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By Joseph Were

12 May 2010

(Kampala, Uganda)--Text to Change, a Dutch non-governmental organization, chose World Malaria Day on 25 April to run a quiz via SMS in a rural fishing community in eastern Uganda to measure knowledge about the disease.

The results showed that most people know how to prevent malaria--notably, 98 percent of the respondents seemed to be aware that insecticide-treated mosquito nets are the best way to prevent malaria. 


         Rural Ugandan Mobile Air Time Kiosk

However, few people said they are following effective anti-malaria practices--for example, only 10 percent of respondents said they sleep under a treated net.

“I believe it is not about the lack of knowledge but about behaviors. Text to Change [TTC] believes that SMS is an additional and very effective medium to encourage people to change their behavior,” says Bas Hoefman, TTC's founder and managing director.

But what is likely to change behaviors? Surely, better and better-targeted information helps; however, other obstacles prevent people from implementing best practices. Hoefman acknowledged that in many cases, regardless of the information flow, a lack of money or conflicting priorities are the problem.

 “People cannot afford to buy more than one mosquito net. Another reason is that people don't have room to put up mosquito nets as they live in small houses. Furthermore, it is very common that mosquito nets are being misused, e.g. to turn them into fishing nets,” the TTC founder commented.Still, Hoefman and his colleagues see good reasons to pursue bolstered malaria education via mobile phones, which are reaching well into rural communities even if only a few people may actually have personal access to them. “People who don't have phones will benefit from the fact that people share phones in Africa."                                           
                                                                                                                                         Standard Mosquito Net

 It is estimated that every phone is shared by five people in Africa. Sharing phones means sharing information,” he noted.

See more about use of Mobile Phones in Uganda

Malaria-induced infant, child and maternal mortality rates in Uganda and many Sub-Saharan African countries remain high despite the many interventions put in place over the past several decades to curb the disease. Malaria is still cited as Uganda’s leading cause of illness and is endemic in 95 percent of the country. Malaria accounts for nearly half of inpatient pediatric deaths, according to the Uganda Ministry of Health  (see President's Malaria Initiative).

The TTC quiz appeared to corroborate information from the 2006 Uganda Demographic and Health Survey, the latest large-scale survey on health issues, which indicated that only 10 percent of pregnant women and children under five had slept under a mosquito net the night prior to the survey. The proportion of children below five treated with an anti-malarial drug from onset of fever was 29 percent, while only 16 percent of  women receiving two doses of intermittent preventive treatment during pregnancy.

Based on studies showing that insecticide-treated nets are one of the most effective ways to prevent malaria (for example, click here) the Uganda government plans to distribute them free to all of the country's 31 million citizens. Already, six million nets have been dispatched.

When used properly, these nets could bring down malaria transmission rates by 50 per cent, child deaths by 20 per cent and the mosquito population by as much as 90 per cent. And yet, only 10 percent of pregnant women and children under five in Uganda sleep under one. Uganda spends up to US$ 6 million annually to fight malaria.

The TTC quiz involved sending multiple-choice questions via SMS to a database of 10,000 cell phone users from the targeted communities. TTC used its flexible mobile phone platform across the four major telecommunications networks in Uganda. The messages were in English and Luganda, and reply was free of charge. The process starts with an SMS announcement to phone users to expect the quiz questions, explaining that it is free of charge and will test their knowledge. People respond to a toll- free number and TTC complies their responses. Participants also had the chance to win free mosquito nets and mobile phone airtime.

“We can see how many people send back the right or wrong answers. We compare that information with baseline information,” says Hoefman.

TTC sees a need to repackage malaria prevention messages to make them more appealing to the public, notably through the kinds of SMS-based methods they are using.  

Hoefman argued that the impact of past SMS campaigns is that “sending out messages in question form encourages people to enter into discussion with each other on health subjects such as malaria. The incentives are given out to motivate people to participate and reward them for doing that. This form of edutainment is essential and especially effective to reach out to youth already familiar with SMS and games.”  

Until now, Malaria prevention messages have been done through other media such as radio and television. However, SMS may be able to boost cost effectiveness, efficiency, scalability, convenience, breadth of reach and responsiveness in developing-world communities.

Joseph Were is associate editor of The Independent weekly in Uganda.  

See our complete Communication Profile for Uganda

Related Blog:
Mobile Applications for Development Poised for Growth in Uganda

Pictures Courtesy: Flickr and Rita Colaca and YoHandy

In Uganda, with less than one dollar, people can buy air time to their cell phones. Also, wooden houses - like in this picture-are used to charge the battery of mobile phones,since most of people do not have electricity at home.Picture: Rita Colaço, Flickr