• Surveillance
  • 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 globally
    • Mobilise resources for its prevention and control
    • Demonstrate 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 communities
    • Surveillance
    • Laboratory 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:

    1. Google Flu Trends (GFT), an Internet-based software system using aggregated data from Google to estimate influenza activity
    2. Computer support for tele-nursing centres
    3. Health service websites
    4. Influenza 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.

  • Africa's eHealth needs stepping up to fight Zika

    Zika’s not new to Africa. WHO’s Zika virus factsheet says “Zika virus is an emerging mosquito-borne virus that was first identified in Uganda in 1947 in rhesus monkeys through a monitoring network of sylvatic yellow fever. It was subsequently identified in humans in 1952 in Uganda and the United Republic of Tanzania.” 

    It maybe that Zika’s taken a step up. The Centers for Disease Control and Prevention (CDC) says “Local mosquito transmission of Zika virus infection (Zika) has been reported in Cape Verde. Local mosquito transmission means that mosquitoes in the area are infected with Zika virus and are spreading it to people.” It’s issued a travel warning.

    Almost 0.5m people live in Cape Verde, off Western Africa. The BBC says about 7,000 people, 1.4% of the population, are suspected of being affected, including 180 pregnant women. An epidemic can be defined on a smaller incidence than this if a disease’s spread is rapid, such as within a fortnight. 

    While many people infected with Zika don’t become ill, people who do usually have mild illness with symptoms that last for several days to a week. In this setting, the effect of unborn babies is a bigger concern. Whether Zika in Cape Verde matches this is somewhat academic. Its seemingly sudden incidence in an African country seems more concerning. 

    An eHNA post set out the roles of eHealth in dealing with Zika. Now’s the time to invest in them.

  • Five countries comprise Africa's CDCs

    The African Union (AU) has nominated five countries to host Africa Centres for Disease Control (ACDC). Olawale Maiyegun, Director of Social Affairs at the AU Commission, explains that the centres will be the Regional Collaborating Centres (RCC) for the AU’s disease control role. The countries are Nigeria, Gabon, Egypt, Zambia and Kenya, says an article in All Africa.

    The countries are spread across West, East, North, South and Central Africa, ensuring effective representation and geographical spread. The concept was approved in 2015, with a mandate to each of the five sub-regions to nominate one country as their collaborating centre. AU representatives will travel to each of the nominated countries to ensure that institutions being established comply with the criteria in article 26 of the ACDC statutes.

    Following Nigeria's success in containing epidemics like Ebola and Lassa Fever, the AU has given the country clearance to become am ACDC. It followed findings of the AU on site assessment of Nigeria's CDC conducted by a team of experts. The centre will act as the collaborating centre, making Nigeria the hub of research and disease surveillance in West Africa and a regional collaborating centre for Africa.

    There’s no doubt that Ebola changed the way African now value surveillance. It’s a vital tool in the fight against these types of diseases and epidemics. If such a system and network had been available at the start of the Ebola outbreak, thousands of lives could possibly have been saved. The epidemic showed that prevention and control of disease outbreaks needs coordinated action and greater national, regional and international collaboration.  

    With many countries exploring the role of eHealth to strengthen their responses and surveillance, the research hubs and CDC centres will play a pivotal role. They can help prevent further outbreaks on the continent by identifying the locations of disease early, by sharing data and communicating properly with regional partners, neighboring countries and the AU to ensure coordinated efforts and provide data and analytics to help make informed decision.

  • Egypt to launch new digital disease outbreak hub

    Disease outbreaks stress Africa’s health systems. Better controls are needed, and a new control hub is starting up.

    A new disease control hub is set to be launched in Egypt to extend across Africa. It’ll use technology to trace and control diseases, predict outbreaks and engage communities in affected areas across Africa, says an article in IT News Africa. The African Health Data and Disease Control Hub (AHDCH) is an initiative by the Government of Egypt through the Egyptian Agency of Partnership for Development (EAPD), with the Association of Friends of the National Cancer-free Initiative (AFNCI) as its implementing partner and Microsoft providing technology support for the platform development.  

    The initiative comes in-line with the African Union’s call for an integrated and innovative effort to improve prevention, detection, and response to public health threats. The initiative is being launched at this year’s Africa 2016 Forum in Egypt. The AHDCH concept is in response to the 2014 Ebola outbreak in West Africa, which affected more than 20,000 people, bringing devastation to several West African countries. The epidemic showed that prevention and control of disease outbreaks needs coordinated action and greater national, regional and international collaboration. 

    Better cooperation and regional communication was emphasised by Dr Ousmane Ly at the Africa Healthcare Summit in London on the 17 to18 February. He believes eHealth and digital technologies are key to monitoring disease outbreaks and could have played a major role in curbing the spread of Ebola. 

    The hub will include a state-of-the-art virtual platform and will leverage Egypt’s recent advancements in ICT and data infrastructure, its commitment to the healthcare, pharmaceutical and environmental industries, and its capacity development and training expertise. It hopes to be a one-stop solution for all African countries, providing a nationwide directory of diseases, prevention methods, medical facility maps, vaccinations and medications. In addition, it will publish government efforts, news and campaigns, as well as provide communication tools to reach out to African citizens and raise awareness. The initiative is open for collaboration and contribution by various relevant national, regional and international organisations. 

    “There is a lot of momentum and enthusiasm at both regional and international levels for a disease control hub, following the Ebola outbreak,” says Ambassador Dr. Hazem Fahmy, Secretary General of EAPD, leading sponsor of the initiative. “The spread of diseases poses a threat to African stability, growth and international security. The AHDCH aims to play a primary role in disease control, enhancing the quality of life of citizens in affected areas, and helping African countries achieve their Sustainable Development Goals around health and the environment.”

    “We are using our cloud platform to make the AHDCH a central portal, where governments, policy makers, non-profits, researchers and other organisations from across Africa can collaborate on disease control,” says Khaled Abdel Kader, General Manager of Microsoft Egypt. “Through Microsoft’s Azure for Research Initiative, researchers will be able to take full advantage of the power and scalability of cloud computing for collaboration, computation, and data-intensive processing.”

    AFNCI will provide customised training and manage the hub’s day-to-day operations, including collecting data, generating reports and maintaining an active user community. Completion of the hub is planned for December 2016, with a roll-out over a period of three years to ensure its sustainable functioning, funding and quality performance.

  • How can eHealth help against Zika?

    With lingering concerns about Ebola, what should Africa do about Zika? While it’s less damaging than Ebola, its effects on some population groups, such as pregnant women and their babies, are very serious. 

    WHO is supporting countries to control Zika virus disease with seven activities

    1. Define and prioritise research into Zika virus disease by convening experts and partners
    2. Enhance surveillance of Zika virus and potential complications
    3. Strengthen capacity in risk communication to help countries meet their commitments under the International Health Regulations
    4. Provide training on clinical management, diagnosis and vector control including through a number of WHO Collaborating Centres
    5. Strengthen the capacity of laboratories to detect the virus
    6. Support health authorities to implement vector control strategies aimed at reducing Aedes mosquito populations such as providing larvicide to treat standing water sites that can’t be treated in other ways, such as cleaning, emptying, and covering them
    7. Prepare recommendations for clinical care and follow-up of people with Zika virus, in collaboration with experts and other health agencies. 

    WHO’s factsheet sets out the diagnosis, prevention and treatment arrangements for Zika. Diagnosis by serology can be difficult because the virus can cross-react with other flaviviruses such as dengue, West Nile and yellow fever. sharecare, a website, describes why people and countries should pay attention to Zika and act to avoid it.

    While it may not be at epidemic proportions in parts of Africa, can eHealth be deployed to help? Some of the eHealth lessons from Ebola seem relevant. With no vaccine available for Zika prevention, eHealth services for vaccination and immunisation won’t be needed initially, and maybe for some time. eHealth initiatives could include:

    • Data collection, data bases and registries, and analytical tools for surveillance
    • Risk communication plans using mHealth seem a valuable initiative
    • Mapping Aedes populations and behaviour
    • Supporting laboratory testing and results reporting can help too
    • Clinical Decision Support (CDS) for treatments and follow-ups offer a way to achieve consistency across numerous locations and easy updates.

    All these have value for health and healthcare, so eHealth initiatives for Zika should be pursued in this context. They can help to spread affordability challenges, and more importantly, avoid the inefficiencies of paper trails. However, this latter goal relies on good eHealth.

  • Does WHO need better surveillance data?

    In January this year, WHO set up an independent Ebola Interim Assessment Panel. Four important themes in its extensive report are relevant for eHealth.

    1. The Ebola outbreak started in 2013, but a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations 2005 was not declared until 8 August 2014
    2. There are disincentives for countries to report outbreaks quickly and transparently
    3. The outbreak was particularly challenging because of the characteristics of the virus, and healthcare systems and public health infrastructure in affected countries were extremely fragile, suffering from structural weaknesses, inadequate surveillance and few laboratories
    4. Messaging needs to be continuously refined so as to be responsive to the changing epidemiological situation.

    These are all activities where eHealth can help. Does the report change the eHealth priorities for Africa, some African countries? The report emphasises how WHO can be changed to be more effective, there’s also an onus on countries to improve their information and communication. Investment in mHealth, surveillance, primary care, diagnostics and general eHealth skills could help.

    The head of the panel was Dame Barbara Stocking. She was the chief executive of Oxfam, a leading aid charity. She was also a senior manager in England’s NHS.

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    Image from Vox

  • The Ebola fight needs better surveillance

    The awful tragedy of Ebola seems to be slipping beyond grasp. President Obama has now urged world leaders to enhance disease surveillance. It needs to operate on a large scale. iHealthBeat has set outa few eHealth initiatives that could help.

    The US is appointing former White House CIO Steven van Roekel to lead the government’s use of technology to combat Ebola. His role will build on several eHealth initiatives already in place.

    When the Ebola outbreak is finally vanquished, one of its legacies should be a vastly enhanced and modernised surveillance infrastructure for Africa. It’s just a great pity that Ebola is part of the price.