Texting away malaria: a new alternative to directly observed therapy

Area of Science:

• Military medicine
• Tropical public health
• Mobile health technology

Background:

• Malaria poses a significant health risk to U.S. Forces deployed in malaria-endemic regions like Liberia.
• Operation Onward Liberty, a U.S. military program, trains the Armed Forces of Liberia, necessitating malaria prevention strategies.
• Ensuring consistent malaria chemoprophylaxis adherence is critical for force health protection.

Purpose of the Study:

• To evaluate the effectiveness of short message service (SMS) technology for monitoring malaria chemoprophylaxis adherence.
• To assess the impact of SMS-based accountability on malaria incidence among U.S. Forces in Liberia.

Main Methods:

• U.S. Forces in Liberia utilized SMS technology to report daily completion of malaria chemoprophylaxis starting January 2011.
• Data on malaria cases, diagnostic tests (Binax rapid diagnostic test, thin smear), and evacuations were collected.

Main Results:

• Following the implementation of the SMS protocol, no malaria cases were identified among U.S. Forces.
• In the preceding year (2010), 12 malaria cases were reported, including 3 evacuations, with an estimated cost of $1.5 million.
• The SMS system ensured 100% daily accountability for medication ingestion.

Conclusions:

• Short message service (SMS) technology offers a viable alternative for ensuring malaria chemoprophylaxis adherence in deployed environments.
• Mobile health solutions like SMS can provide effective accountability, particularly in decentralized operational settings.
• The study highlights the potential of technology to enhance public health outcomes in military operations.