@article{Cressman_McKay_Al-Mafazy_Ramsan_Ali_Garimo_Mkali_Ngondi_2017, title={Using Mobile Technology to Facilitate Reactive Case Detection of Malaria}, volume={9}, url={https://ojphi.org/ojs/index.php/ojphi/article/view/7647}, DOI={10.5210/ojphi.v9i1.7647}, abstractNote={<div style="left: 82px; top: 324.135px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.08211);" data-canvas-width="58.10914814814815">Objective</div><div style="left: 95.6667px; top: 337.757px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.991046);" data-canvas-width="344.5206462962964">This presentation will share findings from more than three years of</div><div style="left: 82px; top: 352.942px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01079);" data-canvas-width="358.9162777777778">using mobile technology for reactive case detection (RACD) to help</div><div style="left: 82px; top: 368.128px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.04622);" data-canvas-width="359.79527222222214">eliminate malaria in a well-defined geographic area. It will review</div><div style="left: 82px; top: 383.313px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.997148);" data-canvas-width="358.3251185185185">the concepts of RACD, the application of mobile technology, lessons</div><div style="left: 82px; top: 398.498px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.991844);" data-canvas-width="358.2373481481481">learned from more than three years of application, and considerations</div><div style="left: 82px; top: 413.683px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00121);" data-canvas-width="337.3738148148146">in applying this technology in other malaria elimination contexts.</div><div style="left: 82px; top: 442.58px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.11815);" data-canvas-width="75.28890740740741">Introduction</div><div style="left: 95.6667px; top: 456.202px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0202);" data-canvas-width="347.5306537037037">Zanzibar is comprised primarily of two large islands with a</div><div style="left: 82px; top: 471.387px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.982443);" data-canvas-width="358.0514814814813">population of 1.3 million. Indoor Residual Spraying (IRS) campaigns,</div><div style="left: 82px; top: 486.572px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00469);" data-canvas-width="360.851098148148">distribution of long-lasting insecticide treated bed nets (LLINs),</div><div style="left: 82px; top: 501.757px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.979193);" data-canvas-width="360.0327685185185">and use of Rapid Diagnostic Tests (RDTs) have reduced Malaria</div><div style="left: 82px; top: 516.943px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.975864);" data-canvas-width="360.63038148148144">prevalence from 39% in 2005 to less than 1% in 2011-2012. As</div><div style="left: 82px; top: 532.128px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.956205);" data-canvas-width="359.8197962962965">malaria burden decreases, there is an increasing need to track and</div><div style="left: 82px; top: 547.313px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01366);" data-canvas-width="358.9717796296296">follow up individual cases to contain transmission that could lead to</div><div style="left: 82px; top: 562.498px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00689);" data-canvas-width="358.72266666666644">resurgence. One method being used to achieve these aims is reactive</div><div style="left: 82px; top: 577.683px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00161);" data-canvas-width="123.66587037037034">case detection (RACD).</div><div style="left: 95.6667px; top: 592.868px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01421);" data-canvas-width="345.288637037037">RACD is generally understood to be triggered whenever a case is</div><div style="left: 82px; top: 608.054px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.973028);" data-canvas-width="357.76622777777754">identified by passive case detection. The response involves visiting the</div><div style="left: 82px; top: 623.239px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.994063);" data-canvas-width="358.3264092592593">household of the newly reported case and screening family members.</div><div style="left: 82px; top: 638.424px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01534);" data-canvas-width="361.00469629629623">Depending on program protocol, it may also involve screening</div><div style="left: 82px; top: 653.609px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.960032);" data-canvas-width="359.93209074074053">neighbors within a defined radius. RACD has been used or tested</div><div style="left: 82px; top: 668.794px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00565);" data-canvas-width="360.8769129629629">in Cambodia, China, India, Peru, Senegal, Swaziland, Tanzania,</div><div style="left: 82px; top: 683.979px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02236);" data-canvas-width="359.30866296296296">and Zambia. RACD can be resource intensive. Several studies raise</div><div style="left: 82px; top: 699.165px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.999352);" data-canvas-width="358.5174388888889">questions concerning whether and how RACD can be prioritized and</div><div style="left: 82px; top: 714.35px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00294);" data-canvas-width="291.77194444444433">targeted effectively as case numbers continue to decline.</div><div style="left: 82px; top: 743.246px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.07341);" data-canvas-width="53.062351851851844">Methods</div><div style="left: 95.6667px; top: 756.868px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02036);" data-canvas-width="345.85269074074074">Since September 2012 Zanzibar Malaria Elimination Programme</div><div style="left: 82px; top: 772.054px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0185);" data-canvas-width="359.1757166666667">(ZAMEP) has used RACD to limit onward transmission, reduce the</div><div style="left: 82px; top: 787.239px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.980622);" data-canvas-width="359.98630185185175">local parasite reservoir, and gather data needed improve program</div><div style="left: 82px; top: 802.424px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02805);" data-canvas-width="361.54938888888887">effectiveness. Zanzibar is one of very few malaria elimination</div><div style="left: 82px; top: 817.609px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01752);" data-canvas-width="324.6212962962963">contexts using a mobile technology system to support RACD.</div><div style="left: 406.637px; top: 817.951px; font-size: 7.74444px; font-family: serif;">1</div><div style="left: 410.509px; top: 817.609px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.0446);" data-canvas-width="30.693814814814814">This</div><div style="left: 82px; top: 832.794px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.983657);" data-canvas-width="360.39546666666655">system, called the Malaria Case Notification system (MCN) uses</div><div style="left: 82px; top: 847.979px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00172);" data-canvas-width="235.52146296296294">mobile software called Coconut Surveillance.</div><div style="left: 95.6667px; top: 863.165px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.980285);" data-canvas-width="344.5374259259256">Coconut Surveillance is free and open source software designed for</div><div style="left: 82px; top: 878.35px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02958);" data-canvas-width="359.3912703703706">malaria elimination. It includes an interactive SMS system for case</div><div style="left: 82px; top: 893.535px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01264);" data-canvas-width="358.9640351851852">notification, a mobile software application designed to guide mobile</div><div style="left: 82px; top: 908.72px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02675);" data-canvas-width="359.43257407407424">case workers through RACD, and an analytics software application</div><div style="left: 82px; top: 923.905px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00171);" data-canvas-width="302.8852222222221">designed for surveillance and response program managers.</div><div style="left: 95.6667px; top: 939.091px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00013);" data-canvas-width="347.3125185185188">Data were collected in the Coconut Surveillance database for</div><div style="left: 82px; top: 954.276px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03325);" data-canvas-width="359.5190537037036">more than three years, beginning in September 2012. Reports were</div><div style="left: 82px; top: 969.461px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.966576);" data-canvas-width="359.9850111111111">monitored in real time and periodically to assess RACD response</div><div style="left: 82px; top: 984.646px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.02403);" data-canvas-width="359.3486759259259">times against protocol targets, case trends, case locations, and other</div><div style="left: 82px; top: 999.831px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.993914);" data-canvas-width="360.42644444444426">data. Geographical Information System (GIS) software was used</div><div style="left: 82px; top: 1015.02px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.988319);" data-canvas-width="360.6045666666663">to produce detailed maps of case households. Three independent</div><div style="left: 82px; top: 1030.2px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03472);" data-canvas-width="361.5816574074073">assessments were conducted of various aspects of the malaria</div><div style="left: 82px; top: 1045.39px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00155);" data-canvas-width="104.67907407407407">surveillance system.</div><div style="left: 82px; top: 1074.28px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.08548);" data-canvas-width="46.62155555555556">Results</div><div style="left: 95.6667px; top: 1087.91px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.03281);" data-canvas-width="345.6990925925925">From September 2012 to December 2015, Coconut Surveillance</div><div style="left: 82px; top: 1103.09px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01522);" data-canvas-width="361.2473555555553">has helped malaria surveillance officers in Zanzibar respond to</div><div style="left: 464.667px; top: 322.572px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.95491);" data-canvas-width="359.58746296296283">more than 8,617 (84%) reported cases of malaria, complete nearly</div><div style="left: 464.667px; top: 337.757px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01618);" data-canvas-width="359.1679722222222">10,245 household visits, test more than 36,185 household members,</div><div style="left: 464.667px; top: 352.942px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01312);" data-canvas-width="358.99759444444436">and identify and treat 2,032 previously unknown cases. The average</div><div style="left: 464.667px; top: 368.128px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.98842);" data-canvas-width="358.1044018518518">number of RACD activities occurring within 48 hours increased from</div><div style="left: 464.667px; top: 383.313px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.94679);" data-canvas-width="359.9062759259259">72% in 2013 to 89% in 2015. The number of household members</div><div style="left: 464.667px; top: 398.498px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01172);" data-canvas-width="358.92402222222216">screened during RACD also increased from 7,589 in 2013 to 14,987</div><div style="left: 464.667px; top: 413.683px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.99647);" data-canvas-width="360.7220240740739">in 2015. Challenges included incomplete registers at health care</div><div style="left: 464.667px; top: 428.868px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.985378);" data-canvas-width="360.5167962962965">facilities, lack of transport, inadequate training for clinicians and</div><div style="left: 464.667px; top: 444.054px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.01453);" data-canvas-width="358.9575814814814">surveillance officers, and insufficient communication to the affected</div><div style="left: 464.667px; top: 459.239px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00123);" data-canvas-width="69.91942592592592">communities.</div><div style="left: 464.667px; top: 488.135px; font-size: 12.9074px; font-family: sans-serif; transform: scaleX(1.10391);" data-canvas-width="77.45735185185185">Conclusions</div><div style="left: 478.333px; top: 501.757px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.981757);" data-canvas-width="346.51096851851827">In Zanzibar twenty malaria surveillance officers equipped with</div><div style="left: 464.667px; top: 516.943px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.997427);" data-canvas-width="360.7194425925924">inexpensive Android tablets and motorbikes are keeping malaria</div><div style="left: 464.667px; top: 532.128px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.952761);" data-canvas-width="359.73073518518504">prevalence at less than 1%. The effectiveness of the system might</div><div style="left: 464.667px; top: 547.313px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.970702);" data-canvas-width="360.08181666666655">be enhanced by improving training for clinicians and surveillance</div><div style="left: 464.667px; top: 562.498px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.04145);" data-canvas-width="359.70104814814795">officers, ensuring the availability of transportation for surveillance</div><div style="left: 464.667px; top: 577.683px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.988475);" data-canvas-width="357.9598388888888">officers, and improving communications to the affected communities.</div><div style="left: 464.667px; top: 592.868px; font-size: 12.9074px; font-family: serif; transform: scaleX(0.990509);" data-canvas-width="358.2012074074075">These results suggest key considerations for applying this and similar</div><div style="left: 464.667px; top: 608.054px; font-size: 12.9074px; font-family: serif; transform: scaleX(1.00123);" data-canvas-width="237.34140740740747">systems in other malaria elimination contexts.</div>}, number={1}, journal={Online Journal of Public Health Informatics}, author={Cressman, Gordon and McKay, Michael and Al-Mafazy, Abdul-wahid and Ramsan, Madhi M. and Ali, Abdullah S. and Garimo, Issa A. and Mkali, Humphrey and Ngondi, Jeremiah J.}, year={2017}, month={May} }