Patient's Rights: Cambodian Vaccine Clinic Builds Local Reporting System Using FrontlineSMS

In the spring of 2012 the Institut Pasteur du Cambodge of Phnom Penh (IPC), Cambodia conducted a pilot study on a text message-based pharmacovigilance tool. Don't know what pharmacovigilance is? Not to worry, neither did I! According to the World Health Organization, "Pharmacovigilance (PV) is defined as the science and activities relating to the detection, assessment, understanding and prevention of adverse effects or any other drug-related problem." The IPC used FrontlineSMS as a tool to follow up with patients after they received vaccinations.

The study took place from March 12th to May 31st and included 184 participants (87 male, 97 female) mainly from Phnom Penh, Kampong Speu, and Siem Reap. All participants had to be over 18 years old, agree to participate, own a cell phone, and know how to send SMS. 192 vaccine doses for 17 different diseases were given to the participants after a research assistant from the public health unit at IPC collected their contact information and entered it into FrontlineSMS. Two days after the patients were vaccinated they received automated text messages asking if they were experiencing any adverse effects. The patients replies were based according to this number-code:

0=No adverse effects

1=Redness and/or pain at the injection site


2=Fatigue and/or weakness



5=Runny or congested nose

6=Muscle pains

7=Abdominal pain

8=Seizures or neurological problems

9=Severe allergic reaction.

The research assistant from IPC exported and examined the participants' replies daily. If a patient responded with codes 0 through 7 they received an automated message thanking them for their participation. When participants responded with code 8 or 9 they were sent the following message:

"You have reported a severe adverse event. Please consult the nearest doctor as soon as possible. If in Phnom Penh, we recommend that you refer to Hôpital Calmette.”

The research assistant then called the patients experiencing severe reactions and covered the transportation costs for those referred to Hôpital Calmette, a national reference hospital who had been informed of the pilot study.


24 of the 132 participants who replied were experiencing adverse reactions to their vaccination. By using FrontlineSMS, the IPC concluded, "this small pilot study serves as a proof of concept that health user-sent, SMS text-based surveillance strategies can be used in an urban Cambodian setting... Technology for mobile telephone–based active surveillance appears to be cheap, easy to implement, simple, and quick to be mastered by field staff."

Thanks to Arnaud Tarantola, MSc Epi, MD, for flagging his paper (read it here) to us and allowing us to paraphrase it for this post!