Will Participatory Syndromic Surveillance Work in Latin America? Piloting a Mobile Approach to Crowdsource Influenza-Like Illness Data in Guatemala

Abstract

BackgroundIn many Latin American countries, official influenza reports are neither timely nor complete, and surveillance of influenza-like illness (ILI) remains thin in consistency and precision. Public participation with mobile technology may offer new ways of identifying nonmedically attended cases and reduce reporting delays, but no published studies to date have assessed the viability of ILI surveillance with mobile tools in Latin America. We implemented and assessed an ILI-tailored mobile health (mHealth) participatory reporting system.ObjectiveThe objectives of this study were to evaluate the quality and characteristics of electronically collected data, the user acceptability of the symptom reporting platform, and the costs of running the system and of identifying ILI cases, and to use the collected data to characterize cases of reported ILI.MethodsWe recruited the heads of 189 households comprising 584 persons during randomly selected home visits in Guatemala. From August 2016 to March 2017, participants used text messages or an app to report symptoms of ILI at home, the ages of the ILI cases, if medical attention was sought, and if medicines were bought in pharmacies. We sent weekly reminders to participants and compensated those who sent reports with phone credit. We assessed the simplicity, flexibility, acceptability, stability, timeliness, and data quality of the system.ResultsNearly half of the participants (47.1%, 89/189) sent one or more reports. We received 468 reports, 83.5% (391/468) via text message and 16.4% (77/468) via app. Nine-tenths of the reports (93.6%, 438/468) were received within 48 hours of the transmission of reminders. Over a quarter of the reports (26.5%, 124/468) indicated that at least someone at home had ILI symptoms. We identified 202 ILI cases and collected age information from almost three-fifths (58.4%, 118/202): 20 were aged between 0 and 5 years, 95 were aged between 6 and 64 years, and three were aged 65 years or older. Medications were purchased from pharmacies, without medical consultation, in 33.1% (41/124) of reported cases. Medical attention was sought in 27.4% (34/124) of reported cases. The cost of identifying an ILI case was US $6.00. We found a positive correlation (Pearson correlation coefficient=.8) between reported ILI and official surveillance data for noninfluenza viruses from weeks 41 (2016) to 13 (2017).ConclusionsOur system has the potential to serve as a practical complement to respiratory virus surveillance in Guatemala. Its strongest attributes are simplicity, flexibility, and timeliness. The biggest challenge was low enrollment caused by people’s fear of victimization and lack of phone credit. Authorities in Central America could test similar methods to improve the timeliness, and extend the breadth, of disease surveillance. It may allow them to rapidly detect localized or unusual circulation of acute respiratory illness and trigger appropriate public health actions.

Mapping of Crowdsourcing in Health: Systematic Review

“…Indeed, many health fields have since used crowdsourcing, with 20 medical fields identified in our systematic review compared with 8 fields in the Ranard et al’s study [ 5 ]. Moreover, crowdsourcing use is still growing, as shown by the 11 articles published in Journal of Medical Internet Research since our last search date, mainly involving a survey task (9/11, 82%) [ 217 - 227 ]. Our study has some limitations.…”

Text-Based Illness Monitoring for Detection of Novel Influenza A Virus Infections During an Influenza A (H3N2)v Virus Outbreak in Michigan, 2016: Surveillance and Survey

“…As they are intended for detection of illness among a select group of individuals, they complement current influenza surveillance systems that are better adapted for capturing population-level trends and impact [28]. Although the cost of texting was not identified as a barrier in this study, application of this method in less-wealthy populations may benefit from participants being provided phone credit [24].…”

Epidemiologic surveillance for controlling Covid-19 pandemic: types, challenges and implications

“…[ 10 ] To update Covid-19 case definition, define transmission pattern, revise the definition of a contact and update on global surveillance with aggregated data reporting Guideline D 11. Prieto JT, et al 2017[ 11 ] To evaluate the quality and characteristics of electronically collected data, the user acceptability of the symptom reporting platform, and the costs of running the system and of identifying ILI cases, and to use the collected data to characterize cases of reported ILI. Quantitative, Follow-up study B 12.…”

“…Covid-19 surveillance involves monitoring the spread of the disease in order to identify the patterns of progression, and for application of preventive and control measures [ 10 ]. In spite of the efforts for enhancing epidemiological surveillance, developing nations still have difficulty in accurate identification, diagnose, and reporting such communicable diseases [ 11 ].…”