For more than 3 years, district malaria surveillance officers in Zanzibar, equipped with motorbikes, inexpensive Android tablets, and Coconut Surveillance have helped Zanzibar to sustain its gains against malaria.
From Control
In 2008 the Zanzibar Malaria Control Program established the malaria epidemic early detection system (MEEDS). Health facility officers in clinics used MEEDS and simple cell phone handsets to submit weekly aggregated case data. This enabled Zanzibar to detect new epidemic outbreaks within two weeks of onset. MEEDS aggregate weekly case reporting was a success.
As control programs proved effective, Zanzibar moved from malaria control to malaria elimination. But Zanzibar knew that weekly aggregate case reporting would not be enough. It would not enable them to maintain their gains, contain outbreaks effectively, and target their limited resources most effectively. They needed to track and follow up individual malaria cases to limit onward transmission that could lead to outbreaks or broader resurgence.
To Elimination
MEEDS was modified to support individual case reporting. It was also rolled out to all private health care facilities. Malaria program managers, epidemiologists, and software developers designed, developed, and tested Coconut Surveillance, a new mobile software tool to alert mobile case response workers to new cases, and to help them track and follow up each case. Each mobile user was equipped with an Android tablet computer running the Coconut Surveillance. A web-based application was developed to enable program managers to monitor case response in near real-time, and to analyze the geo-located case data.
Proven at Scale
Since 2012, Coconut Surveillance has helped malaria surveillance officers in Zanzibar respond to more than 9,500 reported cases of malaria, complete nearly 10,500 household visits, test more than 40,000 household members, and identify and treat 2,100 previously unknown cases. Over this period the software has been progressively improved. Important enhancements included automated risk-based guidance and case transfer for mobile users, automated response and epidemic threshold alerts, and real-time reports and maps designed by and for program monitors.
