1. DISEASE SURVEILLANCE BY USING SMS AMONG ROYAL CAMBODIAN ARMED FORCES (RCAF)
Department of Health, Cambodia Ministry of Defense and
US Naval Medical Research Unit-2 (NAMRU-2) Det. Phnom Penh
Good afternoon ladies and gentlemen, I am Dr. Song Chiv from Health Department of Ministry of Defense, Cambodia. I am happy to be here to talk about disease surveillance by using SMS among RCAF in collaboration with US NAMRU-2 Det. Phnom Penh.
ASIA PACIFIC MILITARY HEALTH EXCHANGE (APMHE)
“ GLOBAL HEALTH COOPERATION”
September 14-19, 2015 in Da Nang, Viet Nam

2. Content Background Mission, vision, Goals Method Activities
Diseases List
Results
Conclusion
Challenges
Future Plan
The contents

3. Background Lack of disease distribution data at military bases.
Lack of an integrated disease reporting system within DoH of MOD.
Disease Surveillance using SMS system started in Aug 2011 (Region 3) and Dec 2012 (Royal Cambodian Navy) until now.
Why did the RCAF use the SMS program ? Because, the disease distribution data and disease reporting system among RCAF are limited. So we started the SMS program in

4. Mission
Detection of infectious diseases of military and public health importance and prompt implementation of preventive and control measures
Our mission: To detect the infection diseases of military personnel and their families.

5. Vision
Participate and collaborate with other health partners to improve public health response.
Our vision : To improve the public health response.

6. Goals
Establish an integrated reporting system from Reporting sites to Regional Office (Main stations) then to DoH of MOD.
Send data routinely to command office/DoH of MOD  Daily/Weekly/ Monthly/Yearly
Detect the disease outbreaks and establish Rapid Response Team (RRT) at Command Office or Headquarters/DoH of MOD
And our goals: To set up a reporting system among RCAF and routinely send data. Especially, establish the RRT

7. Equipment & Supplies
Computers : DoH of MOD office, RCAF Regional 3 office, RCN Headquarter, Ream Naval Base, and RCN Command Office Kampong Speu.
Smartphones: RCAF Regional 3 office, RCN Headquarter and Kampong Speu., Ream Naval Base
Cell phones for all reporting sites
For the SMS program, we provided Computers, Smartphones at the headquarter and Cell phones at reporting sites.

8. Methodology DoH of MOD/NAMRU-2 Unit level reporting Main Station
EDE/OE
Analysis and Graphs
(Software SAGES)
DoH of MOD/NAMRU-2
Unit level reporting
Main Station
It is easy to use, the unit level use the cell phone to report to the main station that use the smartphone which connect to computer to take that data from smartphone. All data collected by the province office is sent to the regional and then to HoD, MoND/Namru-2 PP where we do the analysis and graphs by SAGES software.
Simple cell phone
Smartphone
Computer

9. Diseases List Disease Code Disease Name D1 Acute diarrhea D2
Acute Fever with Rash D3
Acute Flaccid Paralysis D4
Influenza like illness (ILI) D5
Dengue Fever or Dengue Hemorrhagic Fever D6
Meningitis or Encephalitis D7
Acute jaundice D8
Diphtheria D9
Rabies
D10
Neonatal tetanus
D11
Body injuries
D12
Burns and corrosions
D13
Poisoning by drugs medicaments and biological substances
D14
Suspected radiation
D15
Acute lower respiratory tract inflammatory (pneumonia)
D16
Suspected malaria
D17
Unknown disease outbreak C1
Consultation S1
Sick in Quarters
We use code number when reporting these diseases… for example D1 for Acute Diarrhea, D4 for Influenza like Illness, etc…

10. Activities Initial Training Refresher Training Basic IT training
Data Analysis Training
Site Visit
Reporting Daily/Weekly/monthly/yearly and analysis at H.Q, MOD/NAMRU-2
Activity of SMS Program, there are 04 training, 01 site visit and routinely reporting

11. SMS PROGRAM Structure DoH, MOD NAMRU-2 PP Region Unit Unit Unit
Province
Province
Province
This is the reporting system structure of the SMS program that we have been doing.
Unit
Unit
Unit

12. ​Structure of SITE visit
DoH, MoND
Namru-2 PP
Region
Province
This is the flow chart of our site visit that we used for the SMS program.
Unit
Beneficiary
Beneficiary
Beneficiary

13. Reporting Sites RCN RCAF Region 3
We used the location code number for reporting site which were divided on two main regions:
RCAF region 3 with 9 sites, and
RCN region with 23 sites.

14. Coverage of SMS program
The current sites of the SMS program are located in the Southwest and the Island. We are planning to expand to program to Northwest and Northern regions.

15. RESULTS

16. ACHIEVEMENTS OF REPORTING SITE
To date (Jan 2015), 35,276 SMSs were received by the system (include zero cases report)
23,446 cases were reported. The top ten diseases reported are :
1. Influenza Like Illness (ILI) – 38.9%
2. Acute diarrhea – 33.1%
3. Acute fever with rash – 14.0%
4. Body injuries – 6.7%
5. Burns and corrosions – 2.9%
6. Suspected malaria – 1.3%
7. Pneumonia – 0.8%
8. Dengue fever or DHF – 0.7%
9. Poisoning by drugs medicaments & biological substances – 0.6%
10. Meningitis or Encephalitis – 0.4%
As of January, 2015 : We received more than SMSs that include zero case and cases were reported. Why include zero case? … because each reporting site have to report everyday even if no case got sick. In order to know that the reporter did not forget to sent SMS. The highest disease reported is ILI with about 39%, Acute diarrhea 33% and Acute fever with rash 14% …..

17. DISTRIBUTION BY DISEASE
This slide shows the distribution by disease of Ground base and another one is the island base…. No difference between the two was noted…. ILI, acute fever with rash, and Acute diarrhea were the predominant diseases.

18. ACHIEVEMENTS SMS activities
Initial Training : 66 military personnel were trained:
46 from RCN (23 reporting sites)
20 from RCAF Region 3 (10 reporting sites)
Annual Refresher Training : 33 military personnel were retrained:
23 from RCN
10 from RCAF Region 3
Basic IT training : 09 military personnel were trained:
02 from HQ of RCN,
02 from Ream Naval Base,
02 from HQ of Kampong Speu Command,
02 from RCAF Region 3 and
01 from DoH of MOD.
Achievements: 66 military personnel attended the Initial Training , 33 military personnel attended the annual refresher training, and 09 were trained on the Basic IT.

19. ACHIEVEMENTS (CONT’) Data Analysis and Basic Epidemiology Training :
09 military personnel were trained,
02 from HQ of RCN,
02 from Ream Naval Base,
02 from HQ of Kampong Speu Command,
02 from RCAF Region 3
01 from DoH of MOD
Site Visit : 06 provinces (11 sites) were visited
Ensure data is reported daily/weekly/monthly/yearly
09 personnel were trained on the Data Analysis and Basic Epidemiology and 06 provinces were visited.

20. Refresher Traning at H.Q of Ream Naval Base 27-28.01.2014
Field visit at military hospital regional 3
These picture were taken during the refresher training, Data Mgt and Analysis training and the site visits
Data Mgt and analysist using Software SAGES training at Ream Naval Base,
Trip to Koh Kong Krao island for field visit

21. Challenges Human resources
Correct case definition at reporting sites level  need to re- confirm with medical personnel
Only one military personnel per unit
Funding
Lost of communication signal from the reporting sites at Islands (Ex. bad weather)
Other logistic and administrative challenges.
- The correct application of the case definition at some reporting sites was an issue, so they need to re-confirm with medical personnel. Only one military personnel per unit was trained,
The funding is limited, so we need more fund.
Lost of communication signal is also a problem especially at the island bases.
There were also other logistic and administrative challenges too.

22. Conclusion SMS system is an “easy to use” system.
Regular refresher training is needed (2 times/year), especially regarding to the disease’s case definition.
Need to follow up on disease outbreaks reports  Rapid Response Team.
Site visit is very important for the improvement of SMS program.
Educate military personnel and their family.
It is a “ easy to use ” system for RCAF. Regular refresher twice/year training is needed. We need RRT to follow up on the disease outbreak report.
To ensure data is reported daily/weekly/monthly/yearly, the site visits are very important for improvement of SMS program. Through the SMS program, the military personnel shared experience, knowledge, information with each other, especially, they educated their staff and their family.

23. Future Plans Strengthening the referral system
Education the military personnel and their families in disease recognition
Periodic meetings between all Reporting sites and Commanders (Ex. Workshop)
Conduct Epidemiology Training for Region personnel
Conduct Outbreak Response Training and create Rapid Response Team (RRT)
Expand the SMS program to Region IV and V
These are our future plans to strengthen the SMS system
- Educate the military personnel and their families in disease recognition
- Periodic meetings between all Reporting sites and Commanders (Ex. Workshop)
- Conduct Epidemiology Training for Region personnel
- Conduct Outbreak Response Training and create Rapid Response Team (RRT)
- Expand the SMS program to Region IV and V

24. Acknowledgements
NAMRU-2 Det. Phnom Penh 1. CAPT Andrew Vaughn 2. LCDR Michael Prouty 3. LCDR Dustin Harrison\ 4. LCDR Jamal Dejli 5. Agus Rachmat 6. Yi Chenda 7. Sum Bunsong
Dept of Health, Cambodia MOD
MG Prom Satharath
LTC Song Chiv
Royal Cambodian Navy
CAPT Prum Sokha CDR Ky Yadeith
RCAF Regional 3
LTC Tep Moeun

25. -NAMRU-2 Phnom Penh for supporting our SMS program
SPECIAL THANKS TO
-APMHE Committee & Vietnam People Force for their invitation to this meeting.
-NAMRU-2 Phnom Penh for supporting our SMS program
On behalf of RCAF, we would like to special thanks to …..