Tanzania:Morbidity mapping with mHealth tool in Dar es Salaam

The Global Programme for the Elimination of Lymphatic Filariasis (GPELF) aims to eliminate lymphatic filariasis as a public health problem by the year 2020.  To achieve this aim, the GPELF has two major components, namely to stop the spread of infection, and alleviate suffering of affected populations (morbidity management).  While the GPELF has achieved major success in reducing the transmission of disease, the scale-up of morbidity management and disability prevention (MMDP) activities has been slower, gaining increased attention and funding in recent years.

CNTD has supported the LF programme in Tanzania since 2001, and specifically in the Dar es Salaam region since 2013; the population of this region (estimated 5.7 million) represents over 10% of the national population.  While the LF progamme has reached 100% geographical coverage of mass drug administration (MDA) across the country, data on clinical cases remains limited.  Patient searching was implemented using the CNTD mHealth tool MeasureSMS-morbidity to gather baseline data for the burden of disabling conditions caused by LF in Dar es Salaam.  Additionally, mapping the data allows for identification of high-risk areas within the region, which can be used to improve coverage in the MDA.

The MeasureSMS surveys were implemented using a phased approach between March-August 2015 across the three districts in Dar es Salaam.  The training, coordination and implementation of the surveys were jointly conducted by the National NTD control programme (NTDCP) and CNTD staff.  The survey design was adapted to the large, densely populated urban environment, building on previous experiences in Malawi and Ghana.  The survey was designed to be implemented in a two-tier approach of data collection and reporting, where community health volunteers conducted patient searching house-to-house in their catchment areas, and then reported the data to front line health workers (FLHW) who collated the patient data and reported via SMS.  In total, 358 FLHW were trained to identify lymphoedema and hydrocele patients as well as data reporting using MeasureSMS data reports.  The FLHW then trained 1500 community health workers to identify cases and record required data. 

In total, 6,587 patients were reported during the survey 2,695 with lymphoedema and 4,635 hydrocele patients (including 473 patients reported with both conditions).  Prior to the survey, the burden of clinical disease caused by LF was largely unknown to the district health officers, and the high number of reported patients highlighted the need for MMDP services in this region.  The data is being utilised by NTDCP and CNTD to plan future MMDP activities.  In 2016, CNTD provided funding for 1000 hydrocele surgeries in the region, as worked with the NTDCP to plan appropriate approaches to lymphoedema management.  By March 2017, 400 hydrocele surgeries had been successfully coordinated by NTDCP and carried out by local surgical staff, and patients’ recoveries are being monitored by local healthcare staff.