MALAWI: SMS to fight malnutrition

Photo: IRIN

Malawi has one of the world's worst under-five mortality rates

JOHANNESBURG, 13 January 2009 (IRIN) - For the first time in years, John Phiri*, a health extension worker in Malawi's central Salima district, does not have to fill in a stack of forms during his monthly round of collecting data to monitor nutrition levels in the community.

Now he whips out his mobile phone and texts the data, including the height and weight of the children in the area, while covering his beat. The information is immediately captured by a computer that stores the national nutritional and food-security statistics in Lilongwe, the capital.

In previous years the data might have taken two months to be registered in the country's Integrated Nutritional and Food Security Surveillance System. The quick collection and availability of data can help government and other aid agencies intervene if the statistics show a crisis is unfolding.

Malawi has one of the world's worst under-five mortality rates: up to 120 infants in every 1,000 may die before they turn five, and 46 percent of children younger than five years are stunted - an indicator of the malnutrition level.

The RapidSMS system, as it is called, is on a four-month trial run that began in January 2009 in three districts of Malawi's Central Province. The SMS (short message service) text message and web-based tool was developed by the Innovations and Development team of UNICEF, the UN children's agency, and allows text messages to be captured via the internet.

The quick collection and availability of data can help government and other aid agencies intervene if the statistics show a crisis is unfolding

Besides the obvious advantage of speed and quality of data, the system also creates spreadsheets and graphs, allowing for easy interpretation of the data.

Yet doing away with the old system of completing questionnaires and sending them to the capital using the postal system has its drawbacks.

The new system is expensive. In Malawi it costs about 10 US cents to send a text message, "But we are in talks with the mobile phone service provider to make the service toll-free," said Stanley Chitekwe, UNICEF's nutrition manager.

Christopher Fabian, who co-heads UNICEF's Innovations and Development team, maintains that the service is still cheaper than the manual collection of data. "The first week of the trial run only cost about $40."

Replacing the questionnaire with only the numbers also means anecdotal information on household security, obtained via the questionnaire, is also lost. "We are aware of that – we are trying to develop a system which will help us get a sense of household food security levels and coping strategies, and we hope to get the system running after four months," Chitekwe said.

Even before it kicked off, the Malawi project, designed by UNICEF and Columbia University's School of International and Public Affairs, in the US, won first prize in the Development 2.0 Challenge, run by the US Agency for International Development (USAID), for its innovative design for adapting a commonly accessible technology to monitor the health and nutritional status of children.

Tested in Ethiopia

The Malawian programme was developed after UNICEF's success with the RapidSMS system in monitoring and delivering the protein-rich read-to-use therapeutic food, Plumpy’nut, in drought-hit Ethiopia in October 2008.

"It used to take the agency three to four months to respond [depending on when the information reached the head office] to shortages [of Plumpy’nut] in the 1,800 feeding centres in Ethiopia – now the alerts get through within seconds," said Fabian.

Before implementing the RapidSMS system in Ethiopia, initial field testing was done in northern Uganda by Sean Blaschke, a student at Columbia University who worked as a UNICEF intern during May 2008 in Uganda's Kitgum district. The area is prone to Hepatitis E outbreaks, a disease caused mainly by drinking contaminated water or eating contaminated food.

UNICEF is also considering developing the system to monitor school attendance rates. "It can have any number of uses," said Fabian. "We hope to make the system available, free of cost, to organisations and other implementing partners soon."

* Not his real name

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