Nutritional Surveillance - Malawi
UNICEF Malawi deployed RapidSMS to address serious constraints within the national Integrated Nutrition and Food Security Surveillance (INFSS) System, which was facing slow data transmission, incomplete and poor quality data sets, high operational costs and low levels of stakeholder ownership.
Health workers now enter a child’s data, and through an innovative feedback loop system, RapidSMS instantly alerts field monitors of their patients’ nutritional status. Automated basic diagnostic tests are now identifying more children with moderate malnutrition who were previously falling through the cracks. The system also increased local ownership of the larger surveillance programme through two-way information exchange. Operational costs for the RapidSMS system are significantly less than the current data collection system. The Government of Malawi is considering a national scale-up later this year.
There is an average of two to three months delay between data collection at health clinics and delivery of the actual forms
Malawi is one of the world’s most densely-populated, yet least-developed countries. A small, landlocked country bordered by Mozambique, Zambia, and Tanzania, Malawi has remained below the United Nation’s average human development index score of sub-Saharan Africa countries due to a combination of slow economic development, poor infrastructure, the catastrophic public health effects of HIV/AIDS, and chronic child malnutrition. The 2008 UNDP Human Development Report ranked the country 164th out of 177 countries in factors such as average life expectancy (46.3 years), adult literacy (64 percent), GDP per capita (US$667), and percentage of underweight children under five years (22 percent). The country suffered a series of severe droughts over the last decade that led to widespread famine during 2002 and 2006. It is estimated that 13 percent of children in Malawi die before the age of five, and that at least one-third of these deaths are related to acute malnutrition. Over half of all children suffer from stunting (52.5 percent) and 18.4 percent of children under five years old are underweight for their age.
In the wake of Malawi’s severe 2002 famine, the Integrated Nutrition and Food Security Surveillance (INFSS) system was set up with technical assistance from Action Against Hunger (ACF) and the support of the Malawi government, UNICEF, the European Union, and other partners. The nutrition portion of the surveillance system was structured to monitor trends in nutritional status of approximately 9100 children, spread out in five growth monitoring clinics (GMCs) in each of the 26 districts. Monitored children are randomly selected from the population of children visiting GMCs, thereby including a combination of healthy, malnourished, and sick children. These same children are tracked and measured monthly for a period of 12 months. The nutritional data is collected on paper forms and then sent through district health managers to a central office in Lilongwe, where they are manually entered into Excel-based datasets for nutrition analysis.
In 2008, ACF handed the program over to the Malawi government. Data reporting dropped significantly. Paper data forms continued to trickle up to the central government level, yet much of the data was never entered into computers or analyzed. This left the government, UNICEF, and their development partners without any systematic means of identifying acute changes in nutrition status throughout the country and with little information with which to make effective decisions about allocation of resources.