Methods and tools for epidemiological biosurveillance in data-limited settings

1. Methods and tools for epidemiological biosurveillance in data-limited settings Presenter: Kathryn H. Jacobsen, MPH, PhD Associate Professor of Epidemiology, George Mason University kjacobse@gmu.edu

2. Framework Complex Models Field Data Operational Use • Data limitations in: • Conflict & post-conflict areas • Disaster areas • Places with under-developed public health systems

3. Data Needs • How quickly can we set up a system to collect health surveillance data in places with… • No current map • No population census data • No electronic medical records • Almost no public health information system for reporting of infectious diseases • Limited access to laboratory testing

4. Data Collection Components • Geography (mapping) • Demography (household surveys) • Epidemiology (syndromic surveillance / laboratory testing)

5. Principles • Accessible technology: Nearly all of these data collection activities can be conducted by local partners with smartphones and free, open-source apps • Reduces IP concerns about data collection devices • Data are stored on a secure server • Protects IP related to data integration and interpretation • Partner technical support: This work can complement local public health information efforts

6. Community-Participatory GIS (PGIS) of Neighborhoods & Streets Start with images from open sources Local residents walk streets (red) and section boundaries (blue) with GPS-equipped smartphones Add additional points of interest to the GIS Add named features to a GIS

7. Community-Participatory GIS (PGIS) of Neighborhoods & Streets All partners have immediate access to key spatial information clinic bar gas station Facilitates communication by providing a common language for place names bank

8. Household Health Survey Access to utilities (water, electricity) All data entered directly into a smartphone linked to the GIS (with care taken to protect the confidentiality of personal information) Household health • Participation rate: • Pre-survey community meetings • Local interviewers Use of the healthcare system (preferred providers) Red dots are for illustration only.

9. Community-based Surveillance System Local volunteers report new cases of diseases of interest in person or via text message (incentive: cell phone minutes + free testing at locally-run NGO hospital)

10. Syndromic Surveillance • Syndromic (symptom-based) data collection activities • SMS reporting of weekly cases in an assigned “catchment area” via cell phone from community health volunteers (CHVs) in urban and rural areas • SMS reporting from nationwide military unitsimproved weekly reporting compliance from 76% to 100%of Sierra Leone’s military medical units over a year • GPS-linked environmental testing (water, chickens/birds, etc.)

11. Framework • Smartphone • Open-source apps Operational Use Complex Models Once teams are familiar with the smartphone technology, the data collection process can be very time (and cost) efficient.

12. Disclaimer: The views expressed herein are those of the presenter and are not representative of the Department of the Navy or the Department of Defense.