Category Archives: Health Information

iPhones for household malaria surveys in Sierra Leone

World Malaria Day 2014 was observed at the Johns Hopkins Bloomberg School of Public Health on Friday 25 April. 21 posters were presented. Below is the abstract of a poster presented by Suzanne Van Hull of Catholic Relief Services.iForm Builder picture on iPhone

Catholic Relief Services (CRS) and the Ministry of Health and Sanitation (MoHS) of Sierra Leone (SL) are co-implementing nationwide malaria prevention and treatment activities funded by the Global Fund to fight AIDS, Tuberculosis and Malaria. In order to track progress and impact, CRS and partners led the implementation of a malaria indicator survey (MIS) in early 2013 covering a nationally-representative sample of 6,720 households, inclusive of blood testing to determine prevalence of anemia and malaria. In early 2012, CRS also had the experience of using mobile technology for a Knowledge Attitude and Practices (KAP) study.

Fieldworkers used Apple 3GS iPhones for both surveys to collect data via the iFormBuilder platform, a web-based, software-as-services application with a companion app for the mobile devices allowing for timely data collection, monitoring, and analysis.

This was the first time that iPhones were used for a MIS, and lessons learned include: allowing at least four months to transform paper-based questionnaires into electronic format, giving the program enough time for pre-testing the tool and training data collectors/biomarkers/laboratory technicians, and involving key malaria stakeholders to ensure a nationally-led survey. Global Positioning Systems enabled the MoHS to make in-depth analyses on malaria trends based on geographic locations.

KAP survey on iPhoneOverall the benefits of an electronic versus a paper-based MIS questionnaire outweighed the challenges. The iPhone technology eliminated the need for paper transcribing, allowing for quicker data tabulation, real-time identification of mistakes, faster interviewing through skip patterns, and a close-to-clean dataset by the end of data collection saving time and money.

Survey results will be used to set evidence-based targets for all partners’ future malaria activities, especially the next 3 years of GF-supported malaria grants

Cambodia DHS lacks adequate attention to malaria

cambodia-dhs-2010-cover-sm.jpgThe Cambodia Demographic and Health Survey 2010 report is now available for download.

Surprisingly little information is available about malaria.  The following narrative on ‘fever’ was provided:

“Less than 1 percent of children with fever received antimalarial drugs, whereas 44 percent received antibiotic drugs. Use of antibiotic drugs was more common in urban areas (52 percent) than in rural areas (43 percent) and more common among mothers with at least a secondary education (54 percent) than among mothers with no schooling (39 percent). Mothers in Prey Veng (85 percent) and those in Kampong Chhnang and Kampong Speu (79 percent in both) were most likely to use antibiotic drugs to treat fever.”

We note that Cambodia is a place where artimisinin resistance has been suspected and yet these DHS results do not diagnose malaria with RDTs as is done in other DHS and MIS surveys. Therefore, appropriate treatment cannot be ascertained from the results. This is made more complicated by the following list of appropriate and inappropriate medicines in the survey instrument that were lumped together under the title “antimalarials”: SP/FANSIDAR, CHLOROQUINE, QUININE, MALARINE, A+M, MEFLOQUINE, ARTEMISININ, ARTESUNATE TABLET, ARTESUNATE SUPPOSITORY, ARTEKINE, COTEXIN.

While the report mentions…

“Iron and folic acid supplementation and antimalarial prophylaxis for pregnant women, promotion of the use of insecticide-treated bednets by pregnant women and children under 5, and six-month deworming for children are some important measures used to reduce anemia revalence among vulnerable groups…”

… it does not report on bednet use.

RBM partners are trying to take the problem of malaria in Asia seriously. They would be assisted by better data on the malaria situation in countries like Cambodia.