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Technologies for Disease Epidemics: Experiences from Roll-out of a Mobile Data Collection
Platform for Ebola in West Africa.
Robert Peter Ndugwa, PhD
Chief Global Urban Observatory Research and Capacity Development Branch
United Nations Human Settlements ProgrammeUN Avenue Gigiri, UN Complex, Block 4, South Wing, 2nd level
P.O.Box 30030, GPO Nairobi 00100, KenyaTel +254 20 762 23342 | Mob + 254 720 492021
Email: [email protected] | [email protected]
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Overview
• UNMEER background• Assessment findings• Design• Results of pilot• Lessons and challenges• Way forward• Questions
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Background
• UNMEER: The first ever United Nations Mission for Emergency Ebola Response.
• Ebola timelines were pointing to increasing deaths and worse humanitarian situation
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UNMEER-BackgroundAs per Accra planning conference (October 19, 2014), UNMEER responsibilities was based on 4 lines of action and 5 enabling
activities:
Global Support & Funding
Enabling activities
Logistics; personnel and volunteers,cash payments, training, information management
1.
Case finding(Contact tracing,
laboratories, surveillance)
2.
CaseManage-
ment(ETU, CCC)
3.
Community engagement and Social
Mobilisation
4.
Safe and dignified burials
Lines of action
UN support to government response
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PROBLEM AT HAND
• Time stamping• Location stamping• Relational links and structures• Connection trees on individuals• Multi-country• Mapping and GIS• Photographic evidence• Real-time reporting and decision making• Back/forth communication devices• Race against time
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Findings from quick assessment on data collection methods
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Findings from Nethope-led quick assessment
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Findings from Nethope-led survey
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Findings from Nethope-led survey
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Country Region Global
Overall data flow plan
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Visit contact (21d)
Fever+Symp?Fever+Symp?
No
Yes
Epidemiology Team
Suspect taken to isolation facility
LAB results
24h
LAB results
24h
Discharge per protocol
(+)
(-)
Disinfection of Home
Transfer to confirmed
ward
Additional contacts
identified
Identification of contact
Clinical assessme
nt
Contact listing & follow-up forms
Case Investigation form
LAB form
Flow Diagram of Cases and Contacts -- Processes
Inform case
management team
Continue follow-up until 21d
Continue to follow-up for 21d
Isolate?Isolate?
No
Yes
Case Management Team
Meets susp case
def?
Meets susp case
def?
Yes
No
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Requirements and gaps: e.g surveillance
Contacts per month neededContacts per month needed Contact tracing teams neededContact tracing teams needed
Contacts per month
Guinea 10,212
Liberia 115,028
Sierra Leone 46,371
Total 171,611
• At an estimated capacity of 800 contacts per contact tracing team this translated into ~215 teams needed by December 2014
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EPINFO LIMITATIONS• EPINFO is a desktop package that has always
worked well on epi-surveillance in small epidemics
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Can mobile solutions contribute to the response effort…..
Checklists & Protocols
Data collection
Program Monitoring & Evaluation
Client Counselling
Client Records & Tracking
SMS for Performance
Improvement*
14
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• Real-time data collection (on and off mobile grid)
• Patient record tracking over time• Point of care decision making
algorithms• Visit reminder alerts• Alerts for new cases in specific
geographic areas• Multimedia for strengthened
counseling (video, audio, image)• Videos for refresher trainings• Mapping of cases with GPS points
15
Mobile-phone Data collection Opportunities
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TOOLS• 13800 phones (Samsung,
LG, Motorolla, Amazon, HTC)
• 500 IPADs• Solar chargers• Extra batteries• BGANs
In addition online forms were developed for use on laptops and computers
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Supply versus demand balancing…
Pillar / Activity Lead partners involved in mobile data collection
No of Phones Needed
No. of Phone Available
Surveillance/Contact Tracing Liberia UNFPA/ Govt 2600 4000 Guinea Columbia University/ UNFPA/ Govt/ Plan 1933 3500
Sierra Leone UNFPA/ Govt/IPA 2300 3000 Case Management: Treatment ETU Liberia NIL 200 200 Guinea NIL 66 200
Sierra Leone NIL 200 200 Case Management: Treatment CCC Liberia UNICEF/WHO 200 500 Guinea UNICEF/WHO 200 500
Sierra Leone UNICEF/WHO 200 500 Case Management: Laboratories Liberia NIL 40 100 Guinea NIL 20 100
Sierra Leone NIL 40 100 Burial team Liberia IFRC/Govt 150 200 Guinea IFRC/Govt 200 200
Sierra Leone IFRC/Govt 50 200 Management KPI Liberia NIL 20 100 Guinea NIL 20 100
Sierra Leone NIL 20 100 Total 13800
Pillar / Activity Lead partners involved in mobile data collection
No of Phones Needed
No. of Phone Available
Surveillance/Contact Tracing Liberia UNFPA/ Govt 2600 4000 Guinea Columbia University/ UNFPA/ Govt/ Plan 1933 3500
Sierra Leone UNFPA/ Govt/IPA 2300 3000 Case Management: Treatment ETU Liberia NIL 200 200 Guinea NIL 66 200
Sierra Leone NIL 200 200 Case Management: Treatment CCC Liberia UNICEF/WHO 200 500 Guinea UNICEF/WHO 200 500
Sierra Leone UNICEF/WHO 200 500 Case Management: Laboratories Liberia NIL 40 100 Guinea NIL 20 100
Sierra Leone NIL 40 100 Burial team Liberia IFRC/Govt 150 200 Guinea IFRC/Govt 200 200
Sierra Leone IFRC/Govt 50 200 Management KPI Liberia NIL 20 100 Guinea NIL 20 100
Sierra Leone NIL 20 100 Total 13800
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CDC safety checklist built into application
GPS Capture
Advantages of the mobile app
18
Identifying level of risk depending on case profile
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Built in workflow alerts to improve communication
Visual aids forCounseling Quality Control
Advantages of app cont’d
19
Audio aids for Counseling Quality Control profile
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COMBINATION OF TOOLS
• Online forms used to transmit data more easily
• Phones used to map key facilities and geolocations e.g hospitals, ETU, airfields, logistics bases, etc
• Field based Ebola crisis managers used phones to take photos for decision making. Photos have automatic GPS codings.
• Field teams able to collect the WWW
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QUICK MOBILE SURVEY RESULTS
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Example Of Complex Field Deployment Of Contact Tracing
1. Identify a case2. Identify x contacts to case3. Follow contacts for 21 days4. Exit them after 21 days follow up if no
disease 5. Active contacts can be contacts for many
cases6. Report contacts who develop disease7. Follow cases from contacts until outcome
(death or recovery)
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CASE AND CONTACT REGISTRATION (ETU)
CONTACT ASSIGNMENT (DPS)
CONTACT MONITORING (CT)
Three linked applications
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Case registration Index Case
Registration
•Conducted during interview with case at the ETU•Assigns outbreak ID•Registers case details (name, age, location)•Registers health facility•Identifies symptom onset data•Identifies admission date•Identifies number of contacts
*Note: These images are samples taken from the application and do not reflect the full questionnaire
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Contact registration: at ETUContact Registration
•Identified by index case•Registers case details (name, age, location)•Registers relationship to index case•Identifies last contact date with index case•Identifies DPS office that will need to assign the contact •This data gets pushed to the DPS office to then conduct assignment
*Note: These images are samples taken from the application and do not reflect the full questionnaire
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Contact assignment: at district level
Contact Assignment
•Data pushed from the ETU case/contact registration application•One questionnaire that requests the district lead user to assign each contact to a contact tracer•Assignments made based on existing protocols (that balance contact tracer workload, location, etc)
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Contact monitoring: at householdContact Monitoring
•Data pushed from the district head and can be opened by a contact tracer•Edit registration option•Collects GPS (optional)•Asks about fever and other symptoms•Logic flow based on previous answers – i.e. presence of symptoms lead to prompt to contact supervisor•No symptoms leads to sensitization content*Note: These images are samples taken from the application and do not reflect the full questionnaire
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HQ: Performance Snapshots
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HQ: Index Case-Contact Linking
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Our Surveillance Dashboard
30
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Data Analytics: Registration Data
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Data Analytics: Contact Monitoring Data
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Data Analytics: CT Closures
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Data Analytics: CT Performance
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Lesson learnt• Quick assessments are valuable for benchmarking on what
works.• Value of partners and support.• Pilot prior to scale up.• Buy-in is never automatic until you demonstrate value addition.• Connectivity remains a challenge in some parts of Africa.• Many apps exist and sometime expert opinions help to select the
best for the situation at hand.• A combination of tools is sometimes valuable
• BENEFITS• Reduces delays in reporting of possible Ebola cases• Vetted real-time data from contact tracers was available at all
management levels • Streamlined communications and information relevance across
governing authorities• Allowed for use of health and location data for rapid response
deployment
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Partnerships
• UNHABITAT• UNMEER• National Governments• WHO• Samsung• LG• Motorolla• Vulcan Corp Inc.• Dimagi• Tableau• Ericsson• The Earth Institute: Columbia University• CDC