Methods and tools for epidemiological biosurveillance

in data-limited settings

Presenter: Kathryn H. Jacobsen, MPH, PhD

Associate Professor of Epidemiology, George Mason

Universitykjacobse@gmu.edu

Framework

Complex

Models

Operational Use

Field Data

Data limitations in:• Conflict & post-conflict areas• Disaster areas• Places with under-developed public

health systems

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

Data Collection Components

1. Geography (mapping)2. Demography (household surveys)3. Epidemiology (syndromic

surveillance / laboratory testing)

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

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 smartphonesAdd named

features to a GIS

Add additional points of

interest to the GIS

Community-Participatory GIS (PGIS) of Neighborhoods & Streets

All partners have

immediate access to

key spatial informationFacilitates

communication by

providing a common language for place names

clinic

gas statio

n

bar

bank

Household Health Survey

Access to utilities (water,

electricity)

Household health

Use of the

healthcare system (preferre

d providers

)

All data entered

directly into a smartphone linked to the

GIS(with care taken to

protect the confidentiality of

personal information)

Participation rate: • Pre-survey

community meetings

• Local interviewers

Red dots are for illustration only.

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)

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 units improved 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.)

Framework

Complex

Models

Operational Use

• Smartphone

• Open-source apps

Once teams are familiar with the smartphone technology, the data

collection process can be very time (and cost)

efficient.

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.