Using text messaging as weapon in malaria war

Cambodian efforts to contain the spread of malaria have been strengthened by a pilot project using text messaging and web-based technology.



"My work is definitely easier," said Sophana Pich, 41, one of 184 village malaria workers (VMWs) now trained in three provinces (Kampot, Siem Reap and Kampong Cham) since the project launch earlier this year.



She typically diagnoses five to six cases of the often deadly virus each month during the rainy season between May and October.



"Before, it would take a month before this information was reported to the district health level. Now it's instantaneous," the mother-of-three said from her home in Ta Reach, a village of 200 households in Kampot Province, about 150km southwest of Phnom Penh.



There are close to 3,000 VMWs in 1,500 villages across Cambodia, described by many as the "foot soldiers" in the country's fight against malaria.



As part of a larger US$22.5 million malaria containment effort launched by the government in 2009 and funded by the Bill & Melinda Gates Foundation, the volunteers receive three days of training in the early diagnosis of malaria and treatment.



In addition, they are given a bicycle, a pair of boots, a bag, a flashlight and a cooler box for medicines, as well as a small travel allowance.



Under the pilot scheme now under way, they are also given mobile phones.



Using FrontlineSMS - an open-source software enabling users to send and receive text messages with groups of people - VMWs can now report in real time all malaria cases in their villages to the Malaria Information and Alert System in Phnom Penh with a simple text message, including the patient's name, age, location and type of parasite. 



That information is then disseminated to local, district and provincial health offices, with coordinates mapped on the country's national malaria database using Google Earth.



Mobitel (Cambodia's largest telecommunications company) provides free SIM cards and free SMSs, making the system cost-effective and easy to maintain.



"Without doubt, this is an important tool to quickly identify malaria cases and respond effectively," explained Pengby Ngor, data manager for the Malaria Consortium, an NGO working closely with the government's National Malaria Control Centre that helped develop the database.



"This is a pilot project which ultimately could be used throughout the country."



That is good news for Cambodia, where malaria remains endemic; the government hopes to eliminate the disease over the next 15 years.



"We need a series of campaigns and activities so that malaria will go down towards the zero rate of malaria transmission by the year 2025," Prime Minister Hun Sen told participants at this year's 32nd National Health Conference in March.



Challenges



But while there is progress in that direction, including falling numbers of people getting sick or dying from malaria across much of the country, key challenges remain.














Photo: Brendan Brady/IRIN
A village malaria worker administers a simple blood test for malaria in Pailin, considered the epicentre for drug-resistant malaria

According to the Ministry of Health, the number of deaths from malaria fell by 53.8 percent in 2010 from the previous year.



At the same time, however, Cambodia has reported an increased incidence of multi-drug resistant falciparum malaria, one of four types of the disease, along parts of its 800km border with Thailand since 2009.



There health officials have expressed concern that the malaria causing parasite is becoming increasingly resistant to the most effective drug they have for treating it, Artemisinin.



"Here in Cambodia, we've found that the drug is less effective," Najibullah Habib, malaria containment project manager for World Health Organization (WHO), confirmed in Phnom Penh, specifically in the area described as Zone 1.



In Cambodia, some 270,000 people live in Zone 1, comprised of Pailin Province, as well as parts of Battambang, Pursat and Kampot provinces.



Another 110,000 people live in the Thai border areas of Trat and Chanthaburi provinces.



"This is the epicentre of drug-resistant malaria," Habib explained.



To counter that, Cambodian and international efforts are working on the ground to prevent the drug-resistant parasite from spreading elsewhere in the region, focusing on prevention, treatment and testing efforts at the village level.



"The VMWs are all over Zone 1," the WHO official said. "They're an essential tool."



In 2008, prior to the distribution of more than half a million bed nets, as well as the VMW intervention, Zone 1 averaged more than 100 cases per month. Today that number is between 10 and 15.



According to WHO, in 2000, the number of treated malaria cases in Cambodia stood at 129,167 with 608 deaths. In 2010, that dropped to 56,217 and 135 deaths, down 78 percent.



About 3.3 billion people - half the world's population - are at risk of malaria. Every year, this leads to about 250 million malaria cases and nearly one million deaths. People living in the poorest countries are the most vulnerable, the world health body says.



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