Malaria kills more than 400,000 people every year despite being curable and preventable. Global efforts to track, treat, and prevent the disease have proven so effective that the World Health Organization (WHO) now has a bold vision of a world free of malaria.
Coconut Surveillance, an open-source, mobile software application designed by malaria experts specifically for malaria control and elimination, can help realize this vision. Mobile phone signals travel faster than mosquitoes. By capturing data about malaria cases from health clinics via mobile phones and dispatching that information to health workers with GPS-equipped mobile devices, health care officials can map and treat infected households quickly and cost-effectively.
Monitoring Malaria Cases in Real Time
Working with the Zanzibar Malaria Elimination Program, RTI developed Coconut Surveillance to enhance the country’s malaria detection, response, and surveillance efforts.
When a new malaria diagnosis is made at a health clinic, a clinician enters basic information about the case using a simple Short Message Service (SMS) mobile phone messaging system. This creates a record in the system and triggers a follow-up response. A surveillance officer equipped with a tablet computer running Coconut Surveillance mobile software is then alerted of the new case. The software application guides the surveillance officer through a case follow-up and household-based active case detection protocol that aims to limit onward transmission and contain outbreaks. The surveillance officer visits the patient’s home, tests household members and neighbors for malaria, captures the GPS location, collects information on mosquito net ownership and use, and records the patient’s travel itinerary. Any new malaria cases found at or near the patient’s home are treated immediately. The software also has built-in epidemic threshold detection and issue tracking to ensure the appropriate individuals take programmatic action in a timely manner.
All of the health information collected during household interviews and testing is synchronized with a cloud database. Because Coconut Surveillance is often used in areas with limited internet connectivity, the software stores data locally and syncs to a remote server when an internet connection is available.
In addition to case-by-case monitoring, Coconut Surveillance includes real-time reports, maps, and graphs that help program managers analyze and understand malaria transmission and response trends in space and time. Such analysis is essential to target limited program resources and understand the success of public health campaigns for malaria reduction.
Building on Coconut Surveillance Success in Zanzibar
All public and private health care facilities in Zanzibar now use SMS to report new malaria cases to Coconut Surveillance. Coconut has been used to strengthen malaria control and elimination in Zanzibar since 2012, helping surveillance officers respond to more than 30,000 reported cases of malaria, complete nearly 31,000 household visits, test more than 70,000 household members, and identify and treat more than 4,600 previously unknown cases.
Coconut Surveillance has become an essential tool for the Zanzibar Malaria Elimination Program. A team of just 20 malaria surveillance officers equipped with inexpensive Android tablets and motorbikes is playing a significant role in keeping malaria prevalence at less than 1 percent—a steady and sustained decrease from more than 35 percent just 15 years ago.
The Coconut Surveillance name was inspired by the tremendous versatility of coconuts. Now, encouraged by the positive results in Zanzibar, we are adapting this versatile tool to help fight other infectious diseases, including Ebola and Zika.