Mobile Disease Surveillance Project

Mobile technologies are now increasingly being used across Africa for everything from phone to SMS texting. This is associated with widespread access to affordable mobile networks and handsets. In many cases, this technology has overtaken the use of landline phones, radio and internet for communication in rural communities. Innovative examples of the potential of these mobile devices include the potential to make small SMS payments, receiving text alerts of market prices or receiving medication reminders for TB treatment. Nevertheless, their use in disease surveillance is limited.

In general there are three types of mobile technology applications to disease alerts and surveillance. The first relies on either telephoning or sending of SMS messages by field operatives to a central unit. This is particularly useful for disease alerts to observations made in the field or primary health care centre. They are not particularly useful for surveillance as such messages are often not recorded in standard and verifiable formats. The second category combines the use of a digital pen to record observations on specially designed paper form and then transmitting such information via either a mobile telephone or laptop to central database on a server. This is being tested for animal health surveillance in several SADC countries including Namibia, Mozambique, Malawi, Zambia and Tanzania. The third and emerging system is one that uses the Google-Android Open source Data Kit (ODK) mobile telephones to generate forms and transmit information to a database on a server. The second and third systems have the advantage of collecting data that can be verified and analysed by an expert at a distance. Field data can be geo-referenced and depending on the quality of the mobile telephone they can be accompanied by photographed images.

The recent development and access to second generation mobile devices, such as the ODK system, offers significant new opportunities for disease surveillance and prevention. The handsets now have accurate geo spatial sensing, which enables accurate tracking of location and linking to text, image and data. The potential to insert memory cards means that the devices can temporarily capture data off line where a network is poor. This additional memory means that the handsets can be populated with appropriate disease extensions and support material in video, audio and textual format which the operator can refer to in the field.

There are already Open Source tools available for the Android platform which can be relatively simply be engineered to enable disease data collection. Data entry can be done using a pen device, a keypad or touch screen and GPS settings are captured automatically. This data can then be transmitted through a GPRS or low bandwidth network to a central server where it can be analysed, mapped and modelled almost immediately after the data has been collected. The field worker can then be referred to information on the handset memory in the local language for example with advice on suitable biosecurity measure to adopt.

Thus the mobile technologies are serving to overcome the constraints of poor physical infrastructure in Africa and Asia by real-time transmission of clinical observations at the point of disease outbreak (be it in communities, health facilities, on farm or in wildlife) to experts at district, provincial or national headquarters and the feed back (i.e. response) from such expertise to the point of outbreak, also in near real-time. It is a technical empowerment of the primary health (human or animal) responders, who in Africa are invariably sub-professional or even auxiliary cadres. This is a clear example of technology that is fit for the purpose.