Using voice-based technology to improve the awareness and knowledge on malaria, its prevention and treatment among high-risk populations in Thailand
The nature of malaria transmission in Thailand, especially along the Thai-Myanmar border threatened by artemisinin resistance, may benefit from a health education campaign using a new, innovative voice-based technology.
The specific objectives are to:
- Assess the potential of a voice messaging service as an acceptable and feasible intervention
- Investigate the change in the awareness toward malaria prevention and treatment among a high-risk population following the intervention
- Monitor and evaluate any significant change in malaria prevention and treatment behaviour among the target population.
This study has been terminated.
Thailand is pursuing spatially progressive elimination and has a national goal to eliminate malaria from 80 percent of the country by 2020, and malaria elimination by 2025.1 Central Thailand has been malaria-free for more than three decades. However, malaria transmission persists in areas located along the borders with Myanmar to the west, Cambodia to the east, and Malaysia to the south, as shown in Figure 1. Evidence has been found suggesting the emergence of artemisinin resistance along Thai-Myanmar border, as well as Thai-Cambodia side. The country had an estimated population of 70 million, of which approximately 2.1 million people (3%) live in malaria endemic areas in 2,753 villages. In 2013 (October 2012 – September 2013), there were 20,298 reported malaria cases, of which 39.6% were caused by P. falciparum.
Proximity to the border with Myanmar, which represents approximately 80% of the Greater Mekong Subregion’s malaria burden, is a significant risk factor for malaria infection in Thailand. Thailand remains the primary destination for migrant labour from neighbouring countries, particularly Myanmar, which shares an extensive border of 2,000 kilometres. Out of the 20,298 treated malaria cases in Thailand in 2013, 7% of these cases were migrants.
Populations living near the border are at greater risk for malaria, both due to cross-border migration and proximity to forest areas where malaria vector species are prominent. Although malaria diagnosis and treatment is provided free of charge to all via the Bureau of Vector Borne Disease vertical program, some at-risk populations do not access available services. This is due to lack of information, awareness of risk factors, and language barrier between client and service provider.
Maximizing improved malaria preventive and treatment seeking behaviour among at-risk populations along the Thai-Myanmar will be the key to eliminating malaria in both Thailand and Myanmar and to containing drug-resistant malaria. Current IEC (information, education and communication) and BCC (behaviour change communication) materials developed by the BVBD usually require some literacy level and 2 strategies for improving malaria awareness or prevention and treatment seeking behaviour have not changed significantly to respond to these at-risk populations.
The use of mobile technology to establish communication with at-risk populations in Thailand has great potential considering that there are 138 mobile phone subscribers per 100 people2 and mobile coverage is good in rural areas. While text messages have been considered for delivering behaviour change communication messages, literacy among ethnic minorities may limit the penetration and impact of IEC interventions. Verboice,3,4 a free and open-source tool (developed by InSTEDD) which uses interactive voice response (IVR), provides an opportunity to overcome these barriers. Verboice allows users to listen and record messages in their own language and dialect or answer questions with a phone keypad. The user can receive a call and an automated voice asks questions according to a short questionnaire. The technology can also record and save short audio messages. Thus Verboice can be used to establish or improve communication with communities previously inaccessible due to both geography as well as illiteracy. Further, the voice feature makes it possible to reach out and interact with ethnic minority groups, located in remote regions like the Thai-Myanmar border, in their own local languages. While this technology has been used successfully for health education, including Marie Stopes's application as part of their post-abortion follow-up process.in Cambodia, it has not been tested for malaria at-risk populations.
The nature of malaria transmission in Thailand, especially along the Thai-Myanmar threatened by artemisinin resistance, may benefit from a health education campaign using a new, innovative medium like Verboice. Verboice could help overcome barriers of literacy, language, and dynamic population movement that make it challenging to change behaviour related to malaria prevention and treatment seeking. Verboice offers the potential to reach these populations, reduce malaria risk, and put Thailand on the path to elimination.