Insecticide-treated nets are a low-tech, powerful fix, with more than one billion nets distributed in the last ten years. Dr. Sikolia Wanyonyi, who is working in Kenya, cautions that some recipients “will pick the free samples and use them as curtains, pieces of clothes or even resell them to get money for food. The people may not have extra money to buy the insecticide once the impregnated ones expire, so the net becomes a mere piece of cloth.”
Inexpensive rapid diagnostic tests offer a way to reduce incorrect prescribing of malarial drugs, which has helped spread resistant strains. “Test and treat” is a better front line approach than relying on unevenly trained community health workers prone to treat every African fever as malaria, a strategy Dr. Charles Masaki, a doctor in Kenya, says “has failed.”
One new rapid diagnostic test, GeneXpert developed by Dr. David Persing, can detect extremely low levels of a pathogen, along with drug-resistant variants, by testing for signature DNA sequences.
Called a nucleic acid amplification test, it works by placing a clinical specimen in a cartridge containing a series of chambers, which amplify nucleic acid and make billions of copies of the target sequence.
This test is quick—taking 90 minutes—and inexpensive, with a test cartridge costing $10 for poorer countries The machine processing the cartridge is automated, meaning GeneXpert can be operated by people with less technical training.
Eighty-eight percent of Kenyans now have mobile phones, says the country’s Communications Authority. For Dr. Nelson Muriu, director of health services in Nyeri County, Kenya, this doesn’t only revolutionize communicating with patients, including by telemedicine when they are far from clinicians. Tracking SIM cards has helped model people’s movements, and refine models of how malaria spreads—as it turns out, from the Lake Victoria region with its mosquitoes, to the bustling Nairobi hub, and from there outward. Dr. Muriu says it also opens new options for tracking and tracing medical stock between local dispensaries in uncertain security environments.
Smartphones are also connecting clinicians in remote areas to networks like Pathologists without Borders —specialists across Europe and North America who volunteer to review histological slides and biopsies from far away.
“There has been huge growth in health workers using mobile phones to identify where outbreaks are happening, and this allows better identification of disease outbreaks,” says Celina Shocken, a health care consultant, who points to an open-source disease management system called DHIS (District Health Information Software) 2.