Text message-based health surveys distributed to 6,694 Liberians during an Ebola outbreak were generally on par with baseline demographic data collected in a prior household survey, according to a study recently published in Nature Digital Medicine. Further, the text surveys suggested that women sought fewer hospital-based deliveries during the outbreak, a trend consistent with other retrospective studies that have been published since the outbreak.

Why it matters 

Taken together, these findings would indicate that these text-based surveys could be an avenue toward more real-time data collection in developing countries gripped by outbreaks.

"While text messages will not replace national surveys, they can capture changes in health behavior more nimbly,” Rumi Chunara, an assistant professor at NYU and the study’s senior author, said in a statement. “With appropriate methodological approaches, they can be a valuable tool for population health intelligence that allows us to quickly target the affected regions with public health messaging or deploy appropriate interventions.”

Chunara and colleagues conducted the mobile surveys between March and June of 2015 in four rounds, and compared these results with the 2013 Demographic and Health Survey, a nationally-representative household survey of primarily reproductive aged women. Participants in the mobile surveys were provided $.50 in phone credit as a participation incentive. The questions included awareness of Ebola, recent health seeking behavior and information on recent births in the household.

The Ebola outbreak was, and in some areas continues to be, a test of public health infrastructure. In regard to maternal care in particular, the researchers noted that many communities perceived a reduction in care quality as practitioners were advised not to make physical contact patients espousing fluids whenever possible.

As such, a viable, real-time data collection system that is based on a technology widely adopted by residents can be a substantial boon to health systems facing crisis, they wrote.

What’s the trend

Mobile and text-based technology has been a cornerstone for healthcare deployments in low- and middle-income countries for some time, and a number of emergency and public health organizations including UNICEF and the Red Cross deployed such systems to West Africa during the heart of the Ebola outbreak. Within just a couple of years the CDC would roll out another text-based system for Zika, the next global outbreak, to inform pregnant US travelers of potential infection.

On the record

Mobile data collection [is] a useful complement to data on health and health seeking behavior collected from household surveys as demonstrated here, particularly for more nimbly capturing changes in health-seeking behaviors that traditional surveys allow. As mobile phone ownership, and even smartphone use is growing even among poorer segments of the population, and given its low cost, with appropriate methodological approaches, it can be a valuable tool for population health intelligence,” Chunara and colleagues concluded.