Francis Filbert, Ishengoma Deus S, Mmbando Bruno P, Rutta Acleus S M, Malecela Mwelecele N, Mayala Benjamin, Lemnge Martha M, Michael Edwin
National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania.
National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.
Malar J. 2017 Aug 1;16(1):308. doi: 10.1186/s12936-017-1956-z.
Early detection of febrile illnesses at community level is essential for improved malaria case management and control. Currently, mobile phone-based technology has been commonly used to collect and transfer health information and services in different settings. This study assessed the applicability of mobile phone-based technology in real-time reporting of fever cases and management of malaria by village health workers (VHWs) in north-eastern Tanzania.
The community mobile phone-based disease surveillance and treatment for malaria (ComDSTM) platform, combined with mobile phones and web applications, was developed and implemented in three villages and one dispensary in Muheza district from November 2013 to October 2014. A baseline census was conducted in May 2013. The data were uploaded on a web-based database and updated during follow-up home visits by VHWs. Active and passive case detection (ACD, PCD) of febrile cases were done by VHWs and cases found positive by malaria rapid diagnostic test (RDT) were given the first dose of artemether-lumefantrine (AL) at the dispensary. Each patient was visited at home by VHWs daily for the first 3 days to supervise intake of anti-malarial and on day 7 to monitor the recovery process. The data were captured and transmitted to the database using mobile phones.
The baseline population in the three villages was 2934 in 678 households. A total of 1907 febrile cases were recorded by VHWs and 1828 (95.9%) were captured using mobile phones. At the dispensary, 1778 (93.2%) febrile cases were registered and of these, 84.2% were captured through PCD. Positivity rates were 48.2 and 45.8% by RDT and microscopy, respectively. Nine cases had treatment failure reported on day 7 post-treatment and adherence to treatment was 98%. One patient with severe febrile illness was referred to Muheza district hospital.
The study showed that mobile phone-based technology can be successfully used by VHWs in surveillance and timely reporting of fever episodes and monitoring of treatment failure in remote areas. Further optimization and scaling-up will be required to utilize the tools for improved malaria case management and drug resistance surveillance.
在社区层面早期发现发热性疾病对于改善疟疾病例管理和控制至关重要。目前，基于手机的技术已普遍用于在不同环境中收集和传递健康信息及服务。本研究评估了基于手机的技术在坦桑尼亚东北部乡村卫生工作者（VHWs）实时报告发热病例和疟疾管理中的适用性。
2013年11月至2014年10月，在穆赫扎区的三个村庄和一个诊疗所开发并实施了基于社区手机的疟疾疾病监测与治疗（ComDSTM）平台，该平台结合了手机和网络应用程序。2013年5月进行了基线普查。数据上传至基于网络的数据库，并在VHWs后续的家访中更新。VHWs进行发热病例的主动和被动病例检测（ACD、PCD），通过疟疾快速诊断测试（RDT）检测为阳性的病例在诊疗所给予首剂蒿甲醚 - 本芴醇（AL）。在开始的3天里，VHWs每天到患者家中访视，监督抗疟药的服用情况，并在第7天监测恢复过程。数据通过手机采集并传输到数据库。
三个村庄的基线人口为678户共2934人。VHWs共记录了1907例发热病例，其中1828例（95.9%）通过手机采集。在诊疗所，登记了1778例（93.2%）发热病例，其中84.2%通过PCD采集。RDT和显微镜检查的阳性率分别为48.2%和45.8%。治疗后第7天报告有9例治疗失败，治疗依从率为98%。1例重症发热患者被转诊至穆赫扎区医院。
该研究表明，VHWs可成功使用基于手机的技术在偏远地区监测和及时报告发热发作情况以及监测治疗失败情况。需要进一步优化和扩大规模，以利用这些工具改善疟疾病例管理和耐药性监测。
