Daily zero-reporting for suspect Ebola using short message service (SMS) in Guinea-Bissau

doi:10.1016/j.puhe.2016.03.006

Public Health

Volume 138, September 2016, Pages 69-73

https://doi.org/10.1016/j.puhe.2016.03.006 Get rights and content

Highlights

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As of September 2015, the Ebola outbreak in West Africa has claimed over 10,000 lives.
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Zero-reporting is a key surveillance strategy for disease elimination.
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Real-time, SMS-based, daily zero-reporting can be implemented in a rapid, simple way in a low resource country.
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The real-time, zero-reporting through SMS model could be useful for rapid scale-up and implementation of alert systems in other outbreaks and public health emergencies.

Abstract

Objective

Intensified surveillance will be vital in the elimination phase to verify Ebola-free status and mitigate potential reemergence of the disease in West Africa. Zero-reporting from high-risk districts is a key strategy for surveillance. Our objective was to implement a pilot investigation to assess the feasibility of using short message service (SMS) texting for daily reporting of Ebola cases under investigation (CUI) in Guinea-Bissau in the context of an ongoing emergency-response training program known as Surveillance Training for Ebola Preparedness (STEP).

Study design

Prospective cohort (pilot investigation)

Methods

The reporting period for the SMS pilot was January 24–March 24, 2015. STEP was conducted for two sequential groups during January 19–March 27, 2015 in Bissau, Guinea-Bissau. Training on SMS daily reporting occurred over one hour during the first week of didactic training of each group. Fourteen participants (nine from the first group and five from the second), including one surveillance officer from each of the 13 regions in Guinea-Bissau and one from the national laboratory, were selected as reporters, receiving a simple cell phone for sending SMS indicating the number of CUI for Ebola. The WHO suspect Ebola case definition was used initially and then modified on day 32 of the pilot. The text message was sent to the WiFi-connected smartphone at the Instituto Nacional Saúde Pública (INASA). The smartphone utilised an SMS-gateway application (Ushahidi SMSsync Android App) to upload the data to the Magpi cloud application.

Results

The average daily reporting from the first group was 7.7 of 9 (86%) and for the second group was 4.1 of 5 (82%). For the two groups combined, the reporting rate was 85%. Among the 14 reporters the median reporting rate was 85% (range 36%–100%). No cases meeting the definition for an Ebola CUI were reported during the 60 days.

Conclusions

Real-time, SMS-based, daily zero-reporting can be implemented in a rapid, simple way in a low resource country. We believe that the high compliance rates were due to the simplicity and familiarity of SMS and heightened sensitivity that resulted from STEP to the importance of zero-reporting in the midst of an Ebola epidemic in neighbouring countries. This model could be useful for rapid scale-up and implementation of alert systems in other outbreaks and public health emergencies.

Section snippets

Background

As of February 2016, the Ebola outbreak in West Africa has claimed over 10,000 lives; a number greater than the combined number of lives claimed by all previous reported outbreaks.¹ The last confirmed Ebola case in Sierra Leone was reported on January 20, 2016. Currently, both Liberia and Guinea have been without confirmed cases for more than 42 days (two incubation periods) with Liberia having experienced reemergence of Ebola twice after initially being declared Ebola-free in May 2015. West

STEP training and SMS instruction

Five weeks of STEP training were conducted for two sequential groups during January 19–March 27, 2015 in Bissau, Guinea-Bissau. Because of its small size, a region in Guinea-Bissau is more equivalent geographically to district levels in other West African countries. Training on SMS daily reported lasted one hour during the first week of the didactic portion of training of each group (January 23 for group 1; February 24 for group 2). One participant from each region and a representative from the

Results

The SMS system took about eight hours to set up and was operational the day immediately following the training (January 24). Fig. 2 summarises the daily frequency of reporting (regardless of whether the report was a ‘zero’ or other number) during January 24–March 24, 2015, demonstrating high compliance levels. Nine public health officials, representing each of eight regions included in the study and the national laboratory, were the initial reporters selected from the first STEP group. An

Discussion

Our preliminary results from this pilot initiative demonstrate that real-time, daily zero-reporting can be implemented in a rapid, cost-effective way in a low resource country. We believe that the high compliance rates were due to the simplicity and familiarity of SMS and heightened sensitivity resulting from STEP to the importance of zero-reporting in the midst of an Ebola epidemic. The system is being considered for reporting of other epidemic-prone diseases.

The finding of not having any

Acknowledgements

We would like to acknowledge the invaluable contributions of the surveillance officers and other public health staff in Guinea-Bissau who participated in this project as well as staff of the CDC (Fred Angulo, Tim Doyle, Nicholas Gaffga, Jay McAuliffe, Russell Gerber, Tyson Volkmann, Kristin Delea, Amy Kasper, Linda Quick, Laura Martin), Magpi (Joel Selanikio, George Njuguna, Facundo Alberdi), and the CDC Foundation (Reema Bhakta, Verla Neslund).

Ethical approval

This investigation did not undergo IRB approval

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Original ResearchDaily zero-reporting for suspect Ebola using short message service (SMS) in Guinea-Bissau

Highlights

Abstract

Objective

Study design

Methods

Results

Conclusions

Section snippets

Background

STEP training and SMS instruction

Results

Discussion

Acknowledgements

Ethical approval

Ebola outbreak in West Africa—case counts

Training the global public health workforce through applied epidemiology training programs: CDC's experience, 1951–2011

Public Health Rev

Central America Field Epidemiology Training Program (CA FETP): a pathway to sustainable public health capacity development

Hum Resour Health

Polio eradication–the validity of surveillance indicators

Trop Med Int Health

Original Research
Daily zero-reporting for suspect Ebola using short message service (SMS) in Guinea-Bissau