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: robert.ndugwa@unhabitat.org | ndug2000@gmail.com

Overview

• UNMEER background• Assessment findings• Design• Results of pilot• Lessons and challenges• Way forward• Questions

Background

• UNMEER: The first ever United Nations Mission for Emergency Ebola Response.

• Ebola timelines were pointing to increasing deaths and worse humanitarian situation

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

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

Findings from quick assessment on data collection methods

Findings from Nethope-led quick assessment

Findings from Nethope-led survey

Findings from Nethope-led survey

Country Region Global

Overall data flow plan

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

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

EPINFO LIMITATIONS• EPINFO is a desktop package that has always

worked well on epi-surveillance in small epidemics

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

• 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

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

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

CDC safety checklist built into application

GPS Capture

Advantages of the mobile app

18

Identifying level of risk depending on case profile

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

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

QUICK MOBILE SURVEY RESULTS

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)

CASE AND CONTACT REGISTRATION (ETU)

CONTACT ASSIGNMENT (DPS)

CONTACT MONITORING (CT)

Three linked applications

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

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

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)

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

HQ: Performance Snapshots

28

HQ: Index Case-Contact Linking

29

Our Surveillance Dashboard

30

Data Analytics: Registration Data

Data Analytics: Contact Monitoring Data

Data Analytics: CT Closures

Data Analytics: CT Performance

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

Partnerships

• UNHABITAT• UNMEER• National Governments• WHO• Samsung• LG• Motorolla• Vulcan Corp Inc.• Dimagi• Tableau• Ericsson• The Earth Institute: Columbia University• CDC

Questions?

For more Q&A please email

Robert.ndugwa@unhabitat.org or ndug2000@gmail.com