Friday, 10 May 2013

Malaria: Mali: pregnancy and mHealth

From: "Hilde Eugelink" <>
To: "mHealth Working Group" <>

In Mali we have a project whereby a mobile and mobile app is used to help Community Health Workers to more effectively monitor malaria among pregnant women / families with young children. So far we see that the use of mobile technology helps to get patients more quickly into hospitals, enables the CHW to visit more families, enables hospitals to respond quicker to outbreaks of malaria.

It is basically the combination of working with a community outreach team with whom the targeted families can identify themselves with -CHWs are often female volunteers from within the community - and the use of mobile technology that makes the intervention successful.

'Local mothers acting as a Community Health Worker (CHW) play a vital role in overcoming the lack of knowledge on how to prevent diseases such as malaria and making sure patients receive the right treatment in time. CHWs are trained by professionalised health staff to recognise health risks, such as early symptoms of malaria or dehydration of young children. By regularly making house-calls to check upon the health of particularly young children and pregnant women and sharing their findings with health specialists in health centres or hospitals, it is possible to quickly arrange the treatment that they need. By ‘mapping’ the health situation of families on a large scale, health specialists can detect a potential outbreak of infectious diseases, such as malaria. However, in the data collection process and communication between CHWs and health specialists much is still to be gained.

To further improve the monitoring of malaria among children and pregnant women Dutch NGO IICD and mobile operator Orange Mali launched a pilot project in 2011 to strengthen the work of 50 CHWs and 10 health specialists working for Muso Ladamunen, a local NGO fighting malaria. The CHWs were trained in making use of a mobile device and a locally developed mobile application, called MAMMA (Mamans Mobiles contre le Malaria au Mali), helping them to improve patient management. The MAMMA app consists of a questionnaire listing various indicators which have to be checked and filled out during each health visit. The data thus collected is being sent by SMS to a database with a web interface allowing health specialists to monitor the health situation and respond when needed. Being able to use mobile phones and the MAMMA application to collect data in a much faster and more efficient way brings along the following advantages:
- Health clinics and community associations can respond faster to outbreak of malaria
- Health clinics and community associations can allocate budgets to where it is needed most, thus making healthcare more effective
- CHWs are able to more quickly contact the health clinic for advice and ensure that patients get to see a doctor immediately.
- Doctors can more easily contact the CHW and help them to monitor patients;
- Health clinics can quickly alert CHWs and send information to the CHWs in case of an outbreak of malaria.

By conducting prevention, diagnosis and treatment in a more efficient and cost-effective way, more people can be faster served. More lives can be saved.

First results
In the first six months of pilot project the CHWs of Muso Ladamunen managed to collect data on 2,225 malaria patients in the Yirimadjo area, among them are 120 pregnant women and 926 children. The data is now frequently being updated by the CHWs allowing both Muso Ladamunen and authorized health specialists in surrounding health clinics to consult the most recent data online. This enables them to monitor the evolution of the disease almost in real time and detect and respond much faster to outbreaks of malaria. Before, it took three weeks to collect recent data. More important however, is ­ as the figures below show - that the use of the mobile application enables the CHWs to give more young children faster access to treatment of malaria, thus preventing potential complications possibly resulting in death.

Number of health visits of CHWs
Nov 2011: 500
May 2012: 600

Response time after suspected outbreak of malaria
Nov 2011: 1-3 hours
May 2012: 1 hour

% of children < 5 receiving treatment within 24 hours
Nov 2011: 45%
May 2012: 64%

% of children < 5 receiving treatment 48 hours
Nov 2011: 14%
May 2012: 18%

Nr of pregnant women sleeping under treated bed nets
Nov 2011: 18%
May 2012: 49%

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