Can cell phones raise the standard of health in Tanzania?

Cervical cancer is one of the most common forms of cancer at worldwide level.

Seven out of every ten women diagnosed come from a poor country.

Against this background, Ditte Linde from the Department of Clinical Research at SDU has examined whether preventive measures can be improved in the East African country of Tanzania.

In a PhD thesis, she has assessed whether the cell phone can be used as a tool to ensure better cooperation between women and healthcare staff.

“In Tanzania, there are more people with cell phones than people with access to electricity and clean water. It is therefore obvious to try to ensure that mobile technology supports the health of the population,” explains Ditte Linde.

Ditte has lived in Tanzania for several periods during her research for the dissertation. She has seen the big differences between the local GP’s and health centres. And she has followed a number of women who have been invited for screening.

Tested with vinegar

So far, doctors have used a method where a little vinegar is swabbed directly onto the cervix and if white spots appear it may be a sign of cancer,” says Ditte Linde and adds:

“It is an inexpensive and practical method, as the results can be seen immediately. But unfortunately it is also very unreliable,” says Ditte Linde.

The authorities are therefore testing a new screening method - a so-called “rapid HPV test”.

Better test gives rise to new problem

The new method involves scraping the cells and is considered to be safer. The disadvantage, on the other hand, is that the sample must be sent to a local laboratory where you have to wait for an answer.

And a follow-up is necessary if the test shows positive.

“This means that the test is better but also gives rise to new problem. As women often do not return for the follow-up examination,” says Ditte Linde.

Women receive text messages

Ditte has followed 705 Tanzanian women in her study, all of who were declared positive in a “rapid HPV test”. In practice, this does not necessarily mean that the women have cervical cancer. But they have an increased risk of developing the disease at some point.

All of them were therefore re-examined 14 months later and received a series of one-way text messages in connection with this.

Some of the messages contained general information about the condition, while others were distinct reminders inviting the women to turn up for the forthcoming check-up.

One in four turned up

Ditte Linde also worked with a control group of women who did not receive text messages leading up to the examination in question.

It was found that the text messages had no effect. Approximately one in four women from both groups turned up for the check-up, which took place at the hospital in the largest city of Dar es Salaam or Kilimanjaro Christian Medical Centre in Moshi.

“This is not what we had hoped for of course. We called the women who failed to appear after I had concluded my study. Subsequently, an additional 22 per cent turned up. This suggests that it makes more sense to call than to text, but it also requires that there are more healthcare staff,” Ditte Linde points out.

Some of the participants expressed their thoughts on the screening offers in a series of qualitative interviews.

“They are fundamentally positive but there are more barriers than we first anticipated. Many women are afraid of cancer and react by avoiding any involvement in the examinations,” says Ditte Linde and adds:

“Others use the screening as a general gynaecological examination where they can be examined for other problems in the lower body. Many are also afraid of the gynaecological examination.”

Limited by poverty

According to the researcher however, the biggest problem is to be found elsewhere:

“The main barrier is probably related to economy. Although the examination is free, the women must take a day off work and provide their own transport.

One of the women explained to me that if she had one dollar to last the whole day, she could either spend it on a bus ticket to the hospital in Dar es Salaam or use it on food for her children. She would therefore use it for the latter,” says Ditte Linde.

Obvious that mobile technology should be used

For Ditte Linde however, the results do not mean that introducing mobile health technology in Tanzania and similar countries should be given up on.

On the contrary, like others, she believes that it is obvious to take advantage of changes in the local population of recent years.

The inhabitants were thus difficult to communicate with 10-15 years ago, as none of them had a landline telephone.

Better use should be made of the possibilities

Nearly all families now have a cell phone however, and suddenly it is possible for doctors and nurses to contact citizens in rural districts and poor areas far away.

“But we need to be better at varying our use of technology. It transpires that it is obvious to use text messaging for some health-promoting messages, while in other cases we need to use other methods,” the researcher explains.

As part of her PhD thesis, she is the first to review all of the trials that have been published on the use of one-way text messages in connection with health behaviour in poor countries.

Great potential

“One of my conclusions is that we have been too rigid in our approach to the use of mobile technology up until now,” says Ditte Linde.

For example, one-way text messaging has proven effective for the vaccination of children in the clinical areas, but has not helped in getting people to take their medication,” she emphasises.

“I certainly believe that technology has a great potential and it is obvious that it should be taken advantage of. But we need to divide it into some bases and learn which type of communication works best in the different clinical areas.”