January 2nd, 2014
The power of cell technology is changing nations with less infrastructure as a solution for connectivity and smart grid development. It was not too long ago that Google commitment to wiring parts of Africa for internet connectivity. The power of using “Cell Phones Help Detect Disease Outbreaks in Papua New Guinea” to manage health.
For many nations the cell phone is means for connectivity. The platform for engagement. The news of Papua illustrates the power for the cell.
Wynnee Parry writes, When cases of infectious disease appear, saving time can mean saving lives or preventing suffering. The sooner health officials realize an outbreak like influenza, measles, cholera or dengue fever is under way, the sooner they can mobilize to treat and contain it.
In developing countries, a lack of resources can make keeping tabs on outbreaks difficult. In Papua New Guinea, an island nation in the southwestern Pacific, health officials are turning to cell phones, an abundant technology here and elsewhere in the developing world, to help address this challenge.
The national health department, with support from the World Health Organization (WHO), is rolling out a system that allows certain facilities around the country to report suspicious cases via cell phone text messaging. Health officials can access these reports immediately to look for signs of outbreaks or collect other information about disease.
Mobile phones bring opportunity
Health care is not readily accessible to many people in Papua New Guinea; 87 percent of the country’s 7 million citizens live in rural areas.
“When I say rural, I mean like mountain valleys that are so remote only a helicopter can get to them,” says Dr. Boris Pavlin, a WHO infectious disease epidemiologist and government adviser, who is overseeing the rollout.
Villagers in these remote locations may have to travel several days down a river or hike across a mountain to get health care, Pavlin says. The first destination is often an aid post staffed by a community health worker with limited training, limited access to medicine and, in many cases, limited or no electricity.
While many other modern conveniences may be scarce, cell phones are common in the country, as they are in other developing nations. The growth in the technology’s penetration in these places has been meteoric. In low-income countries, less than one person per 100 people had a mobile phone subscription in 2000. A decade later, that ratio had risen to almost one in three, according to a 2012 World Bank report, which argues that developing nations are increasingly well-placed to exploit the benefits of mobile communications.
Efforts to apply new communication tools, including social media, have sprung up in many fields, including agriculture, election monitoring and security. In Kenya, for example, a police chief has used Twitter to fight crime.
“Mobile phones are fairly widespread in Papua New Guinea; people know how to use them. Using the standard Nokia as a data-sending tool didn’t seem like it would be a great jump for people,” says Alexander Rosewell, who was an epidemiologist with the WHO’s Papua New Guinea country office and oversaw a 10-week pilot of the system in 2011. He now works for the New South Wales Ministry of Health in Australia.
Other countries have seen the potential in improving health, and the pilot in Papua New Guinea built on similar systems employed elsewhere.
Phones employed for this system needed to be durable and capable of supporting new software, leading to the selection of the Nokia 3720 for the pilot. One of these phones went to each of 10 hospitals or health centers. A person was appointed to enter weekly or urgent case tallies into a template in the phone. This information was sent via text messaging into a password-protected, online database.
Tracking suspicious symptoms
This system, which is still in place at a few sites, does not collect tallies of diagnosed cases of cholera, measles and other infectious diseases. Instead, it focuses on sets of suspicious symptoms, called syndromes.
If health authorities see something concerning in the data — if, for example, the reported cases of acute fever and rash indicate a possible measles outbreak — they contact the site in question to investigate.
One of the eight categories included in Papua New Guinea’s system is a catchall: an outbreak or cluster of unexplained disease or deaths, intended for “whenever somebody gets their hackles on the back of their neck raised,” Pavlin says.
Last year, the disease chikungunya, caused by a mosquito-borne viral infection, was reported in the country for the first time. The pilot had already ended, but a cell phone-equipped site still operating on the northwest coast picked up the illness through an increase in cases of prolonged fever and unexplained disease. Blood tests later confirmed the presence of the virus, which causes fever, joint pain and other symptoms.
A permanent program
The country has other systems in place for keeping tabs on disease. But these require disease control officers to visit hospitals, or involve more comprehensive, paper-based tallies that must pass through multiple governmental levels, a process that takes 90 days.
On a number of important fronts, the pilot appeared successful. The cell phone-based system made data available much faster, in an average of 2.4 days; it appeared capable of picking up cases that would otherwise have been missed; and its simplicity made it easy for health facility staff to use. There were challenges, too. Clinicians who saw the patients did not always stick closely to the criteria defining what cases to count, and not all health officials made use of the data. What’s more, the system has technical limits: It requires cell service and reliable access to electricity.
“There are definitely places where it still is not practical, but it is at least as good and in almost all cases better than any traditional system,” Pavlin says.
Most of the sites stopped participating after the pilot ended, though four still may be operating, he says. However, Papua New Guinea and WHO health authorities, along with service provider Digicell, are working to bring the same system, with upgraded phones, to 30 facilities. The results of the pilot are described in the November issue of the journal Emerging Infectious Diseases.
Top Image: A health worker in Papua New Guinea provides health education information during an influenza outbreak. Photo courtesy of Dr. Boris Pavlin.