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The Promise and Limits of Technology: Supplemental Strategies for Surveillance

In this section, Eric Mafuta discusses technological innovations to aid surveillance activities. (Step 2.17)
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ERIC MAFUTA: To increase acute flaccid paralysis case detection rates in this context and address challenges to the surveillance system in this area, some innovation were used. The first innovation is maps. Mapping in public health is not new. You can remember the general snow mapping that marked a critical turn in the use of map to understand geographic pattern and disease. Geographic information system technology is increasingly used by public health professional to better understand how geographical relationship affect disease transmission patterns, access to health care, and health outcome. For example, in some provinces in the Democratic Republic of the Congo, the impact of the polio campaign to control outbreaks was low.
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Detailed maps and information of entire section of the provinces were not known or unavailable. Therefore, potential population eligible for vaccination services and living on islands or along tributary up to the river, the Congo river, were not included in immunization microplan and not reached by a routine immunization or by supplementary immunization activity services. So some author publish, in 2008 and 2018, Google map in DRC outbreak. They used geocoded data of cases and have information from different outbreak, use also data from the population, to try to identify at-risk population, those who are living in floating highland population along the river or hard-to-reach population. This research was done near Mbandaka.
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Mbandaka is in the north part of the DRC, which were after, in 2016 and 2017, a site for Ebola outbreak. What they have was it shows spatial distribution of polio cases that show that the outbreak follow the course of the Congo River. This raised suspicion that the river could play an important role in the propagation of the outbreak to the neighboring districts. This helped to set the strategy that includes mobile population on both canoe or rafts, population of seasonal village, and fixed population on highland and stilt village. The overall result of using Google Earth map was a better allocation of resources and an improved dispatch of vaccination and surveillance teams.
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This similar process was carried out for Haut-Lomami and Tanganyika, provinces situated in the southwest of the Democratic Republic of the Congo, where several outbreak occurs. Health professional work to map health area, health facilities, using various strategy. The results map, that we will show in the next slides, has multiple use for microplanning or for study sampling frame. You can see in this map that there is some location where we have polio virus outbreak. And this can help people and health population, health professional, to make plans to allocate resources or to make surveillance. We can also use mapping in environmental surveillance.
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The environmental surveillance consist of monthly waste water grab samples, collected from area with a history of wild polio cases, inadequate immunization coverage, or perceived risk of importation of wild polio virus. The collection and the test of sewage sample supplements the acute flaccid paralysis surveillance by identifying polio transmission in the absence of detected cases. So in this graph and photography, you can see digital level in the relief, where we can detect water catchment, drainage line, or draining catchments. We can also estimate the population to try to figure out which is the draining slope. And we can have all this information and their geolocation that can help to improve the water waste collection site selection.
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The second innovation that can be used for surveillance is phone. The surveillance system require that detected case are promptly reported and investigated by disease service personnel. The use of mobile technology for health in developing country, such as Nigeria and DRC, appear to be a new innovation way of reaching people and collecting and reporting data, given its extension in this area. By simply using an application, such as eSurv, for electronic surveillance on their smartphone, health workers and dedicated community members can send message about polio cases to the surveillance officer that can centrally generate maps. In their control room, public health experts can quickly analyze data, visualize surveillance map, and conduct active case research and risk assessment at the health facility level.
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And here we have example from the Nigeria, where you can see the point where there are location of polio cases. And also, we can have a map with different color that can show where there is a problem of surveillance. For example, here we have the use of the eSurv for real-time tracking of APV cases. It’s acute flaccid paralysis cases. So we have information from the community. They use their smartphone with this application. And the information is sent to the disease surveillance notification officer, which collects all this information on a smartphone. And this information can be gathered for a local government area, a ward, a reporting site level.
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And this can be used too for other disease in the integrated disease surveillance system. Another tool that we have using phone is Open Data Kits, ODK. The ODK is an application that can be used for real-time data collection on mobile phone. It’s a free and open source set of tools that allow to collect data, to manage data from the field. And the ODK can help to collect even GPS, location, and photo. So you can extract data and analyze for decision making. We have also for phone what we call AVADAR.
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It’s the audio-visual acute flaccid paralysis detection and reporting, which is a SMS, short message system, based smartphone application that was designed to address problem with detection and reporting of polio cases. By using their phone, health workers and community members can send weekly reports on the presence or the absence of polio cases in their respective area. And this generates an instant notification, with a minimal set of information, directly to the disease surveillance notifier officer responsible for the area and the upper level. This improve investigation of cases and prompt response. In conclusion, new technology and innovation, such as map and phones, can be used to improve or address challenges encountered in polio eradication activities.
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These strategy work better in one context cooperatively to others and are still implementation barrier that are not safe. So before I conclude my session, I would like you to keep in mind some few question. First, why might some of these strategy work better in one context and not in another? What implementation barrier are solved and not solved for mapping of phone in the surveillance? Is there some location in your respective country where you think this technology can be used and why? And are there other technology you know that can be adapted to the surveillance of polio or of another health problem? Thank you, for joining us.

Eric Mafuta, MD, MPH, PhD
School of Pubilc Health, University of Kinshasa, Democratic Republic of the Congo (DRC)

Reflect on the different strategies discussed in the lecture, and think about your own work or educational context as you consider the following questions:

  • Is there some location in your country where you think these technologies can be used? Why would it be useful in that context?

  • Are there other technologies you know of that can be adapted for the surveillance of polio or another health problem?

Please share your thoughts in the discussion.

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