Open Access Using mobile phone text messaging for malaria surveillance in rural Kenya

Background: Effective surveillance systems are required to track malaria testing and treatment practices. A 26-week study “SMS for Life ” was piloted in five rural districts of Kenya to examine whether SMS reported surveillance data could ensure real-time visibility of accurate data and their use by district managers to impact on malaria case-management. Methods: Health workers from 87 public health facilities used their personal mobile phones to send a weekly structured SMS text message reporting the counts of four basic surveillance data elements to a web-based system accessed by district managers. Longitudinal monitoring of SMS reported data through the web-based system and two rounds of cross-sectional health facility surveys were done to validate accuracy of data. Results: Mean response rates were 96 % with 87 % of facilities reporting on time. Fifty-eight per cent of surveillance data parameters were accurately reported. Overall mean testing rates were 37 % with minor weekly variations ranging from 32 to 45%. Overall test positivity rate was 24 % (weekly range: 17-37%). Ratio of anti-malarial treatments to test positive cases was 1.7:1 (weekly range: 1.3:1–2.2:1). District specific trends showed fluctuating patterns in testing rates without notable improvement over time but the ratio of anti-malarial treatments to test positive cases improved over short periods of time in three out of five districts. Conclusions: The study demonstrated the feasibility of using simple mobile phone text messages to transmit timely surveillance data from peripheral health facilities to higher levels. However, accuracy of data reported was suboptimal. Future work should focus on improving quality of SMS reported surveillance data

A mobile phone displaying the stock request message sent to registered health workers.

<p>A mobile phone displaying the stock request message sent to registered health workers.</p

RDT stock-out trend over 26 weeks monitoring period.

<p>RDT stock-out trend over 26 weeks monitoring period.</p

AL stock-out trends in study districts and stock-out comparisons with national trends.

<p>(A) Proportion of health facilities stocked out of all four AL packs and at least one AL pack over 26 weeks. Legend. Blue bars show stock-outs of at least one AL pack; red bars show stock-outs of all four AL packs. (B) Proportion of health facilities stocked out of AL 6, AL 12, AL 18 and AL 24 packs over 26 weeks. Legend. Yellow bars show stock-out of AL 6; blue bars stock-out of AL 12; red bars stock-out of AL 18 and green bars stock-out of AL 24 (C) Stock-out trends of all four AL packs and at least one AL pack in study districts compared to a nationally representative sample. Legend. The 7 consecutive bars show stock-outs in August, September, October, November, December, January and February. (D) Stock-out trends of AL 6, AL 12, AL 18 and AL 24 packs in study districts compared to a nationally representative sample. Legend. The 7 consecutive bars show stock-outs in August, September, October, November, December, January and February.</p