Mobile Health Around the Globe: Treating Malnutrition in Zanzibar

Editor’s note: Marc Mitchell will be a distinguished participant in our webinar on May 23rd at 1pm EDT

Zanzibar, an island nation off the coast of Tanzania evokes images of cloves and cinnamon, white sandy beaches and fishermen in their Dhows, a boat that brought traders from the Arabian Peninsula to the East Coast of Africa. But it is also known for its high rates of childhood malnutrition. It is estimated that 12% of children on Zanzibar have acute malnutrition, among the highest in Tanzania.

Editor’s note: Marc Mitchell will be a distinguished participant in our webinar on May 23rd at 1pm EDT

Zanzibar, an island nation off the coast of Tanzania evokes images of cloves and cinnamon, white sandy beaches and fishermen in their Dhows, a boat that brought traders from the Arabian Peninsula to the East Coast of Africa. But it is also known for its high rates of childhood malnutrition. It is estimated that 12% of children on Zanzibar have acute malnutrition, among the highest in Tanzania.

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Malnutrition is a disease that threatens the lives of children worldwide. It is estimated that 53% of all child deaths in low income countries can be attributed to being underweight[1]. In Tanzania, it is responsible for more than 130 child deaths every day, making it the single greatest contributor to under-five deaths in the country. Malnutrition impacts health, education and work productivity, and is a major impediment to economic growth and development. Malnourished children start school later in life and are more likely to drop out. As adults, their work productivity is limited by poor educational achievement and stunting, often combined with poor diet and anemia that continue to make them tired and weak.

Yet malnutrition is an entirely treatable disease. D-tree International, working closely with the government of Zanzibar, UNICEF, and the Innovation Working Group has developed an ambitious program to eliminate acute malnutrition as a public health problem in Zanzibar. The program uses a mobile phone based application that supports health workers to follow the Zanzibar guidelines for severe acute malnutrition exactly. The program was implemented in 2 sites in 2010-2011 and is now being scaled up to cover about 50 facilities throughout Zanzibar.

The software is an interactive application taking the health worker step by step through the guidelines using data from past and current visits to determine the child’s progress and treatment. The software captures the data as it is entered into the application so has a secondary benefit of making program data available to health service administrators on a daily basis. The software runs on the Android operating system and combines on-device electronic medical records with protocol execution. The application protects data via a login procedure requiring a password. Our solution partitions the national guidelines into several electronic protocols which all contribute to, and have access to, the patient record:                                       

• Screening and Registration of each child with malnutrition

Then, for each visit of the enrolled child

• Screening for status (weighing, etc.)
• Appetite Test, as prescribed by the guidelines
• Physical Examination (e.g. to check for complications)
• Treatment (e.g. provision of correct amounts of RUTF)
• Counseling of the caregiver
• Setting next appointment date

The business model brings together the private sector, public sector and donor community to develop an integrated approach to the delivery of high quality child health interventions. The public sector funds all health workers and drugs needed for treatment of children as well as support of clinics in which children are treated. The private sector partner, Zantel (a subsidiary of Etisalat based in UAE) has agreed to support the scale-up of this project by:

• Equipping the nurses with the Android phones; providing data transfer for this project at free or reduced cost; providing high quality technical support services (encryption, network testing tools, etc.); providing awareness of the program in the community via a media campaign

The second private sector partner, Edesia will ensure adequate supplies of RUTF and assist with procurement and logistics. UNICEF has funded the pilot phase and has agreed to contribute funding to the scale up costs of this project from their overall funding to support malnutrition programs in Zanzibar. D-tree International will be the lead on this project and manage and evaluate the project overall.

[1] Robert E Black, Saul S Morris, Jennifer Bryce, Where and why are 10 million children dying every year? The Lancet, Volume 361, Issue 9376, Pages 2226 – 2234, 28 June 2003

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Marc Mitchell will be a distinguished participant in our webinar on mHealth this Wednesday, May 23rd at 1pm

To read other posts in this exclusive ongoing series, please visit the Mobile Health Around the Globe main page.

And if you have a Mobile Health Around the Globe story to tell, please email me at joan@socialmediatoday.com