The World Health Organization (WHO) has set ultimate goal to fight against malaria towards the elimination of the disease by which starts with good and effective malaria control programme [1, 2]. Several control measures and interventions have been developed and implemented across the region, including mosquito control, indoor residual spraying, insecticide-treated nets, prompt and effective treatment, intermittent preventive prophylaxis, and behavioural change education [3, 4]. One of the key strategies for eliminating malaria is the prompt identification and treatment of malaria patients. To achieve this goal, an effective disease-management system should exist to enable rapid and accurate malaria case detection in target areas, and ensure effective treatment. Therefore, an effective system should allow case detection for early treatment at the point-of-care, and real-time case investigation and active follow-up of positive cases at the community level [5, 6]. Although the vertical control programme administered by the Bureau of Vector-borne Diseases (BVBD) in Thailand is well organized and distributed throughout epidemic areas across the country, preventive and treatment control measures may not cover fully and efficiently in rural and remote communities. Difficulties in those communities might include limited service access, due to poverty and illegal immigration status, which inhibit villagers' treatment-seeking behaviours .
In the BVBD's vertical malaria-control programme , malaria-case treatment and care are managed down to the village level. In villages in epidemic areas, village malaria volunteers (VMVs) and/or village health volunteers (VHVs) work at the point-of-care, malaria posts (MPs), which collaborate with staff at the official malaria clinic (MC). At the upper levels, treatment and care are monitored vertically by the Vector-borne Disease Unit (VBDU), Vector-borne Disease Center (VBDC), up to the regional Offices of Disease Prevention and Control (ODPC), and BVBD. In passive case detection, the local febrile patients visit at MC/MP or VBDU office for diagnosis. The VBDU staff, however, also conduct periodic active case detection in their responsible villages. The infected cases are registered and investigated in more detail. According to the standard malaria case management practices of Thailand's Ministry of Public Health (MOPH), medication and follow-up days are different, corresponding with the type of infection. The first-line drugs for malaria treatment adopted by the MOPH adhere to the national guidelines of Thailand and the WHO [9–13]. Typical uncomplicated Plasmodium falciparum cases are treated with three days of artesunate, plus mefloquine on day2 and day3; with recommended follow-up at days 7 and 28, with additional days 60 and 90 [13–16]. For typical Plasmodium vivax malaria cases, patients are treated according to recommended WHO and Thai MOPH practices, with chloroquine for three days and a 14-day course of primaquine to prevent relapse; with recommended follow-up on days 14, 28, 60, and 90 [14, 17–19].
A major challenge for malaria-control programme is the assurance of prompt and effective treatment. It has been suggested in the literature that monitoring of prompt diagnosis and effective management of acute clinical episodes with anti-malarial drugs are crucial to reducing morbidity and mortality [20–22]. The WHO suggests that standard guidelines on duration of follow-up for safety monitoring are needed in different regions [11, 23]. In Thailand, designated malaria staff routinely assess safety and tolerability, and monitor clinical failures, in accord with WHO guidelines. Strategies to promote patient adherence would improve drug performance and thereby might help to prevent the rapid emergence of drug resistance [24, 25].
This study was part of the project Application of Smart Phone in "Better Border Healthcare Programme" (BBHP) that was awarded by the Microsoft Research in early 2008. The main objective of this two-year project was to develop technology-based healthcare solutions that would increase the accessibility and affordability of treatment and care services to the under-served communities . The BBHP modules were developed in part to correspond with the United Nations' Millennium Development Goals (MDG), and BVBD malarial-control indicators. One MDG targeting healthcare services included combating malaria and other diseases, while the BVBD had set its mission for prevention and control of malaria to eventually eliminate it. The module for Disease and Treatment Monitoring of Malaria (DTMM), one part of the BBHP project, was thus developed in an attempt to find a solution using mobile technology to alter treatment-seeking behaviours and facilitate better treatment and care for malaria patients in low-resource settings. Mobile technology, particularly the cellular phone, has not only penetrated the daily lives of people in metropolitan areas and large rural cities/towns; they have also become popular among those living in remote areas. Thus the DTMM combined both web-based and smart-phone applications to manage malaria treatment and care activities, integrated into routine case detection and follow-up at selected MCs and VBDU. The main objective of this study was to assess the module's effectiveness in improving case follow-up and treatment compliance among an under-served population in a border area.