Abstract
BackgroundIt is a challenge in low-resource settings to ensure the availability of complete, timely disease surveillance information. Smartphone applications (apps) have the potential to enhance surveillance data transmission.MethodsThe Central African Republic (CAR) Ministry of Health and Médecins Sans Frontières (MSF) conducted a 15-week pilot project to test a disease surveillance app, Argus, for 20 conditions in 21 health centers in Mambéré Kadéi district (MK 2016). Results were compared to the usual paper-based surveillance in MK the year prior (MK 2015) and simultaneously in an adjacent health district, Nana-Mambére (NM 2016). Wilcoxon rank sum and Kaplan-Meier analyses compared report completeness and timeliness; the cost of the app, and users’ perceptions of its usability were assessed.ResultsTwo hundred seventy-one weekly reports sent by app identified 3403 cases and 63 deaths; 15 alerts identified 28 cases and 4 deaths. Median completeness (IQR) for MK 2016, 81% (81–86%), was significantly higher than in MK 2015 (31% (24–36%)), and NM 2016 (52% (48–57)) (p < 0.01). Median timeliness (IQR) for MK 2016, 50% (39–57%) was also higher than in MK 2015, 19% (19–24%), and NM 2016 29% (24–36%) (p < 0.01). Kaplan-Meier Survival Analysis showed a significant progressive reduction in the time taken to transmit reports over the 15-week period (p < 0.01). Users ranked the app’s usability as greater than 4/5 on all dimensions. The total cost of the 15-week pilot project was US$40,575. It is estimated that to maintain the app in the 21 health facilities of MK will cost approximately US$18,800 in communication fees per year.ConclusionsThe app-based data transmission system more than doubled the completeness and timeliness of disease surveillance reports. This simple, low-cost intervention may permit the early detection of disease outbreaks in similar low-resource settings elsewhere.
Highlights
It is a challenge in low-resource settings to ensure the availability of complete, timely disease surveillance information
The app-based data transmission system more than doubled the completeness and timeliness of disease surveillance reports. This simple, low-cost intervention may permit the early detection of disease outbreaks in similar low-resource settings elsewhere
In low-resource settings it is challenging for health facilities to deliver paper-based surveillance reports to national authorities in a timely manner [4, 5]
Summary
It is a challenge in low-resource settings to ensure the availability of complete, timely disease surveillance information. Smartphone applications (apps) have the potential to enhance surveillance data transmission. Since 1998, the World Health Organization (WHO) Regional Office for Africa and Member States have adopted the Integrated Disease Surveillance and Response (IDSR) strategy [1]. In low-resource settings it is challenging for health facilities to deliver paper-based surveillance reports to national authorities in a timely manner [4, 5]. Smartphone applications (known as apps) have been developed to support data transmission between health facilities and district offices in a number of low-income countries, including several in sub-Saharan Africa [2, 6, 7]. This report describes the implementation and evaluation of an app surveillance system for the notification of Alerts and transmission of Weekly Reports on conditions from health facilities in the southwestern part of Central African Republic (CAR), in a pilot study entitled “Projet d’Alerte Précoce” (PAP; Early Warning Project, in French)
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