Public health Archives — LIRNEasia

The “mobiles in support of Sentinel Site Surveillance (mS-cube)” project, following the success of the Real-Time Biosurveillance Program (RTBP), investigated the scalability and institutionalization issues. The mS-cube project was carried out in the Wayamba Province of Sri Lanka. The Infectious Disease Control (IDC) nurses, in the province, were given training on the “mHealthSurvey” mobile application and provided with mobile phones for submitting digitized all outpatient and inpatient health records. The findings are that the relatively older IDC nurses find it difficult to enter data with the mobile keypad and do not have an incentive to submit all patient records (i.e.
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 IEEE-RIVF – Research, Innovation, and Vision for the Future –  International Conference on Computing and Communication Technology took place in Hanoi, Vietnam at the Vietnam National University, Nov 02-04, 2010. The plannery sessions were on applied operations research, software engineering, human machine interface & imaging technology, computational Intelligence, information & knowledge management, communication & networking, and modeling & computer simulations. I presented out paper titled: T-Cube Web Interface as a Tool for detecting disease outbreaks in real-time: a pilot in India and Sri Lanka. This paper discusses the results from the pilot in India and Sri Lanka, namely the Real-Time Biosurveillance Program (RTBP). While may discussed the science behind their solutions, we had surpassed that and were able to discuss the challenges in practically working the solutions in the real world.
The Director of Carnegie Mellon University’s Auton Lab – Prof Artur Dubrawski – delivered a keynote speech at the Health Informatics Society of Sri Lanka organized eHealth Sri Lanka 2010 conference, 15-16 September, 2010. His talk titled – Detection of Informative Disjunctive Patterns in Support of Clinical Informatics (click to view slides) – has synergies with the Real-Time Biosurveillance Program (RTBP) we are piloting in India and Sri Lanka. RTBP specifically integrates a data mining and probability testing tool called the T-Cube Web Interface. In addition to the keynote, Chamindu Sampath, LIRNEasia Research Assistant, presented a paper titled the “T-Cube web tool for rapid detection of disease outbreaks in India and Sri Lanka” (click to view the slides) and a poster. Several interesting issues regarding data quality needed for event monitoring was discussed by the audience during the session: public health informatics.
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 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.