: while nets are traditionally purchased
by families with paper vouchers, work is being done
to create text message vouchers, speeding up reimbursement
of retailers and thus encouraging their participation.
Texting is also being used to improve the performance
of health workers who aid in the treatment of malaria.
A lapse in communication has emerged between supervisors
and field health workers, who often give care in rural
areas, and it has potentially serious consequences.
Without frequent contact with supervisors, and with
written protocols unlikely to be revisited by workers,
there has been growing concern that health workers are
faltering on their adherence to government protocol
for treatment of the disease.
A study in Kenya held that texting might assuage this
problem. The study, which involved 119 health workers
and lasted six months, involved a group of workers receiving
texts twice daily on five days per week offering tips
and information, such as correct prescriptions of anti-malarial
drugs. At the end of the study, more than double the
amount of children afflicted by malaria were receiving
correct treatment than before; when the study began,
20.5% of the children were treated correctly, as opposed
to 49.6% at its conclusion.
Interestingly, six months after the study ended, the
proportion of children who were receiving correct treatment
had slightly increased, with 51.4% of children being
managed correctly. While it is possible that other factors
may be behind this slight increase, the maintenance
of a roughly similar proportion six months after the
study ended demonstrates that this application of SMS
to the management of health workers may stand the test
of (at least some) time.
Notably, text messaging is also an incredibly cost-effective
mode of managing workers remotely. During the six months
in which the study was conducted, texting each worker
cost an estimated total of £1.59, or $2.52, per worker.
Another important feature of the fight against malaria
is surveillance systems that effectively track testing
and treatment practices, and, you guessed it, texting
represents a useful and cost-effective option to this
end. In a trial study published in Malaria Journal in
2014, health workers in 87 public health facilities
were asked to follow guidelines to text weekly reports
on testing and treatment procedures, and the facilities
were evaluated simultaneously so that the data reported
by the health workers could be tested for accuracy.
The trial found a 96% rate of response, with 87% of
the facilities reporting their data by the set deadlines.
This high response rate and fairly good punctuality
indicates that the use of texting as a vehicle for this
type of surveillance is indeed feasible. However, only
58% of the data reported was done so accurately; while
texting is a promising medium for this sort of work,
the way it is applied must be further developed so as
to promote higher accuracy of data.
While some developments stand to be made, it's clear
that text messaging represents a promising resource
for organizations that aim to treat malaria and fight
the disease's spread. We look forward to seeing what
else texting will do for medicine in the coming years.
About the Author -
Sharon Housley is the VP of Marketing for NotePage,
Inc. a software company for communication software solutions.