Use of SMS to Share Information on Potential Bird Flu Outbreak

1. Use of SMS to Share Information on Potential Bird Flu Outbreak Cecile M Lantican, PhD AED Country Coordinator Don Chan Palace Hotel, Vientiane Capital, Lao PDR 26 May 2011

2. Contents of the presentation • Background • Methodology • How the Mpanel was set up and managed • Panel Evaluation and Lessons Learned • Monitoring Results

3. Background • In November 2010, AED commissioned Rapid Asia to set up a rapid response mechanism in Lao PDR, to monitor public health initiatives in cross-border sites. • The panel participants were members of LWU who have previously been involved with avian influenza prevention response and vaccine deployment for H1N1 pandemic influenza. • The panel members were recruited from several villages in and around Vientiane, Savannakhet, Luang Namtha and Bokeo. The process was to initially train a group of Master Trainers who in turn would go back to their city and train additional panel members.

4. Background Lao Women's Union’s capacity to move community outreach and mobilization during disease outbreaks and pandemic can be further strengthened if they will be introduced and trained on the use of SMS technology.

5. Objectives • Monitor public health initiatives both for human and animal health. • Monitor animal deaths and cases of sick animals • Gain insight into health seeking behavior • Uncover the best form of support for addressing health problems • Obtain feedback on what support materials are most useful • Gain insight into current health reporting practices

6. Methodology How the mobile phone panel was set up and managed

7. Panel Recruitment • AED appointed a Panel Coordinator who would work closely with Rapid Asia during initial recruitment and training. • Panel participants were recruited following carefully prepared screening criteria: • Stationed in their area for the duration of the survey period • Have a GPRS enabled mobile phone • Should not have a copy phone or Chinese phone (sometimes difficult to determine) • Phone should not be older than 5 years • Should not be sharing their phone with someone else on a regular basis • Their current provider must be either LTC, ETL or TIGO. These are the three largest service providers in Laos. Several providers were needed as some offer better coverage in some of the areas selected.

8. MpanelParticipants • A total of 17 panel participants were recruited and trained initially to become Master Trainers. Together with the Panel Coordinator from AED, they in turn went out and did additional recruitment in their respective areas. A total of 71 participants were recruited and successfully registered on the panel.

9. Training guide The training guide is consisted of five sessions: • Brainstorming: About infectious diseases • Role of LWU members in EID issues • Mechanics of the mobile phone panel • Recruitment of SMS panelists (for trainers)   • Oversight of mobile phone panel coordinator (PC)

10. Training guide (+ required forms) The training guide also contains the screening documentation forms: • Background and consent form. • Panel screening form • Self completion test • Panel registration form • Connection information

11. Mpanel Training • When the participants’ mobile phones had been successfully connected to the internet, they had to register to the panel on-line and complete a test survey. • During registration, essential panel member information was collected for the panel data base including Name, Phone Number, Service Provider and Location. Phone brand and model was also needed for technical reasons. . • A two- day training was conducted. An IT consultant provided technical support. A total of 20 participants came to the initial training session and 17 participants passed the initial training successfully.

12. Data Capture - How it works Send the SMS: mpanel to +65 97 41 28 91 Wave 4 questions. Please click to begin. http://202.150.214.178/node/45015?msisdn=8562077907202

13. Response Rate • For each wave, the first SMS link was sent out early on Monday morning. • Following the first wave, additional panel participants were recruited by the Master Trainers. New registrations continued up to wave 4.

14. Analysis of Drop-out Rates Recruitment 100 • It was initially expected that the total drop out rate would be between 10-15 percent. However, it turned out to be much higher than this due to phone compatibility and participant capacity issues. Registered panel members 71 100% Drop-out 9 12% Average non-response per wave 5 7% Active Members 57 81%

15. Panel Evaluation and Lessons Learned Overall, the panel worked well. There still areas for improvement, especially in terms of improving recruitment criteria and recruitment process.

16. Evaluation Based on Set Criteria Recruitment Criteria Ability to establish screening criteria that will ensure the person recruited will be able to participate on the panel. Amber Training of Master Trainers Ability to train Master Trainers to a level where they in turn can go out and recruit additional panel members. Green Panel Member Recruitment Ability of the Master Trainers and the Panel Coordinator to independently recruit additional panel members to the panel. Amber Registration Process Ability to register participants correctly while at the same time screen out panel members who are not suitable to be on the panel. Green Data Capture Ability to send regular SMS links to panel members in local language and receive data in a timely manner. Green Coverage Ability to collect data from panel members in different locations in Laos. Green

17. Amber Recruitment Criteria Ability to establish screening criteria that will ensure the person recruited will be able to participate on the panel? Lessons Learned • Screening criteria is useful to ensure that those recruited to the panel have a suitable phone and have the ability to participate during the panel period. • It is difficult to know in advance whether a person will have the capacity to participate or not.

18. Green Training of Master Trainers Lessons Learned • Training the members of the LWU was initially met with some resistance. But this changed following an orientation with key members of the LWU. The orientation helped to turn things around and those present became very excited about participating on the panel. Ability to train Master Trainers to a level where they in turn can go out and recruit additional panel members.

19. Amber Panel Member Recruitment Lessons Learned • The IT Consultant had to support on subsequent recruitment but it was evident that the Panel Coordinator and the Master Trainers became more proficient over time. • Phone compatibility and participant capacity continued to present problems. Ability of the Master Trainers and the Panel Coordinator to independently recruit additional panel members to the panel.

20. Green Registration Process Lessons Learned • Registration helped to screen out people who don’t have the capacity to submit data via their mobile phone. • The registration process worked very well to single out people who did not comply on these points. Whilst the size of the panel ended up smaller than expected, the quality of the participants on the panel was very good. Ability to register participants correctly while at the same time screen out panel members who are not suitable to be on the panel.

21. Green Data Capture Lessons learned! • A challenge in Laos is that there are almost no mobile handsets that support Lao characters. Hence, all text had to be scripted in picture format. This worked well but this necessitated that translations and subsequent testing had to be done before going live on the system. Ability to send regular SMS links to panel members in local language and receive data in a timely manner.

22. Green Coverage • Several service providers had to be used as mobile internet services vary by location. Internet connectivity is a challenge in Laos but over time, panel members learned to recognize when they had a good signal and to time their responses accordingly. Lessons Learned Ability to collect data from panel members in different locations in Laos.

23. Monitoring Results Monitoring information included both issues related to human and animal health.

24. Topics Covered in Each Wave Wave 1: Human Health Each wave was devoted to either human or animal health. Wave 2: Animal Health Wave 3: Human Health Wave 4: Animal Health Wave 5: Human Health

25. Human Health (Wave 1, 3 and 5) • The LWU is involved with a number of activities related to human health ranging from providing basic health information to local families to assisting the district health office (DHO). They support, local communities and local health care personnel with information and education. They also engage in local media campaigns and media broadcasts. • The LWU are able to report on symptoms they have observed and at times these can be linked to specific diseases. Hence, the LWU could potentially be involved and play a role in regular disease monitoring or surveillance. • Providing IEC materials and talking points appears to be the best way to support the LWU in their work.

26. Wave 1: Human Health Q1. Which of the following symptoms have you noticed among your friends, family or other villagers during the past week, if any? (base: n=17 villages) Q2. Have you personally seen anyone this past week that has any of the following diseases? (base: n=17 villages) Comment: The most common observations are sneezing and coughing, each observed in over half of the villages. Diarrhea and other symptoms are also quite common. Flu is the most common disease and there was at least one case of Malaria and one case of dengue. However, in many cases symptoms are not linked to any of these specific diseases.

27. Wave 1: Human Health Q3. How do people in your village normally treat illnesses? (base: n=17 villages) Q4. In what ways does the Lao Women's Union assist in health issues in your village? (base: n=17 villages) Comment: Most people self medicate and just stay at home when they are ill followed by visiting the local health clinic. In 24% of the villages, people still visit traditional healers. The LWU report that they assist in a number of way and the most common activity is providing information on where to seek treatment. They also conduct health education, media campaigns and broadcast information through the public address system (PAS). To a lesser extent (29%), the LWU also assist the District Health Office (DHO).

28. Wave 3: Human Health Q1. Which of the following symptoms have you noticed among your friends, family or other villagers during the past week, if any? (base: n=54 villages) Q2. Have you personally seen anyone this past week that has any of the following diseases? (base: n=54 villages) Comment: Sneezing and coughing are the most common observations, each observed in at least half of the villages. Diarrhea and congestion are also quite common. One in four villages did not observe any symptoms. Flu has been observed in two out of three villages together with a few (6%) cases of malaria. No dengue cases were reported. This means that many of the symptoms observed in Q1 may not be linked to any of these specific diseases.

29. Wave 3: Human Health Q3. How do people in your village normally treat illnesses? (base: n=54 villages) Q4. What have you done personally this past week regarding health issues in your village? (base: n=54 villages) Comment: When ill, most people will go to the local health clinic or self medicate and just stay at home. Traditional healers are also consulted in 15% of the villages. The more common human health assistance activities, provided by LWU members, include providing information on where to seek treatment and informing health care personnel. Some LWU members are also involved with media campaigns, broadcast information through the public address system (PAS) and health education. Assisting the District Health Office (DHO) is less common.

30. Wave 5: Human Health Q1. What do Lao Women’s Union members currently find most useful in order to help address health problems? (base: n=50 villages) Q2. What materials did you personally find especially most useful in working on health issues this past week? (base: n=50 villages) Comment: To help the LWU address health problems, IEC materials and talking points are the support materials seen to be most useful. However, other support mechanisms such as a directory of health care providers and mobile phones are favored by others. The ranking order of support materials does not change when looking at what materials were most useful in the past week. IEC materials and talking points still top the list but other items are still relevant except for reimbursement for fuel costs.

31. Wave 5: Human Health Q3. To whom does the Lao Women’s Union share events of disease outbreaks? (base: n=50 villages) Q4. This past week, who did you speak to with about illness or diseases that you noticed in your village? (base: n=50 villages) Comment: Events of disease outbreaks are shared mostly with other LWU members and village health care professionals. Around half of the villages also share with other community groups such as family and friends, health volunteers and village chiefs. In the past week, 94% of the villages spoke to family and friends about illnesses in the village, 66% also spoke to other LWU members and 54% spoke to village health care professionals. Less than one in four villages consulted with media and other groups.

32. Animal Health (Wave 2 and 4) • The LWU also support on animal health issues and are involved with a number of different activities. They provide information to the local community, and coordinate with the District Agriculture & Forestry Office (DAFO). • Observation of sick and dead animals such as poultry, pigs and buffalos are common. It is possible that such cases could be observed in around half the villages on a weekly basis. Evidence suggests that many of the cases are not reported through formal channels and this means that potential infections could go unnoticed. • Again, the best way to support the LWU in their work would be to provide IEC materials and talking points.

33. Wave 2: Animal Health Q1. Which animals have you observed DEAD in your village this past week, if any? (base: n=42 villages) Q2. Which animals have you observed SICK in your village this past week, if any? (base: n=42 villages) Comment: Dead animals have been observed in 50% of the villages and the most common observation is dead chickens followed by other dead birds and ducks. Larger animals such as buffalo and pigs have also been seen dead in quite a few villages. Sick animals have also been observed in 50% of the villages and again, the most common observation is sick chickens. Sick buffalos and ducks have been observed in one out of five villages.

34. Wave 2: Animal Health Q3. What did the owners do regarding their animals that were sick? (base: villages with sick animals n=21) Q4. What does the Lao Women's Union currently do to help in the event of animal disease? (base: n=42 villages) Comment: If animals are sick the most common remedy is to provide some kind of medicine or keep the animals in confinement. However, only 38% are expected to report it to the village chief. The LWU currently do a range of activities and the most common one is to provide information on where to seek treatment for animals followed by coordinate with the District Agriculture & Forestry Office. In over half of the villages, the LWU engage in media campaigns on animal health as well as helping to inform the village veterinarian.

35. Wave 2: Animal Health Q5. What do the LWU members currently find most useful in order to help address health problems? (base: n=42 villages) Comment: IEC materials and talking points are the aids the LWU find most useful when supporting on animal health issues. Only 17% find village meetings to be most useful. However, directory of health care providers, reimbursement for fuel costs and provision of mobile phones are not seen to be very useful.

36. Wave 4: Animal Health Q1. What did you personally do last week in your village regarding animal diseases? (base: n=60 villages) Q2. What materials did you personally find most useful in working on health issues this past week? (base: n=60 villages) Comment: Main activities include providing information on where to seek treatment for animals and informing the village veterinarian. Just under half of the villages coordinate with the District Agriculture & Forestry Office and conduct media campaign on animal health. One third rated mobile phones as the most useful tool when dealing with health issues. It is possible that the mobile phone panel has influenced this result. Other than that, talking points and IEC materials are seen to be most useful.

37. Wave 4: Animal Health Q3. To Whom does the Lao Women's Union generally report in case of an animal disease outbreak in your village? (base: n=60 villages) Q4. Who did you personally speak to last week about sick or dead animals, if anyone? (base: n=60 villages) Comment: Most of the reporting is directed to the village veterinarian or village chief, followed by local government officials. Reporting directly to newspapers or other media is less common. Nearly all the villages have spoken to friends and families about sick or dead animals in the past week and around two thirds have also talked to a veterinarian. Around half of the villages also talked to the village chief and local government. Communication to other groups has been less common.

38. Thank you! http://mekong.aed.org/