Sanitation-related disease surveillance using community health promoters and mobile phone technology

Poor utilisation of oral rehydration and zinc therapy for diarrhoeal disease is a major impediment to early and preventative interventions of dehydration and diarrhoea in Guatemala. Improvements in culturally-sensitive public health education, patient screening and healthcare follow-up are necessary to address the growing burden of disease in children under 5 years-of-age. This paper presents a system combining mobile phone text messaging with a web-based platform to support continual education of trained health promoters, to provide real-time reporting of consultations, and to track promoter activity. The system was developed to act in coordination with a validated training framework for oral rehydration therapy and diarrhoeal disease in Guatemala in July 2013. Twenty-three local women in the village of Pixabaj in Sololá Department, Guatemala, who elected to participate in the study, were given ORT/Zn utilization and diarrhoeal diagnosis training and technical training on using the platform during a 1-week interactive education course. There have been several findings from the initial phase of this on-going study. Operator findings on the system have been positive and the resultant data collection was strong, though the framework experienced intermittent lags in service due to transiently poor mobile connectivity. It was also found that the acquired competency from the training on the promoters involved had a positive impact on the whole study cohort, including those who did not successfully complete the training course. The use of the web-based monitoring system with trained promoters has proved to be advantageous in remote tracking of activity. The identified limitations to the efficacy of text-message monitoring systems will be addressed in the next steps of this study.