Timely intervention is critical to curbing the spread of vector-borne diseases like malaria. A team of researchers from Mangaluru, Karnataka, has shown that information technology tools such as their Malaria Control System can be powerful allies in anti-malaria programs. Here is a report on how digitisation helped Mangaluru chalk its success story against malaria.
India carries a high disease burden and mortality rate of malaria. Karnataka is one of the states with a high prevalence of the disease. In the state, Mangaluru city has the highest number of malaria cases. Until a few years ago, the case reporting was done manually by field workers who visited, recorded, and reported the cases, after which measures to contain the spread of the disease would be implemented.
However, in 2014, Mangaluru witnessed a massive spike in malaria. In order to combat the situation, B Shantharam Baliga, Professor Emeritus, Kasturba Medical College, Mangalore, conceptualised a digital surveillance system for malaria. His team, along with Naren Koduvattat, Director, i‑POINT Consulting, Mangaluru, developed an indigenous software tool called the Malaria Control System (MCS) to monitor malaria cases in the city. The team reports that five years post the digitisation, the annual malaria incidences in the city reduced by 83% and further to 90% to date (Fig. 1).
Baliga says, “Malaria is endemic to Mangaluru since 1995. In the manual surveillance system, little or no action would be taken most of the time because of the gap between incidence and reporting of the case.” The team realised the urgency of the matter. “We had a clear intervention protocol and a good workforce in place. But the flow of information was far from satisfactory,” adds Koduvattat.
So, in October 2014, the team collaborated with Mangaluru City Corporation, Mangaluru, District Health and Family Welfare Department, and the Indian Council of Medical Research — National Institute of Malaria Research (Field Unit), Bengaluru, and initiated the use of MCS to monitor malaria cases in Mangaluru.
MCS is an android-based software designed for the stakeholders in a malaria control programme – the diagnosticians, field workers and the civic authorities. The software is installed in a hand-held tablet whose geographical location is linked with a web-based reporting system. All the stakeholders can enter data into the application even without internet connectivity. The device then uploads the information whenever the internet connection becomes available.
Hospitals and diagnostic centres use the application to report malaria cases along with the patient’s address. Healthcare workers ‘open’ a case and file reports. Field workers access the information, visit the patient’s house, spot and upload images and location of nearby potential mosquito breeding sites to the application. The software then tabulates these data into a spreadsheet, which is accessible to health administrators. In the meantime, the patient receives treatment as per the malaria treatment protocols. The case ‘closes’ once the treatment is complete (on the 14th day of the treatment).
The city’s civic body completely digitised the monitoring by September 2015. The reporting speeds were immediately apparent. The team noticed that 89% of the new cases were reported within 48 hours of the incidence — a stark contrast to manual reporting, which would take up to a month earlier. The following year saw a steady increase in reported cases indicating that digitised monitoring fostered better reporting.
The researchers also tracked the rate of positive cases and the disease burden of a location (determined by a parameter called Annual Parasite Incidence, API). Over the years, the annual number of malaria incidences decreased as now, the field workers could implement containment measures (such as arresting mosquito breeding sites) within a day or two of detecting a case. The researchers found that the API reduced by 80% or more in 43 municipal wards (Fig. 1).
“MCS has given some promising results in the district,” says Aparna Sen Chaudhary, Medical Consultant and a public health professional who was not involved in the study. “Such software could help curb malaria in India as it allows for the micro-level implementation of anti-malaria activities.” She adds that the researchers can use data of the reported cases to build models that predict cases on a fortnightly, monthly or annual basis to guide administrative actions.
Baliga says that MCS is a versatile tool that can be used to monitor other diseases like chikungunya or dengue and even those like COVID-19.
The authors also posit that information technology systems like MCS are essential to maintain continuity of control measures, even when civic bodies are compelled to divert resources to fight new battles.