When a malaria research project in Uganda was expanded into a full-fledged malaria case-tracking effort across the country in 2006, health officials saw the move as a great opportunity to save lives. After all, malaria is the number one cause of death in Uganda, and occurs throughout 95% of the country, according to one of the research project's coordinators.
But after starting with such promise, the project quickly became mired in a series of technology shortcomings. The original database application used to keep and sort information -- an ancient version of Epi Info -- was an old, slow, flat-file database that was difficult to use and to search.
Even worse, the only way to get that case data out of the malaria project sites dotting the country was through paper printouts carried by human couriers. The couriers traveled in vehicles over bad roads on trips that took several days and cost around $550 per excursion.
Adding to the troubles: There were no Internet connections available in the nine remote, rural locations where the data collection centers were located, and there was little or no electricity anyway.
Fixing the problems would require an entirely new approach.
It finally all came together this spring after the introduction of a few key high-tech tools -- a modern relational database, nine smartphones and a remote-access software application that was originally meant for a completely different use. These pieces were all brought in to fill the gaps and drastically speed the collection of the data to help fight the spread of malaria inside the country.
Now the malaria case data can be collected at research sites across Uganda, sent wirelessly using smartphones, then quickly entered into research databases at a central location in Kampala, the capital of the country.
But it wasn't easy getting there.
A plan unfolds
The Uganda Malaria Surveillance Project (UMSP) began to conduct clinical trials for malaria drugs in 2001. The project was expanded to track individual cases starting in 2006. Because of the courier-based collection system, it regularly took eight months for the incoming data to be added into the database, making it out-of-date for tracking malaria and its treatment in real time.
All of that changed, however, after two tech-savvy experts, and one expert in the community-health arena, heard about the problems. They visited Uganda in October 2008 to witness the difficulties with their own eyes so they could investigate ways to fix them.
What they found was a situation reminiscent of a Rube Goldberg diagram, with one change affecting a host of other needed changes, all linked together in a confusing and ultimately messy chain of disconnected technologies.
"They needed consistent data reporting done easily and quickly," says Josh Mailman, director of technical operations for the Global Health Research Foundation (GHRF) in Los Altos, Calif., a non-profit organization that helps bring health technology to underserved populations around the world. "Their original database required brute force to get reporting out of it."