August 6, 2013

An SMS To Contain Tuberculosis

BY: Ariane Combal-Weiss  :

To answer the request of Family Health International (FHI) to promote earlier tuberculosis case detection, iLab Southeast Asia (iLab SEA), located in Phnom Penh, is designing a step by step TB Lab Result Alert System. It aims to offer early detection of tuberculosis in rural and remote villages in Kampong Cham province and to accelerate patient  access to care. Leveraging mobile technology (SMS), this system is involved in the containment of tuberculosis.

A common scenario: the average man in the street in a rural village in Kampong Cham contracts tuberculosis. He is not aware he has the disease but describes having some symptoms. The village Health Center (“HC”) doesn’t have the facilities to make a diagnosis based on medical analysis, and therefore turns to a specialized laboratory at the downtown district.

Until recently, the diagnosis of a patient such as the one described above could take as long as 14 days without the patient receiving proper treatment. During this time frame, the patient could have unknowingly spread his disease and contaminated many other people. The staff in the HC usually collect about 4 smears per week and then send them to the nearest lab using motorcycle, often taking between 2 and 3 hours. The delay between the submission of the smear to the lab and the receipt of the paper-based results at the Health Center  made it nearly impossible to prevent the disease from being spread. This delay allowed the disease to spread and contradicted all hopes of improved lives and development in Cambodia rural villages.

At the Kampong Cham operational district laboratory,
using the TB Lab Alert Result System...
With the use of the InSTEDD iLab SEA designed SMS- Based TB Lab Result-Alert System, the HC receives a quicker response from the lab. As in the paper-based system, as soon as four or five smears are gathered, the samples are brought by motorcycle to the lab. The Health Center must send an SMS to the system with the serial number of the patient (with his name, sex, age, and the village code) recorded in the HC log book.  

After three days of lab testing, as the results become available, the lab sends them to the system using SMS. The SMS must contain the lab result and the Health Center serial number. If the results are proven to be negative (i.e. the patient isn’t infected with tuberculosis), the system informs the Health Center. If the results are proven to be positive (i.e the patient has tuberculosis), the system alerts the Health Center and the Cultures and Directly Observed Therapy (CDOT) volunteers.The volunteers inform the patient about the need to come to HC to start the treatment against tuberculosis.

In these conditions, after having waited 5 days in total, the infected patient will be given medical treatment. This reduction of the delay before treatment begins is critical to contain the disease spread.

Without proper treatment up to two thirds of infected people with TB will die (Source :  This new system shapes the path to early detection of the disease, can improve the access to care and reduce the delay in treating the patient. The prompt response enabled by the TB Lab Result Alert System plays a prominent role in the reduction of the morbidity due to tuberculosis.

In collaboration and with funds provided by Family Health International (FHI), the National Center for Tuberculosis and Leprosy Control (CENAT) and USAID, iLab Southeast Asia addresses the unique needs of each village. Relying on the feedback of  users, the iLab Southeast Asia does their best to match up the system with the different needs and abilities of the users. Using a human-centered design approach, FHI and some of the staff of InSTEDD iLab South East Asia conducted some early field testing to find out about the ability of the lab, Health Center and volunteers to send SMS reports. It allows them to get their input to shape the system according to their problems.

A  member of InSTEDD is teaching a lab technician how to send the results by to the system

Additionally, the staff and the volunteers are given a leaflet with the instructions on how to send an SMS and how to open it. (picture(s) of the leaflets). 

Leaflet for the HC staff with the instructions on how to read the results

If FHI and InSTEDD have already deployed the TB Lab Alert Result System in 15 Health Centers in 184 villages, the assessment is quite mitigated. 

HC and lab staff are often confronted with some obstacles. They admit that it takes them quite a lot of time to send 5 SMS one by one to the system, each of them containing the informations of each sample. Basing on this feedback, FHI is thinking of the implementation of bulk messages, so that the HC and lab staff are able to send one SMS that contains the  informations of the 5 samples. Another area that should be improved is related to acknowledgements of the receipt of SMS. Sometimes, as the HC or the lab staff don’t receive their SMS’s acknowledgement of receipt from the system, they send the same SMS again.

Apart from these two inconvenients that should be solved without any delay by InSTEDD and FHI, the users are very satisfied with this tool overall. As they get the results faster, they can provide medicines faster to the patients. Since July 2012, the turnaround time has been reduced from 14 days to less than 5 days, which was the initial objective of FHI to answer the request of the CENAT.

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