Texting away malaria: a new alternative to directly observed therapy

Operation Onward Liberty is the current U.S. military mentorship program working with the Armed Forces of Liberia, training their national army. Throughout West Africa, and Liberia in particular, malaria remains a serious health concern. This is a critical concern to all U.S. Forces deployed in areas endemic with malaria. In January 2011, a new protocol was instituted among Operation Onward Liberty members using short message service (SMS) technology to ensure 100% daily accountability.

Beginning in January 2011, SMS was used to report completion of daily ingestion of malaria chemoprophylaxis by U.S. Forces in Liberia.

Since then, there were no cases of malaria identified by both Binax rapid diagnostic test and thin smear. The previous year (2010) saw 12 cases of malaria among U.S. Forces in Liberia (9 during the same 6-month period), with 3 evacuations for malaria, costing an estimated 1.5 million dollars.

Although directly observed therapy is still the gold standard of malaria chemoprophylaxis, use of cellular telephone texting technology, or SMS, for communicating ingestion may be the best alternative for reasonable accountability in the deployed setting, especially considering the highly decentralized nature of this and other deployment locations.