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Mon September 16, 2013
Shots - Health News

How Smartphones Became Vital Tools Against Dengue In Pakistan

Originally published on Tue September 17, 2013 2:14 pm

A line of men in black rain boots push trash carts through the alleys of Lahore, Pakistan. They stop at an open sewer along a neighborhood street and start to pull up shoes, bricks, plates and any other trash that might block the flow of wastewater.

Standing water is a prime breeding ground for mosquitoes. And the local government in Lahore is on a focused mission: Stop the spread of dengue fever by mosquitoes.

Two years ago, an estimated 20,000 people in and around the city of Lahore contracted the deadly tropical disease. This year, the region has recorded just a few dozen cases of dengue fever, which usually involves a high fever, horrible headache, and severe bone and joint pain.

What triggered the sharp decline in dengue cases? Fortuitous weather patterns may have helped to keep the mosquito population low. But many leaders also credit a mobile phone app — and the public health campaign that uses it.

"We pull up the trash, put it in the basket, tie up the bag and take it away," says sanitation worker Tanvir Channa. He says that he doesn't often think about his role in combating a deadly epidemic. "Whatever I do, it's just to provide for my kids," the thin 30-year-old says.

To make sure workers like Channa don't skip out on their tasks and allow the dengue mosquitoes to breed, they're followed by an investigator who uses a smartphone to their progress. In this case, it's a tall man in plaid shirt named Mohammad Saleem Taqi.

"I open this application, called Clean Lahore, to enter a field activity," he says. "I take pictures before and after the work is done, enable location services to map this spot, and then send it on to my supervisors."

"Of course it seemed strange at first," Channa says, of having his picture taken on the job. But now he believes the monitoring campaign is to his benefit because the photos show supervisors that he's on the job and can't be marked absent.

Across town from the sewer, men with the fishery department tip a bucket of water into a small neighborhood pond. Dozens of tiny tilapia fish swim into the pond. These fish have a taste for mosquito larvae and naturally curb the mosquito population.

As the two men work, an inspector snaps a photo of them with the Clean Lahore app.

The app is the brainchild of Umar Saif, a Cambridge-educated computer scientist, who now manages part of the anti-dengue campaign.

"So let me tell you the story from the top," Saif says, settling into a couch in the center of his office in a Lahore high-rise building.

For him, the story begins in the summer of 2011. "What happened is, Punjab was hit with one of the worst dengue epidemics anywhere in the world."

Government officials realized they would need to work harder — and smarter — to prevent another epidemic. That's why they turned to Saif. He developed a smartphone app to track all efforts to prevent the disease. And the idea has contributed to the city's striking success against dengue.

"If Punjab averted another epidemic in 2012, then it didn't happen by accident," Saif says. "There were 67,000 different prevention activities [that] were performed and were photo-logged by the smartphones."

Other public health researchers have suggested that the decline in dengue cases might be because of environmental factors, at least in part. But still, the government's prevention campaign has been widely lauded.

One reason for the accolades is that Saif took the mobile campaign one step further: He built a Google map that correlates the locations of dengue cases and hot spots for mosquito larvae. "So there's a clear pattern of disease outbreak that corresponds to reports of positive dengue larvae," he says.

With these visuals, Saif and his team could zero in on problem regions in the province and predict future outbreaks.

The mobile phone campaign also helps to stop another issue that plagues Pakistan: entrenched public sector corruption.

"You have people who have not done — maybe for decades — work as well as they were supposed to do," Saif says. "So the government needs to therefore now use technology in innovative ways to monitor its functions."

"This is quite remarkable," says Patty Mechael, about the anti-dengue campaign. She studies how mobile technology is helping public health at the nonprofit mHealth Alliance.

When it comes to tracking infectious diseases with cellphones,
Mechael says, the possibilities are endless. "It's really up to the health sector to imagine what it needs, and then think about where mobile technology can actually play a role in solving some of those problems."

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

ROBERT SIEGEL, HOST:

The smartphone is also helping to solve some serious problems. Here's a case in point. Two years ago in Pakistan's Punjab Province, there was a deadly epidemic of dengue fever. About 20,000 people contracted dengue, which is spread by mosquitoes.

This year, numbers are way down - just dozens of cases. And the credit goes to a campaign that utilizes mobile phones. Here's reporter Beenish Ahmed.

(SOUNDBITE OF ROLLING CARTS)

BEENISH AHMED, BYLINE: A line of men in black rain boots push several trash carts through the archways and alleys of Lahore's congested old city.

(SOUNDBITE OF ROLLING CARTS)

AHMED: They stop at an open sewer along a neighborhood street and set to work pulling up plates, shoes, bricks, and anything else that might block the flow of wastewater. That's because standing water is prime breeding ground for the mosquitoes that spread dengue fever.

But sanitation worker Tanvir Channa doesn't think about his role in combating a deadly epidemic.

TANVIR CHANNA: (Through translator) We pull up the trash, put it in the basket, tie up the bag, and take it away. Whatever I do, it's just to provide for my kids.

AHMED: To make sure workers like Channa don't skip out and allow the dengue mosquitoes to breed, they're followed by an investigator armed with a smartphone, who tracks their progress. In this case, it's a tall man in a plaid shirt, named Mohammad Saleem Taqi.

MOHAMMAD SALEEM TAQI: (Through translator) I open this application called Clean Lahore, to enter a field activity. I take pictures before and after the work is done, enable location services to map this spot, and then send it on to my supervisors.

AHMED: Channa says having his picture taken on the job seemed strange at first.

TAQI: (Foreign language spoken)

AHMED: But he likes that the monitoring program shows supervisors that he's on the job and can't be marked absent. Across town, a similar scene plays out.

(SOUNDBITE OF SPLASHING WATER)

AHMED: A pair of men tip a bucket of water into a small pond at the center of a neighborhood park. In flow dozens of tiny tilapia, a fish with a taste for mosquito larvae. As the two men work, an inspector snaps a photo of them with the Clean Lahore app. All of this is a part of a public health campaign managed by Umar Saif.

UMAR SAIF: So let me tell you the story from the top.

AHMED: It begins in the summer of 2011.

SAIF: What happened is that Punjab was hit with one of the worst dengue epidemics anywhere in the world.

AHMED: Government officials realized they would need to work harder, and smarter, to prevent another epidemic. That's why they turned to Saif, a computer scientist. He developed a smartphone app to track all efforts to prevent the disease - with striking success.

SAIF: If Punjab averted another epidemic in 2012, it didn't happen by accident. You know, 67,000 different prevention activities were performed, and were photo-logged by smartphones.

AHMED: While experts suggest the decline in cases might be due, in part, to environmental factors, the government's prevention campaign has been widely lauded. That's because Saif took the mobile program a step further. He points to a Google Map image of Lahore. The map correlates larvae citations and actual dengue cases.

SAIF: So there's a clear pattern of disease outbreak that corresponds to reports of positive dengue larva.

AHMED: These visuals helped Saif home in on problem areas and predict future outbreaks, all this while treating another issue that plagues Pakistan: entrenched public sector corruption.

SAIF: People who have not done - maybe for decades - work as well as they were supposed to do. So the government needs to therefore now use technology in innovative ways to monitor its own functions.

PATTY MECHAEL: This is quite remarkable.

AHMED: Patty Mechael studies the use of mobile phones to meet public health goals. This is the first time she's seen phones used to track an infectious disease.

MECHAEL: It's really up to the health sector to imagine what it needs, and then think about where mobile technology can actually play a role in solving, you know, some of those problems.

AHMED: And combating dengue fever in Pakistan is just one such example.

For NPR News, I'm Beenish Ahmed.

(SOUNDBITE OF MUSIC)

SIEGEL: This is NPR News. Transcript provided by NPR, Copyright NPR.

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