Participatory surveillance of zoonotic disease: Putting the public back in public health

Abstract

The Southern African Centre for Disease Surveillance (SACIDS) in collaboration with the East African Integrated Disease Surveillance Network (EAIDSNet) has designed and piloted One Health (OH) disease surveillance system in East and Southern Africa. Initially, a rapid situation analysis was carried out to characterize existing disease surveillance systems in animal and public health sectors in Burundi, Democratic Republic of Congo (DRC) and Tanzania and it was found that there was no formal, routine collaboration between the two sectors. It was further observed that in the two sectors, disease surveillance and reporting starts with the lowest level where officials residing within community are engaged. The new system designed combines the use of participatory and OH approaches with district-based passive- (DPS) and community-based active (CAS) surveillance system components promoted to participate in detection of disease events at source. The CAS system is based on use of community-based health reporters (CHRs) to search for and report disease events occurring in animal and human populations in the study areas. Mobile technologies are being employed as the technology enablers. We selected two sites, Ngorongoro (an ecosystem with maximum human-wildlife and domestic animal interactions) and Kagera River Basin (a cross-border ecosystem with two districts across the border between Burundi and Tanzania) to test performance of the system. We have piloted and introduced android mobile phones running the EpiCollect and Open data kit (ODK) applications to aid geo-spatial and clinical data capture and transmission from the field to the remote IT servers at the research hubs for storage, analysis, feedback and reporting. Phase I results have proved that the participatory disease surveillance approach in combination with use of mobile technologies are capable of improving early detection and response to disease events particularly in remote hard-to-reach areas. A total of 387 disease events were reported by CHRs between 2011 and 2013. In some cases, reports of disease events submitted by CHRs triggered immediate response from official system making use of them in public health relevant. Phase II of this work focuses on integrated disease surveillance combining voice recording, hand-writing recognition, mobile spatial and participatory epidemiology revolutionalizing collection and reporting of disease event data. We also plan to set up a one health disease surveillance resource center that will strengthen regional capacities in designing ‘fit-for-purpose’ technologies to support disease surveillance and response and develop appropriate technology transfer platform to expedite use of mobile phone technologies in disease surveillance. This work was funded by the Rockefeller Foundation Grant (2009 DSN 305) and the IDRC Grant No: [107030-001] to Sokoine University of Agriculture for its Southern African Centre for Infectious Disease Surveillance (SACIDS)www.sacids.org