• Surveillance
  • African countries setup Country Health Situation Rooms for better health monitoring

    Two weeks ago, I was fortunate to participate in a workshop in Ethiopia hosted by the African Union, Africa CDC and UNAIDS.  The workshop aimed at strengthening the Country Health Situation Room initiative and roll-out across African countries.  Its goal is to support better use of health data and help countries keep populations healthier by improving their response to infectious diseases and epidemics.  

    Kenya was the first African country to adopt the Situation Room in 2015.  A further six countries – Cote d’Ivore, Lesotho, Namibia, Zambia, Uganda and Zimbabwe – have launched their Situation Rooms and are currently at different stages of scale-up and roll-out. 

    The Situation Room software integrates health data from multiple sources such as the DHIS2 and logistics management information systems (LMIS) at a country level.  Data are presented visually to help countries track progress and identify gaps in key health indicators.  The customisable interface allows countries to design their Situation Room around their health areas of interest and user types. 

    Matthew Greenall’s case study on the Country Health Situation Rooms describes the progress so far. Achievements include; 

    Enhanced collaboration between different health programmesImprovements in health decision makingImprovements in data qualityIncreased data use for decision makingImproved data sharing between stakeholders at national and regional levels

    Important challenges are also identified, such as;

    High turnover of staff and leadership compromised progressOperational and budgeting constraints interrupted roll-out in some countriesPoor quality of data at sub-national levelsOwnership – a strong desire for countries to host the software themselvesMaintenance of the Situation Room software requires strong technical support

    The Health Situation Room is a bold step for the participating African countries. We look forward to reporting the progress of this important eHealth contribution to health systems strengthening.  

  • Better eHealth can improve HIV monitoring and surveillance

    Ambitions to eliminate HIV are enthusiastically in place. Achieving them, such as the 90-90-90 goals can benefit from better eHealth. An article in the Journal of Medical Internet Research (JMIR) says questions remain about the sustainability of the programmes and the value of data initiatives. 

    Five principles identified in Sustainable Monitoring and Surveillance Systems to Improve HIV Programs: Review are:

    Better quality, local, granular, and disaggregated data to design and support a sustainable responses to ending the AIDS epidemicSupporting the health services cascade needs a cascade of linked dataUsing surveillance data is an intervention in itself, allowing programmes and communities to improve services’ responsesSurveillance needs systematic investment of at least 5 to 10% of programme budgets so that remaining resources address the epidemic and its impact can be assessedIncreased support for routine, integrated, district health data as part of health information systems, including sexually transmitted infections and hepatitis, linked to real-time health decisions.

    The study found that data’s been removed from healthcare settings and communities. It’s part of anonymous testing, national surveys, and modelling. It says that routine data’s part of implementation and an essential part of public health interventions,  packages of prevention and care. Without routine data availability, it’s difficult to achieve an effective public health or community responses. 

    This highlights the need for Africa’s health systems to review their HIV data components to test how they fit the service requirements identified by the study. It seems that some development or resetting may be needed.

  • GPS tracking finds a role for dementia patients

    Location, location, location’s not just a property agents’ mantra for house hunting and valuations. It’s essential for dementia patients and their health workers and family carers too. Knowing the whereabouts of the patients and loved ones can be supported by GPS. A NHS organisation in Dorset, UK’s testing a tracking device in shoe insoles to know patients’ locations and help to keep them safe.

    It was reported in a BBC Radio 4 programme that alerts are sent to carers’ mobiles when users stray from designated areas. The can be a nursing home yard or garden. The GPS can pinpoint patients precisely to map. When they stray, they can be found, minimising the risk of harm and needing hospital care. 

    Alz Products makes trackers prices at £75 and a £26 monthly fee. They can be transferred to other footwear, so it’s a price per user. 

    A report from the South Central Region of the Dementia Action Alliance South Central Region says there are 670,000 people with dementia in England and 550,000 friends and family acting as their primary carers. Socio-economic costs across healthcare, social care and wider society are estimated at £19b in 2011. It’s more than cancer, heart disease or stroke costs.   

    These kinds of impacts from imaginative innovation offer Africa’s eHealth programmes direct patient and healthcare benefits. They need a significant place in their strategies and plans.

  • GIS software helps optimise health efforts

    Graphic information systems (GIS) software could change the way countries tackle public healthcare issues. GIS helps capture, store, combine, analyse and display aggregated data from censuses and national health information systems and then overlays this data onto regional maps.  This visual representation of data then allows departments of health and ministries to better manage resources and plan accordingly. 

    A great advantage of using GIS technology in healthcare application is the spatial dependency of health related factors.  Several countries and organisations have already started to invest in GIS programmes.  In the United States, the Centre for Disease Control (CDC) launched its 500 Cities Project, which aims to provide geographic data on the distribution of chronic disease risk factors.  In South Africa, the South African National Aids Council (SANAC) launched the Focus for Impact Project, which aims to identify populations most at risk in areas most severely affected by HIV and TB. 

    The hope is that by better visualising and understanding the geographic distribution of health variables, health departments and planners will be able to plan public health interventions more effectively.  GIS software helps with this by answering 2 key questions; 

    Where are the high burden areas? – by overlaying routine health data on geographical regionsWhy is it a high burden area? – by profiling epidemiology and associated risks using secondary data and community dialogue 

    This in turn allows health departments and health planners to identify; 

    Who is at risk in this high burden area?What interventions can help reduce this burden? 

    To improve the overall health of our communities, access to these kinds of services is vital.  Further investment into GIS programmes could reveal other beneficial use cases for the healthcare industry, improve overall efficiency and better manage the cost burden of the healthcare system.

  • Facebook’s using AI to prevent suicides

    According to the World Health Organisation (WHO), a suicide occurs every 40 seconds globally.  Social, psychological, cultural and other factors can interact to lead a person to suicidal behavior.  Facebook believes that they are uniquely positioned to help combat suicides amongst adolescents and its users.

    They’re using AI and smart algorithms to detect suicidal tendencies and patterns.  The AI software scans users’ messages and posts for signs of suicide, such as asking someone if they are troubled.  Facebook already has tools in place for people to report concerns about friend's who may be considering self-harm, but the new AI software can speed the process and even detect signs people may overlook. 

    Posts that are flagged as worrisome are communicated to first-responders.  It’s also dedicating more human moderators to suicide prevention, training them to deal with the cases 24/7. They have partnered with organisations like Save.org, National Suicide Prevention Lifeline and Forefront from to provide resources to at-risk users and their networks. 

    Ubiquitous technologies often come with unrealised responsibilities.  Facebook’s demonstrating they're willing to take on these responsibilities and use their platform for greater social and health benefits.

  • eHealth Africa pilots AVADAR to track Toward Polio Eradication progress

    In response to the reported cases of wild poliovirus in Nigeria, eHealth Africa (eHA) partnered with Bill & Melinda Gates Foundation, the  WHO, and Novel-T to pilot a mobile surveillance app for Acute Flaccid Paralysis (AFP) in children. It’s a condition of a rapid onset of weakness of people’s extremities, and includes Guillain-Barré syndrome.  AFP often causes weakness of respiration and swallowing muscles, progressing to maximum severity within one to ten days. 

    WHO defines AFP surveillance as six goals:

    Track wild poliovirus circulationUse data to classify cases as confirmed, polio-compatible or discardedMonitor routine coverage and surveillance performance using standard indicators in all geographical areas and focus efforts in ones that are low-performingMonitor seasonality to determine low season of poliovirus transmissions to help to plan National Immunisation Days (NID)Identify high-risk areas to plan mop-up immunisation campaignsProvide evidence to certification commissions of interruptions of wild poliovirus circulation. 

    Standard indicators are: 

    >90% of expected monthly reports>1/1000,000 annualised non-polio AFP rate per 100,000 children under 15>80% of AFP cases investigated within 48 hours>80% of AFP cases with two adequate stool specimens collected 24-48 hours apart and less than 14 days after onset>80% of specimens arriving at laboratories in good condition>80% of specimens arriving at a WHO-accredited laboratories within three days of despatch>80% of specimens for which laboratories’ results sent within 28 day turn round. 

    AFP surveillance’s one of four cornerstone strategies of polio eradication. The objective’s to identify all cases of polio through a system that targets any case of AFP as a potential case of polio.  AVADAR’s a surveillance tool on android mobile devices provided to health workers and community informants. It aids AFP detection and reporting both in health facilities and local communities.

  • ASEAN shows how sharing data can help fight dengue

    Every 15 June since 2010, the Association of Southeast Asian Nations (ASEAN) denotes it as Dengue Day. It’s concept’s to:

    Increase public awareness of the disease, the most rapidly-spreading mosquito-borne viral disease globallyMobilise resources for its prevention and controlDemonstrate ASEAN’s commitment to tackle the disease.

    ASEAN’s E-Health Bulletin Special Edition The ASEAN Dengue Day: sustaining the united fight against dengue provides updates from ASEAN’s Member States on their dengue situations, national prevention and control programmes, challenges and priorities. Reports from each Member State combine into a regional profile and comparator of progress, initiatives, challenges and ideas. 

    Core themes consist of prevention and control relying on:

     Educating communitiesSurveillanceLaboratory services.

    Laboratory-based surveillance against dengue is a vital component of combating dengue. It addresses emerging infectious diseases too, such as Zika. ASEAN’s template for sharing information and experiences in dealing with high priority diseases is a constructive template for all global regions and sub-regions to adopt.

  • HISP-SA at the DHIS2 Academy in Goa, India

    Surveillance of priority diseases and events is a core part of the Global Health Security Agenda. Success depends on access to, and using, reliable information systems for prevention, detection and response.

    In most developing countries, public and Community Health Workers (CHWs) are challenged with collecting, disseminating, analysing and presenting  surveillance data. It’s a task hampered by a lack functional structures to support them in their response to public health events.

    Health Information Systems Program South Africa (HIPS-SA), with financial support from the Center for Disease Control and Prevention (CDC), in Atlanta, is part of the global District Health Information System 2 (DHIS2) community working closely with global, regional and national partners to improve diseases surveillance systems. In support of this, a DHIS2 Academy, hosted by HISP India in collaboration with University of Oslo and HISP teams from ten countries, met in Goa, India.

    Participants came from Asia and East, West and Southern Africa representing Ministries of Health, CDC Atlanta and country offices, WHO, Population Services International (PSI), eHealth Africa, University of Oslo and HISP teams from India, Vietnam, Uganda, Bangladesh, Tanzania, South Africa and Namibia to identify ways to strengthen capacity for implementers to use DHIS2’s tracker application as a customised system to support disease surveillance.

    The workshop’s main aim was exploring key components of a DHIS2 Surveillance template. Based on the DHIS2 tracker module, it’ll provide countries with an easy-to-use, integrated surveillance system they can customise for their use locally. It won’t take them long to refine it.

    A surveillance system developed by HISP-SA for use in South Africa  was developed into a template and shared with Sierra Leone. It took the team there only a month to customised and deployed it. Sharing this experiences at the Goa Academy aims to shorten customisation and deployment time.

    DHIS2’s current surveillance functionality shows great promise in its ability to address 90% of reporting requirements. This could increase as further releases of the tracker module addresses the remaining requirements.

    A challenge the 32 participants reviewed was the off-line data capture functionality of the mobile android app that feeds data into the surveillance database. During the Ebola epidemic, offline data capture was a huge challenge. A range of solutions were explored during the academy, and will inform the development of the DHIS2 android app. Other technologies will benefit too.

    HISP-SA will be working closely with the South African and Namibian governments, and supporting countries is East and West Africa, to implement and build their  disease surveillance capacity. Dr Vincent Shaw, CEO of HISP-SA, said “The potential of this work is that it can help to establish systems that will respond quickly to an epidemic threat, and prevent the kind of spread, and damage, that was seen during the Ebola epidemic.“

  • CDC backs automated cause-of-death reporting app

    Every death tells a story. Taken together, they provide valuable insights about the deceased and the population around them. These details are crucial for the Center for Disease Control and Prevention (CDC). The longer it takes for them to access Cause of Death (COD) details, the less valuable the data becomes for surveillance and responses. Health Data Management has a report saying to address this challenge, the state of New Hampshire has launched a mobile app, eCOD, for doctors to use to submit prompt COD reports to CDC.

    eCOD’s an original solution. Its developers are excited about its benefits. “Historically, this has been a pen and paper process that takes a long time and keeps valuable data from the CDC they could use to track disease and make public health decisions,” Stephen Wurtz, New Hampshire’s state registrar and director of the Division of Vital Records Administration said in an article in MobiHealthNews. “With eCOD, physicians or the medical examiner, wherever they may be, can immediately report and certify the death and get that information to the CDC.”

    This real-time death data could transform public health surveillance and disease prevention. “From a surveillance standpoint, a state might have an obligation to the CDC to share data once a month or whatever, but with the enhancement of eCOD, we can currently disseminate information twice per day,” said Wurtz. “That’s unheard of. We’re talking hours. Other states are talking days and weeks.”

    The app makes it easier to collect and report information to formulate complete prompt COD profiles It also enables CDC to raise follow-on questions, all of which can be quickly collected and disseminated to improve public health surveillance and response. This is mainly due to the ability to update vital statistics twice a day instead of monthly.

    For complicated or combined death cases that need coroner’s office certifications, eCOD can speed up documentation before cases are completed. “They don’t have to make a complete report and have it certified before they can start centralizing the data and helping state and other government agencies,” Wurtz said.

    The app took a year to complete. Financed by the CDC’s National Center for Health Statistics and developed by CNSI an IT company. Pilots are underway to develop a national model for mobile COD reporting and certification.

    eCOD uses Validation and Interactive Edit Web Service (VIEWS), CDC’s death certificate audit programme, to ensure all information is accurate and understandable.  It’s a format that every person who needs to access the information can already interpret.

    African countries that face disease outbreaks can benefit from this simple disease surveillance system. It can ensure  that authorities and agencies have near real time data on outbreaks and help to save lives. 

  • How can Africa monitor influenza during the upcoming season?

    In 2009, Sweden was one of the countries affected by A (H1N1) influenza, commonly called swine flu. Two minor peaks occurred during summer and winter. Starting among school children, the main epidemic occurred in late September and peaked in mid-November. It affected most parts of the country. An article in British Medical Journal (BMJ) says it leads to a debate on the level of the country’s preparedness.

    During this time, the epidemic was monitored using data from eHealth records and eSurveillance systems. A report supporting evidence-based strategies for eHealth system development in infectious diseases was published in the Journal of Medical Internet Research (JMIR). The study’s primary objective was to examine correlations between data from:

    Google Flu Trends (GFT), an Internet-based software system using aggregated data from Google to estimate influenza activityComputer support for tele-nursing centresHealth service websitesInfluenza case rates during seasonal and pandemic outbreaks.

    Results indicated important correlations. These are between GFT, tele-nursing data and website visits. All influenza case data showed large effect sizes.

    With the influenza season due in May and June in Southern Africa, it’s essential to review other eHealth surveillance systems to help prepare countries for likely outbreaks. eHealth innovators can then design initiatives to ensure the region’s prepared to deal with influenza.