ChildCount+

According to the organisers, to make progress towards achieving the Millennium Development Goals that relate to hunger, and child and maternal survival, there is a critical need to strengthen nutrition programmes for children and pregnant mothers. This includes community-based programmes for monitoring and managing acute malnutrition and public health education campaigns to promote better nutritional practices. One of the challenges of community-based health practices is the limited availability of accurate and timely health information. ChildCount+ has been designed to leverage advances in mobile phone data collection to improve the collection of community-based and household level information.


The specific objectives of ChildCount+ are to achieve the following:

• Register every child and pregnant woman - create a "living" registry of all children under five and pregnant women in a community. This list provides the basis for community health teams to monitor the health status of their children and women who are to give birth.
• Screen for malnutrition every 90 days - Record the Mid-Upper Arm Circumference (MUAC) of every child from 6 months to 5 years every 90 days. When a child with acute malnutrition is detected, the programme provides support for plumpynut-based malnutrition treatment (where available) based on community-based management of acute malnutrition (CMAM) protocols.
• Monitor for malaria, diarrhoea, and pneumonia - track and treat the three major preventable causes of death in children under 5.
• Full child immunisation support - Group all children in monthly age groups to know when a particular immunisation is due. Record all immunisations and follow up with all children who are behind with their immunisation schedule.
• Record all births and deaths – Record when child and maternal deaths occur and when pregnancies don't come to term. Enable local health teams and communities to understand why. Register all newborns to be tracked by ChildCount.

The user or health care worker are registered into the system via an SMS message that generates a username and id that is registered to the user’s phone. Once a user is registered they have access to the direct messaging and report functions of ChildCount+. Upon registration, the system generates a user ID and user name that is linked to the phone number used in the registration. Users are able to text message each other as well as send messages to groups. Users are also able to register new patients via a text message that includes the patient's last and first name, gender, date of birth, guardian’s name, and contact number (when available) to the system.

Based on information submitted by users, the system is able to provide a number of reports to assist health workers:

• SMS health reports - provides the basis for reporting and monitoring the health status of patients in ChildCount+. Currently, ChildCount+ has reports to support malnutrition monitoring used in a Community-Based Management of Acute Malnutrition (CMAM) programme and malaria rapid diagnostic testing.
• Malnutrition Monitoring Reports - Community-based Management of Malnutrition (CMAM) is based on the principle of using field based health care staff to monitor malnutrition in children through frequent home visits. CMAM uses two primary indicators to check for malnutrition: a MUAC (mid-upper arm circumference) measurement and an edema (swelling) check. In addition, health care workers are also trained to look for specific risk symptoms that pose significant danger to a child suffering from malnutrition which include: diarrhea, vomiting, chronic cough, high fever, and unresponsiveness.
• Malaria Rapid Diagnostic Test Reports – ChildCount+ also includes an SMS health report for malaria rapid diagnostic tests (MRDT) to diagnose malaria in a patient at the household level. MRDTs are used whenever a child presents with a fever to diagnose whether or not malaria is at the root of the child's illness.
• Clinical Diagnosis Reports – ChildCount+ provides support for basic clinical recording basic medical diagnosis including lab results. Diagnosis are entered using ICD9 codes prefaced with a "-". Multiple diagnoses can be entered in a single message and intermixed with additional free form text that allows for a clinician’s notes.

Automated alerts are designed to keep the health care team aware of the overall status of a community’s health by providing automatic updates to each other when important health events occur. Alerts are triggered by a range of events from the diagnosis of a medical condition to a change in treatment status. Similar to Twitter, ChildCount+ allows users to "follow" other users to receive their alerts. Using this, a CHW manager, for example, could receive an alert whenever a case of severe acute malnutrition is registered by one of the CHW’s they manage allowing them to provide additional support as required. Core to ChildCount+ is an automated reminder system to help ensure that no patient falls between the cracks. When certain events occur, like when a patient enters into a home-based Supplemental Feeding treatment programme with CMAM, a follow-up alert can be assigned to the caregiver assigned to that patient. When the time for a follow-up visit nears, in this case seven-days, a message will go out to the patient’s health care provider requesting a follow-up malnutrition monitoring report. After one day, if ChildCount+ does not receive an update for that patient, the alert status for the patient will be elevated to urgent. At this point, a reminder will be sent out on a daily basis not only to the health carer but to their manager and teammates for follow-up.

ChildCount is in active use in the Millennium Villages site in Kenya and is in the process of being rolled out across the remaining 14 MVP representing approximately 500,000 people 100,000 of which are children under five. ChildCount is also being expanded to provide support for maternal health by registering all pregnant mothers and providing support for important antenatal care. UNICEF is in the process of rolling out a variation of ChildCount in Senegal and is considering it for its activities in other countries.

Maternal Health, Child Health