Epidemiology


Ideally, we would have had findings. But we are in the middle of research, so what we can present is work in progress: problems that have been faced; those that have been solved; those we’re still working on; etc. Hopefully, once we get our hands on the needed epidemiological data we will present findings in a few months. We are grateful to the incoming President of the Commonwealth Medical Association, Professor Vajira Dissanayake, for creating this opportunity for us. The presentation was made at a session chaired by Dr Hasitha Tissera, the Head of the Epidemiology Unit of the Ministry of Health.
“Often, most cases are suspected cases, with fewer confirmed cases. Patients with symptoms are asked to go for further tests, and this takes time. By the time a good number of confirmed cases are collected, the disease has spread rapidly. From a public health perspective, this is just not good enough. We need to catch it at the out-patient care level, restrict spread to clusters and deliver a cure before it grows into a wider geographical spread.
Fidelity of digitized data in the Real-Time Biosurveillance Program (RTBP) was not promising; especially with the personnel in Sri Lanka with no medical knowledge but technically capable were producing up to 45% noisy data (second stacked graph). On the contrary the medically trained but less fluent in mobile phone usage Indian nurses were less prone to producing noisy data. The Indian health workers had an incentive because the erroneous data would produce false alarms, and they would need to respond to these false alarms or it would portray a bad image of the health situation in their area; while the Sri Lanka data digitizing personnel had no incentive besides picking up a paycheck for the data entry work they did. The data was submitted through the mHealthSurvey mobile software that works on less expensive Java-enabled hand-helds. The RTBP envisions that hospital data is submitted each day; thus, the real-time expectations.
I just received my copy of the book: Biosruveillance methods and case studies edited by Taha Kass-Hout and Xiaohui Zhang. I first met Taha in cyberspace when he was with InSTEDD, we had started a Google group: Biosurveillance, which we use as a knowledge-base. Their approach to disease surveillance was through “event-based surveillance” and our approach was through “indicator-based surveillance” but both converging at finding signals for timely public health alerts that would advocate early control measures. We had contributed three chapters in the context of the Real-Time Biosurveillance Program pilot (RTBP) – Chapter 9: “The role of Data Aggregation in Public Health and Food Safety Surveillance” – Artur Dubrawski Chapter 13: “User Requirements towards a Real-Time Biosurveillance Program” – Nuwan Waidyanatha and Suma Prashant Chapter 14: “Using Common Alerting Protocol to Support a Real-Time Biosurveillance Program in India and Sri Lanka” – Gordon A. Gow and Nuwan Waidyanatha.
The key take home from the workshop were: the Regional Epidemiologist – Dr. P. Hemachandra – stressing the need for Syndromic surveillance; especially, the ability to monitor escalating fever like disease and geographic clusters of increase in common symptoms. Dr. Lakshman Edirisinghe (Deputy Director Planning) emphasized the need for comprehensive patient clinical data for becoming a data driven organization that can optimize the resources opposed to speculative expert opinion.
The “Evaluating a Real-Time Biosurveillance Program” (RTBP) research team meet in Chennai, July 6 – 7, 2010 to discuss the interim findings of the evaluation work (click to read workshop report) carried out in Tamil Nadu India. In addition to the workshop a news conference was organized to disseminate the pilot project findings. The links below are some of the news prints (click on the thumbnails to view news clippings) :: – Mobiles on Health Calls, The Hindu Business Line, September 13, 2010 – Pilot study in using mobile technology for disease reporting shows promise, Thehindu.com, July 07, 2010 – Pilot study on epidemiological early disease warning system, Chennaionline.com, July 07, 2010 – New tech to keep tab on diseases, timesofindia.
The present day disease surveillance and notification system in Sri Lanka, confined to a handful of diseases, known as Notifiable disease, and reporting large numbers of common cases, is what the British introduced in 1897 as part of the quarantine and prevention of diseases ordinance. This paper based surveillance and reporting system has its shortcomings that the health professionals themselves have voiced. The Real-Time Biosurveillance Program (RTBP) pilot, during the first week of April, interviewed health workers and health officials in Kurunegala District to study the notification and response policy and procedures. These interviews revealed that in some occasions by the time health officials receive the notification to inspect the patient, with the infectious disease, at the patient’s residence, the patient had already died; health workers literally pull their hair trying to decipher the illegible handwriting on the paper forms; they also mentioned that they have to travel long distance from their villages to the Medical Officer of Health (MOH) office to pickup the paper forms with the patient’s information. These inefficiencies and excessive costs can be drastically reduced with ICT; with a technique as simple as a communicating the information via SMS text messages that costs Rupees 0.
The literarcy rate in Tamil Nadu is above that of the national average. Health workers assisting in the Real-Time Biosurveillance Program (RTBP) in Tamil Nadu, all of whom are female, 68% have 10 years of education and the rest only 12 years of education. They have more than 10 years experience working in the field providing primary health care and reporting on relevant health statistics to the government. These health workers (few of them are in the photo with their backs to you) were given training and mobilized with the mHealthSurvey, mobile phone application, for submitting patient disease/syndrome data for the surveillance of epidemiological events. Data that used to take over 15 days to relay up to the paper chain, but was not subject to any detection analysis (i.
Sixteen Sarovdaya Suwadana Center Volunteers working in the capacity of Research Assistants for the real-time biosurveillance program were trained in the use of the m-HealthSurvey mobile application. The training took place at the Sarvodaya Kuliyapitiya District Center, April 23 – 25, 2009. The three day program comprised lectures on disease surveillance and notification, use of mobile application for communicating patient data, and a field visit to understand the working environment. The Suwadana Center Volunteer training workshop report carries the full story.
Press Release 2009 from Brown Lloyd James. ICTD2009 highlights new developments in technology for developing countries “Dr. Artur Dubrawski, Director of the AutonLab at Carnegie Mellon University and Mr. Nuwan Waidyanatha, Senior Researcher and Project Director of LIRNEasia in Sri Lanka, are presenting their collaborative project using mobile telephony. The project uses the T-Cube Web Interface, a tool developed by Carnegie Mellon University to visualize and manipulate large scale multivariate time series datasets, to support real-time bio-surveillance.