Award-winning mobile phone app boosts rabies-control efforts in Tanzania

A few years ago, former University of Glasgow PhD researcher Zac Mtema developed an application for rabies monitoring that could run on the most basic mobile phone handsets. (Less than 5% of health workers in Tanzania own a smart phone.) This app lets health workers record information on patients with animal bites and their treatment using a simple form on the phone, while veterinary workers can submit records on outbreaks and dog vaccinations. This work was recently awarded the Guardian University Award in the International Projects category.

All this information goes to a website that is accessed by government staff. It lets them see where dog bites are occurring, where vaccine stocks are running low, and where not enough dogs have been vaccinated. Equally important, it lets two sets of workers share information in real time in a place where typically lines of communication between sectors are weak.

In low-income countries in Africa, vaccines are often out of stock in rural clinics. The problem is not a lack of vaccines per se, but a supply chain that is not responsive to demand because there are no electronic records and monitoring systems are virtually non-existent. The information available to the authorities tends to reveal only the tip of the iceberg. And this is not just a problem for rabies vaccines, but for essential medical supplies in general.

Mobile phones look like the answer to this information problem. Over 97% of Tanzanians now have access to a mobile phone. While most clinics do not have a computer, every health worker has a mobile.

We have just reached the end of a five-year trial of this mobile-phone reporting system in southern Tanzania that involved over 300 health and veterinary workers submitting over 30,000 records across an area home to several million people. The mobile phone app has supported a WHO-funded rabies control programme, in which the government has been aiming to vaccinate at least 70% of dogs in the 2,000-plus villages across the region every year since 2011. This is part of a global push to eliminate human deaths from rabies by 2030.

Our results have been very encouraging. Patients reporting to clinics with dog bites have halved over the past five years, and rabies has disappeared entirely from Pemba, a Tanzanian island with a population of over 400,000. Admittedly, it is much easier to eliminate rabies from an island with a small dog population, but the trajectories across the pilot area are promising, too. Dr Chibonda, the director of a rural medical clinic, used to see bite patients almost every day, but now he sees just one or two a month; and when previously he didn’t even know the veterinary officer in his community, now they call one another and even carry out joint outbreak investigations.

The system may not solve the problem of chronic underfunding, but it helps make the most of the resources available. The fact that the handsets are so familiar and easy to use is almost certainly one of the reasons why it has taken off.

Our rabies-monitoring programme is an example of “mhealth”–using mobile phones for healthcare. It’s a promising and rapidly growing area, though there are few examples of programmes of this scope and scale. The Tanzanian government has adopted our application as a pilot in the region for rabies prevention. We hope it will be rolled out across Tanzania, where the disease remains rampant. Elsewhere in the country, the mobile phone app has already been adapted for other uses including monitoring pregnancies and birth complications, as well as for malaria control.

The more that cheap, easy-to-use, and familiar tools such as ours can become standard practice to support health workers, the better equipped they will be to deal with the entrenched disease problems of today–and for epidemics in the future.

Submitted by Katie Hampson, University of Glasgow rabies researcher. Excerpted from a recently published report by the author in The Conversation, “A new weapon in the war on rabies: mobile phones”. There is more information about the award available here.  This work was published in PLoS Medicine, “Mobile phones as surveillance tools: Implementing and evaluating a large-scale intersectoral surveillance system for rabies in Tanzania”.

View an online presentation of this article on YouTube.