Thailand: eHealth strengthening fight against malaria drug resistance

A new project has accelerated progress in the fight against artemisinin-resistant malaria parasites in Thailand by using smart phones to capture data on patients and monitor treatment.

October 2012

Darunee Kongkarat, a health worker at the Mae Sariang Malaria Clinic, has a busy schedule. The clinic covers 47 villages in a populous district of Thailand. About 20 to 30 patients walk into Kongkarat’s clinic every day; in the rainy season that number can jump to 100. Kongkarat tests blood, distributes antimalarial medication, makes sure that patients take their drugs, and monitors treatment effectiveness.

Health worker Darunee Kongkarat educates students about malaria.
MoH Thailand

Thailand has made big strides in its fight against malaria over the past 60 years. But the Government’s goal to eliminate malaria was seriously threatened in 2008, when malaria parasites were reported that were resistant to artemisinin, the most effective single drug to treat malaria.

“Malaria is one of the most deadly mosquito-borne infectious diseases and is responsible for more than 650 000 deaths worldwide every year”, says Dr Maureen Birmingham, the WHO Thailand representative. “If the artemisinin-based drugs are lost to resistance, the consequences could be disastrous.”

Combating resistant malaria strains

The artemisinin-resistant malaria strains were first detected along the Thailand-Cambodia border and have since emerged in other places in the Greater Mekong area, including Myanmar and Viet Nam. To control resistant parasites, Thailand and Cambodia launched a joint monitoring, prevention and treatment project in seven provinces along their shared border.

Village health workers distributed insecticide-treated mosquito nets to the people living in border villages and the seasonal migrant workers who come into Thailand to help harvest fruit, corn and cassava. In Thailand alone, more than 300 volunteer village malaria health workers were trained to provide free services to test for malaria and directly observe the treatment of patients with confirmed malaria in remote villages.

Going electronic to control malaria drug resistance

Use of a smart phone to capture essential data on the patients and monitor their treatment has accelerated progress.

With e-MIS smartphones can support efforts to identify and control drug resistant malaria parasites.
BIOPHICS, Thailand

When the project started in 2008, health workers still recorded basic patient information on paper forms. Data collection was time-consuming, inconsistent and it was difficult to share and consolidate data across units. Today, the health workers have gone electronic. An electronic malaria information system (e-MIS) uploaded on the health workers’ mobile devices shows malaria volunteers where to find patients, the status of their treatment, and the situation and trends anywhere in the area at any time.

E-MIS also enables staff to transfer patient records from one generation of malaria workers to the next, and obtain the most up-to-date data.

“We cannot allow artemisinin-resistant parasites to spread,” stresses Dr Charles Delacollette, coordinator of the WHO Mekong Malaria Programme. “Our evaluation of e-MIS shows that the electronic system has contributed to our efforts to identify and control resistance.”

Building on success

Use of the e-tool has now expanded to 44 provinces in Thailand.

Mobile malaria unit of Mae Sariang malaria clinic tests teachers and students at local school
MoH Thailand

Until the Mae Sariang district was included, health worker Kongkarat used pen and paper to capture patient information. She has been trained to use e-MIS and is happy about its efficiency: “We are now much faster in reporting. Once we get information on a case, we can see the trends, analyze the situation and adjust our activities on time,” she smiles.