Rural health centres, communities and malaria case detection in Zambia using mobile telephones: a means to detect potential reservoirs of infection in unstable transmission conditions

Abstract

Background: Effective malaria control depends on timely acquisition of information on new cases, their location and their frequency so as to deploy supplies, plan interventions or focus attention on specific locations appropriately to intervene and prevent an upsurge in transmission. The process is known as active case detection, but because the information is time sensitive, it is difficult to carry out. In Zambia, the rural health services are operating effectively and for the most part are provided with adequate supplies of rapid diagnostic tests (RDT) as well as effective drugs for the diagnosis and treatment of malaria. The tests are administered to all prior to treatment and appropriate records are kept. Data are obtained in a timely manner and distribution of this information is important for the effective management of malaria control operations. The work reported here involves combining the process of positive diagnoses in rural health centres (passive case detection) to help detect potential outbreaks of malaria and target interventions to foci where parasite reservoirs are likely to occur.

Methods: Twelve rural health centres in the Choma and Namwala Districts were recruited to send weekly information of rapid malaria tests used and number of positive diagnoses to the Malaria Institute at Macha using mobile telephone SMS. Data were entered in excel, expressed as number of cases per rural health centre and distributed weekly to interested parties.

Results: These data from each of the health centres which were mapped using geographical positioning system (GPS) coordinates were used in a time sensitive manner to plot the patterns of malaria case detection in the vicinity of each location. The data were passed on to the appropriate authorities. The seasonal pattern of malaria transmission associated with local ecological conditions can be seen in the distribution of cases diagnosed.

Conclusions: Adequate supplies of RDT are essential in health centres and the system can be expanded throughout the country to support strategic targeting of interventions by the National Malaria Control Programme. Participation by the health centre staff was excellent.

Figure 1

Elevation/Contour map of the Rural Health Centre Study Area in Choma/Namwala Districts, Southern Province, Zambia. Rural Health Centres collaborating are names and indicated. Drainage lines and river systems are indicated in categories. Category 1 is a simple drainage line that flows during and shortly after rain, Category 6 is a permanent large river.

Figure 2

Graph showing the mean number of malaria cases per week diagnosed using malaria rapid diagnostic tests in a series of rural health centres in a section of the Choma and Namwala Districts in the Southern Province of Zambia. *The centres were segregated in two sections based on locality and elevation, as being in the "Kafue Flats" area (in, or close to the flood plain with elevation mainly below 1,100 m) and "Macha Heartland" (in slightly higher and drier area mainly above 1,100 m).

Figure 3

Graph showing the incidence of malaria cases per week diagnosed using malaria rapid diagnostic tests in a series of rural health centres in a section of the Choma and Namwala Districts in the Southern Province of Zambia.