eHealth Africa expands Disease Surveillance across West and Central Africa

Written By Olajumoke Arinola & Nwanyibuife Obiako

eHealth Africa (eHA) is collaborating with the World Health Organization (WHO), Bill and Melinda Gates Foundation (BMGF), and Novel-T to scale up Acute Flaccid Paralysis (AFP) surveillance in Liberia, Sierra Leone, and Chad.

AFP surveillance remains a key indicator of the progress of polio eradication in Africa. Building on the success of the pilot of the mobile based Auto-Visual AFP Detection and Reporting (AVADAR) surveillance system in Nigeria, the project has been scaled up to strengthen surveillance by improving timely detection and reporting of suspected AFP cases in countries at risk of the re-emergence of the polio virus, and those most recently affected by the Ebola virus disease.

AVADAR has been operational since March of 2017 in the Liberian districts of Commonwealth, St. Paul, Careysburg, and Central Monrovia. It has also been used in the Sierra Leonean districts of Western Urban, Western Rural, Tonkolili, and Kono. More recently, Community Informants and Healthcare Workers (HCWs) were trained by eHA instructors on the use of the AVADAR app in Chad, making Chad the first francophone country utilizing AVADAR.

"In Chad, our team saw first hand the essence of integration of project planning with local context in terms of recruitment, training language, understanding health administrative levels, and the impact of country-specific regulations on logistics coordination and project success" - Olajumoke Arinola, Assistant Project Manager

Five weeks after its implementation in Sierra Leone, 4 AFP cases were detected out of the 41 suspected case alerts reported through the AVADAR. In Liberia, 6 AFP cases were detected out of the 89 suspected cases. After one week of implementation in Chad, 8 cases were reported and investigated with 1 confirmed to be an AFP case by Disease Surveillance and Notification Officers (DSNOs). Pre-implementation activities and partner coordination have commenced for other Lake Chad region countries, namely Cameroon and the Niger Republic.

In 2016, there were 3 new cases detected of wild poliovirus and circulating vaccine-derived poliovirus type 2 (cVDPV2) in Borno, a security-challenged state in northern Nigeria. This prompted the urgency to strengthen surveillance not only in Nigeria but across the entire Lake Chad region. In selecting specific local government areas and districts where AVADAR would be functional per country, WHO and the respective Ministries of Health (MoH) prioritized working in densely populated areas where AFP surveillance had been reportedly low.

[youtube=://www.youtube.com/watch?v=XAdFYmQ2oMo&w=640&h=480]

The AVADAR app has a 30-second video of a child with AFP symptoms embedded in it which reminds Community Informants and Healthcare Workers to report suspected cases weekly. In addition to English, the video has already been produced in the three major Nigerian languages (Hausa, Igbo, and Yoruba), major languages in Sierra Leone (Krio, Themne, Mende, and Kono), and French. To avoid ambiguity and to generate maximum impact, the AVADAR video was also voiced in Chadian Arabic with text translations in French for its implementation in Chad. This has increased the surveillance network in these countries through sensitization of traditional birth attendants, traditional healers, barbers, and other community residents on how to accurately detect and report suspected AFP cases.

To date, eHA has distributed GPS-enabled mobile devices and solar chargers to over 2,000 Community Informants and Healthcare Workers in the four current AVADAR focus countries. eHA has also trained each mobile device recipient on the proper use of the phones and the AVADAR app. To ensure Community Informants were fully sensitized on how to detect and report suspected AFP cases through the app, participants were divided into small groups, with just 10-15 students per eHA instructor. Ample time was allocated to role plays and class demonstrations with the instructors communicating in the local language of the informants.

"Without eHA’s strategy of one facilitator to a group of 10 informants, these people (informants) wouldn’t have been able to use these phones and report AFP cases." - Dr. Faisal Shuaib, Executive Director, NPHCDA

eHA remains committed to working with Ministries of Health and other AVADAR implementing partners to strengthen AFP surveillance systems across Africa in order to end the spread of polio. Visit our website to find out more about our work strengthening West Africa’s disease surveillance systems.

eHealth Africa Providing Technical Support to Help Curb Nigeria’s Meningitis Outbreak

By Daniel Ojabo

Between December 13, 2016 and April 30, 2017, 11,594 suspected cases of Meningitis and 955 deaths have been reported across Nigeria. The current outbreak of Meningitis in the country is bigger in magnitude than previous outbreaks and has affected 184 Local Government Areas (LGAs) across 13 states and the Federal Capital Territory (FCT).

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Meningitis is an inflammation of the membranes covering the brain and spinal cord. Meningococcal meningitis is a bacterial form of meningitis, a severe and deadly infection of the membranes that cover the brain and spinal cord (1). Six states, namely Zamfara, Sokoto, Katsina, Niger, and Kebbi have crossed the epidemic threshold. These states are affected by Meningitis serotype C strain (NmC) as the predominant serogroup and Yobe with Meningitis serotype A strain (NmA) as the predominant serogroup (2).  NmC has accounted for 83% of laboratory-confirmed cases and the population is severely under-vaccinated against Nmc in these affected areas (3).

Due to the lack of robust diagnostic laboratories in this region, suspected cases of meningitis were being tested using the Pastorex test kit; a rapid test kit used to determine whether a cerebrospinal fluid (CSF) sample is positive for Meningitis or not. Further tests to determine the type of causative organism (Microbial Culture) and its abundance in test samples usually require samples to be transported to the Federal Capital Territory, Abuja and Lagos.

eHealth Africa (eHA) is partnering with the World Health Organization (WHO), the Nigeria Centre for Disease Control (NCDC), the National Primary Health Care Development Authority (NPHCDA), the University of Nebraska Medical Center (UNMC), UNICEF, and others to continuously support the Ministry of Health in the fight to contain the current widespread outbreak of Meningitis. As part of efforts to control the spread of Meningitis in northwest Nigeria, eHA designed and built a well-equipped laboratory in Sokoto state. Tests conducted in the laboratory involve gram staining, cytology, Pastorex Agglutination Test, and Microbial Culture. Over 345 samples have been registered and analyzed at the Sokoto lab during this current outbreak.

Housed in a 40-foot shipping container, the laboratory has room for a modular setup that allows for mobility to locations with an active outbreak, and thus diagnostic needs. This equipment allows not only the Pastorex test to be carried out on CSF samples collected in Sokoto and neighboring states but also culture and gram staining. For the initial weeks of operation, staff from IFAIN laboratory, Abuja, served as laboratory systems managers to support the operation of the Sokoto lab and to guide the Sokoto Medical Laboratory Scientists (MLS) through operations of the laboratory.

To strengthen surveillance and effective response to active public health emergencies, eHA also set up a toll-free hotline (08003432584) to receive reports of suspected cases. The hotline collects basic information about the cases and shares the information on the number of reported cases and the respective location with stakeholders on a daily basis. The hotline also receives calls from hospitals designated as sample collection and treatment sites for Meningitis. Eventually, this information will be collected using electronic data collection tools located at each of the sample collection centers, but in the meantime, the information on cases and sample collection will be collected through calls to the hotline. The hotline experience will be aligned with the Nigeria Centre for Disease Control (NCDC) efforts towards preventing outbreaks of this scale in the future.

Visit our website here to find out more about our work improving preparedness for potential public health emergencies and responding effectively to active public health emergencies.

References

1. World Health Organization (WHO). Media Center: Meningococcal Meningitis page. World Health Organization (WHO) website. http://www.who.int/mediacentre/factsheets/fs141/en/. Updated November 2016. Accessed April 26th, 2017.

2. The Nigeria Centre for Disease Control (NCDC). An Update of Meningitis Outbreak in Nigeria for Week 18. Nigeria Centre for Disease Control (NCDC) website. http://ncdc.gov.ng/diseases/sitreps/?cat=6&name=An%20Update%20of%20Meningitis%20Outbreak%20in%20Nigeria. Updated April 2017. Accessed April 26, 2017.  

3. Assessment Capabilities Project (ACAPS). Nigeria: Meningitis Briefing Note 11 April, 2017. Assessment Capabilities Project (ACAPS) website. https://www.acaps.org/sites/acaps/files/products/files/20170411_acaps_start_briefing_note_nigeria_meningitis.pdf. April 11, 2017. Accessed April 25, 2017.

eHA Announces Three New Board Members

By Daniel Ojabo

eHealth Africa (eHA) is proud to announce the appointment of three new members to its Board of Directors. Joining the Board of Directors are Andrew Karlyn, My T. Le, and Jamie McPike. The development of a comprehensive Board of Directors will give support to eHA by providing:

• Professional governance
• Service as global representatives
• Mentorship to senior leadership, and
• Guidance on important organizational functions

Andrew, My, and Jamie each bring invaluable expertise to the eHA community and we look forward to working with them in the coming months and years. Their appointments are part of a multi-year expansion of the eHA Board of Directors. You can learn more about each of our Board of Directors by visiting the " Our People" section of the eHA website.

Andrew Karlyn

Andrew Karlyn is USAID’s Global Development Lab’s Africa Regional Advisor and is based in Nairobi, Kenya. In this role, he supports USAID’s digital finance initiatives in health, social protection, agriculture, and democracy and governance programs. Andrew was a principal contributor to The Population Council’s mHealth initiatives. This work spans over 30 projects in HIV prevention and treatment; maternal and newborn health; and poverty, gender, and youth interventions.

My T. Le

My is a lecturer in the Electrical Engineering Department at Stanford University. She also serves as the Founding Director of the Stanford Gap For Good Program, a program that enables students to work with leading NGOs and nonprofits on global health and sustainable development projects. In addition, My invests in and advises startup companies in the US, Canada, and India.

Jamie McPike

Jamie has played an integral role in several large-scale quantitative and qualitative research initiatives, working to investigate and understand complex social issues. The focus of her human rights research includes child health inequalities in rural and urban India, gender inequality, housing and social inclusion, and sustainable urban development. Her National Science Foundation funded dissertation project is an ethnographic examination of social processes that shape the implementation of urban housing policies in Bangalore, India. Jamie is currently a Ph.D. candidate in the Department of Sociology at Brown University.

Sierra Leone’s New Digital Health Reporting System: Greater Accuracy and Timeliness

This article originally appeared on K4Health and was written by Taylor M. Snyder MPH, Senior Technical Advisor, eHealth Africa. 

eHealth Africa (eHA) is collaborating with the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and other partners to support Sierra Leone’s Ministry of Health and Sanitation (MoHS) to strengthen surveillance for all priority diseases and improve preparedness for potential public health emergencies.

eHA’s main role in the eIDSR Technical Working Group set up by the MoHS is developing and implementing a mobile electronic Integrated Disease Surveillance and Response (eIDSR) application for health care workers (HCWs). The eIDSR app improves the entire health system by allowing data to be more accurately captured at facilities, and then allowing this improved data to be shared with the district and national levels.

eIDSR was built on DHIS2, which supports the MoHS’ decision to utilize DHIS2 as the preferred health data collection tool. eHA used an open-source native app from DHIS2 and expanded its functionality to improve the submission capabilities and user interface. Each of these expanded functionalities was based on understanding the Sierra Leonean health and HCW context.

eIDSR app’s intended users are predominantly first-time smartphone technology users, so eHA simplified the user interface and designed it to closely resemble familiar paper reporting forms. Following initial trainings, members of eHA’s Global Health Informatics Team go into the field and mentor HCWs on the use of their Android phones and the eIDSR app.

Visit here to find out more, please. 

eHealth Africa Transforms Disease Surveillance and Response in Sierra Leone

Electronic Integrated Disease Surveillance and Response (eIDSR)

By Daniel Ojabo & Hawa Kombian

Sierra Leone’s Ministry of Health and Sanitation (MoHS) is collaborating with eHealth Africa (eHA), the Center for Disease Control and Prevention (CDC), World Health Organization (WHO), and additional partners to strengthen surveillance for all priority reportable diseases and improve preparedness for potential public health emergencies.

To reduce the frequency of the errors, which are prevalent in paper-based reporting and during the process of transferring data from one platform to another, eHA developed a mobile electronic Integrated Disease Surveillance and Response (eIDSR) application. This eIDSR app enables the entire health system to accurately record and share community-level health information from the district level to the national level.

Sierra Leone’s disease surveillance and reporting has improved drastically as a result of this new process. According to a recent CDC article, weekly disease reporting improved from occurring in 35% of health facilities, to occurring in 96% of all Sierra Leonean health facilities. This new disease reporting system has also cut the number of data entry errors in half, and verifies data 60% faster than the previous paper-based reporting system.

At the recent eIDSR National Rollout Review event in the Port Loko district (a district in the Northern Province of Sierra Leone), health facility workers and representatives from eHA, CDC, and WHO convened to assess the extent to which the rollout objectives had been achieved thus far. While speaking at the event, eHA’s Executive Director Evelyn Castle expressed her delight and emphasized that the system would be closely linked to Sierra Leone’s Front Line Field Epidemiology Training Program (FETP).

“We have been working with the Ministry of Health and WHO for the last few months on implementing a new electronic way to submit disease surveillance information. Instead of only submitting information from the district level, we are looking at collecting information from the health facility level ”

— Evelyn Castle, Executive Director and Co-Founder of eHealth Africa.

Collecting data at the health facility level would ensure that community-level health issues are captured. It also increases the accuracy of population wide health information. Thus, this approach better supports the district's’ ability to understand the needs of the multiple communities located within their district. When the information is ultimately provided to the national level, this allows for a more accurate, detailed, and timely assessment of disease prevalence nationwide. This information can then be used to make near real-time decisions about any potential disease outbreak.

Healthcare workers can now use the eIDSR app to submit weekly case reports of the standard 44 WHO priority diseases, conditions, and public health threats - including cases of diseases such as malaria and cholera. The eIDSR app is operational at all District Health Management Teams (DHMTs) across the country. It is currently being piloted in six (6) community health facilities within the Port Loko district to ensure that granular area level data is as accurate as possible before being consolidated at the DHMT level, through to the national level.

For the pilot, data was entered into mobile devices (i.e. tablets and smartphones) at the community health facility and sent to the DHMT before final transmission to the national level at the MoHS. This data is stored within DHIS2 (District Health Information System 2), a web-based open-source information system. DHIS2 is housed in the MoHS server and is managed by the MoHS Directorate of Policy, Planning Information. The DHIS2 is a tool for collection, validation, analysis, and presentation of aggregate statistical data, tailored to integrate health information management activities. The DHIS2 analytics and reporting functions utilize a dashboard interface to develop graphic and comprehensive insights into the state of public health across Sierra Leone.

eHA remains committed to achieving its mission by improving preparedness for potential public health emergencies across underserved communities in West Africa. To find out more about the work that eHA does, kindly subscribe to our monthly e-newsletter here.

GIS Open Source versioning tool for a multi-user Distributed Environment (part 2)

This article is the 2nd part of GIS Open Source versioning tool for a multi-user Distributed Environment and originally appeared on GOGEOMATICS Canada. 

An Interview with Dami Sonoiki, GIS Department Manager and Samuel Aiyeoribe, Lead GIS Architect at eHealth Africa in Kano Nigeria.

1- What projects and workflow in eHealth Africa is this FOSS4G tool being used for within your GIS Team?

One of our largest data management platforms is the Geospatial Database dedicated for our National Polio program support. The data is used to support Polio Vaccination Campaigns in Northern Nigeria to ensure maximum vaccination coverage during every round of campaign.

Thus, the database must be kept up to date with the latest available geospatial data. This always requires having multiple staff processing geospatial data from multiple locations. Hence this is a good use case for the plugin. The plugin is also currently being used to manage geospatial data among multiple countries where eHA operates. This has helped simplify workflow, improved efficiency and increased data integrity.

Furthermore, we use the QGIS Versioning plugin to manage our Health Facility Database.

2- What did you see as the next development of such QGIS versioning plugin?

It will be great to develop and enable spatial filtering when using the PostGIS checkout. This is currently possible with SpatiaLite checkout, but it will be great if this can be the next phase for PostGIS checkout.

In addition to the above, the possibility to implement a PostGIS checkout (offline form the source DB) to another PostgreSQL/PostGIS instance will be a good plugin upgrade.

To learn more, click here for full article.

Coding for Good: Finding Tech Jobs in the Social Sector

eHealth Africa (eHA) hosted 'Coding for Good – Finding Tech Jobs in the Social Sector' to bring together the non-profit, development aid, and social enterprise sectors with tech professionals searching for jobs. The event was held at the Co.up, a co-working space in Kreuzberg, Berlin.

Although finding employees with technical expertise is often a priority for social organizations, and finding a socially responsible career is important to many tech professionals, these groups often struggle to reach one another. Amongst the panelists were:

• Naomi Ryland, Co-founder of The Changer
• Julius Murke, Sector Initiative Social Protection, German Society for International Cooperation (GIZ)
• Matthias Hellmund, Head of Product and Technology at ShareTheMeal
• Adam Butler, Technical Team Lead at eHealth Africa (eHA)

Key learning points for attendees covered the topics of: finding job positions, compensation for work in the social sector and the intersection of tech and health NGOs. Panelists highlighted how channels that social organizations, especially non-profits, typically use to recruit differ from the ways tech professionals normally navigate the job market. Many nonprofit organizations lack the resources to hire recruiting agencies or head-hunters, so they rely on community job boards (job websites that do not charge a fee for posts) and the personal networks of their employees.

Remuneration in the social sector was also discussed by the panelists. A common misconception among attendees was that working in the social sector could mean a pay-cut. However, the expert panel shared information on the many nonprofits and for-profit social businesses which do pay the industry standard in the tech field.

Additionally, not every nonprofit is behind on technology and trends - there are many that are run like successful for-profit businesses by thought leaders who are paving the way for a massive new generation of tech professionals. At eHA, we are committed to using tech to improve and expand availability of health care for underserved populations in Africa.

eHA was pleased to host an event that provided tech professionals with valuable insights into the environment and daily work occurring in the social sector. Additionally, social businesses and NGOs gained first-hand perspective from tech professionals regarding what they are looking for in their careers and how they maneuver through their job search processes. Having provided thought leadership and a great exchange platform to attendees, eHA is looking forward to hosting similar events in the future.

Integrating tech and health, eHA achieves its mission by establishing new standards in the delivery of healthcare to most vulnerable communities in West Africa. Our outstanding technical personnel is an essential part of our success. If you are interested in joining us, please have a look at our job board here. You can also check out our Elastic Stack Volunteer program here or contact our team at berlin@eHealthAfrica.org.

GIS Open Source versioning tool for a multi-user Distributed Environment

This article originally appeared on GOGEOMATICS Canada and was jointly written by Nicolas Gignac, Dami Sonoiki (eHealth Africa) and Samuel Aiyeoribe (eHealth Africa). 

In today’s digital world, organizations are effectively working to publish clean and up-to-date dynamic geospatial data. This data needs to be time-based in order to track changes in multiple versions within short periods. Finding the best tool that adapt seamlessly to one’s own organization’s workflow and capability has been a challenge faced by many organizations.

Managing geospatial data processing within a large team of editors in a distributed work environment can be complex especially with regard to conflicting modifications related to geometries or attributes. When managing a centralized database or an open crowd-sourcing environments, editors may like to track changes and edit data while disconnected from the centralized master database, using source code versioning like tools.

A number of tools already exist in the market to tackle versioning, for instance ArcGIS versioning database in the ESRI world. Unfortunately, this option requires buying multiple Desktop and Server licenses.

In the OpenStreetMap platform, Overpass queries can reveal modification history. However the tool cannot be used for an in-house database. There is also GeoGig and PGversion as Free and Open Source Software for Geospatial (FOSS4G) tools, but both lack functionality to fulfill the above described purposes. The setup involves using PostGIS as the main repository by having the ability to edit specific geographic sections of a data layer and to work offline without having to write any lines of code from the editor.

To learn more, click here for full article.

'Africa Health' features eHA's Integrated Community Health Pilot (ICHP) in Guinea

A holistic approach to improving community health in Guinea

This article originally appeared on Africa Health and was written by Taylor M. Snyder, MPH, Senior Technical Advisor, eHealth Africa

eHealth Africa (eHA) is driven by the philosophy that focusing on improving the overall basic standard of healthcare, rather than using a disease-based model of healthcare, can lead to population-wide health improvements that achieve value for money.

eHA Guinea’s Integrated Community Health Pilot (ICHP) implemented connected reforms in order to improve community health at scale through sustainable platforms. ICHP was funded by The Paul G. Allen Family Foundation, and its project realisation phase was less than one year. The Guinean Ministry of Health (MOH) was critical to the project’s success, as they were engaged from ICHP’s onset and selected the subprefecture of Timbi Touni as the pilot’s site. Continuously engaging the Timbi Touni community to collaboratively implement evidence-based and locally-adapted solutions was key to achieving health infrastructure and medical supply improvements, connectivity and the digitisation of health data, and healthcare worker (HCW) capacity building.

To learn more, click here for full report.

Health Camps: Enhancing Access To Healthcare in Kano State

By Daniel Ojabo

Some areas of northern Nigeria still do not have consistent access to healthcare. This is mainly due to the lack of health facilities in remote areas, and the inability of local populations to access transportation to functioning primary healthcare centers.

Health Camps (HC), a demand-creation intervention, was birthed to fill this gap by working with government partners to supplement monthly polio vaccination campaigns (Immunization Plus Days) with essential medicines. It also serves as a means to address persistent cases of refusal of polio vaccines by heads of households.

Funded by the Bill & Melinda Gates Foundation, eHealth Africa (eHA) has supported the Kano State Ministry of Health as an implementing partner. We procure, package and distribute medications across the 44 Local Government Areas (LGA) in the State.

By the end of 2016, eHA had distributed 82,452 HC boxes across over 27,000 settlements in Kano; up from 34,188 HC boxes delivered in 2014. In September 2016, to ensure that the National Guidelines of Malaria testing before treatment were met, Rapid Diagnostics Test (RDT) Kits were introduced to the HC boxes. RDTs permit a rapid, accurate, and accessible detection of malaria parasites, particularly in remote areas with limited access to health facilities. This exercise has promoted a more rational use of increasingly costly drugs, through enabling health workers to distinguish between fevers caused by malaria parasites from those caused by other illnesses.

“Last year, we recorded increased cases of malaria in the state. So, the Kano State government provided some rapid diagnostic test kits for malaria. ”

— Dr. Kabir Ibrahim Getso, Commissioner For Health, Kano State.

Each HC box contains supplies for 100 people. These supplies include RDTs, and medicines to treat malaria, tapeworms, ulcers, diarrhea, scabies, and other diseases. Trained community health workers administer RDTs for malaria and prescribe corresponding medications. In cases where the diagnosis are advanced, the beneficiaries are referred to the nearest health center.

eHA procures and packages over 2,000 HC boxes for every Immunization Plus Day (IPD) campaign. Since 2014, over 5 million people have benefited from HCs; including 2.2 million children under the age of 5. This initiative has also seen 3.6 million cases of malaria diagnosed and treated, which is around 70 percent of total patients serviced since inception.  

“We found out that a lot of people were voluntarily bringing out their children to accept the vaccination, getting an opportunity to also treat minor ailments which the Health Camps were designed to basically address.”

— Dr. Ahmed Suleiman Haladu, State Lead Polio CDC-NSTOP

After more than two years without wild poliovirus in Nigeria, the Government reported in August 2016 that 2 children had been paralyzed by the disease in the northern Borno state. The cases highlighted the need to prioritize immunization of children particularly, in hard-to-reach areas in northern Nigeria. In the last quarter (Oct. Dec.) of 2016 alone, over 480 thousand children were Immunized with Oral Polio Vaccines (OPV) at HCs. The significant progress and achievements in the past couple of years, have been due to the high level of political commitment and leadership. Traditional community leaders have also provided credibility to the project by openly promoting and encouraging community members to attend HCs.

“We are making all efforts to ensure that the government reaches everywhere for people to understand the mission behind this program.”

— Alhaji Ja’afaru Ahmed Gwarzo, Sarkin Tsafta, Kano Emirate Council.

eHealth Africa Pilots AVADAR Surveillance System to Track Progress Toward Polio Eradication

By Daniel Ojabo

In response to the recently reported cases of wild poliovirus in Nigeria, eHealth Africa (eHA) partnered with Bill and Melinda Gates Foundation, WHO, and Novel-T to pilot a mobile-based surveillance application  for Acute Flaccid Paralysis (AFP) in children.

Defined by WHO as “a rapid onset of weakness of an individual's extremities”, AFP often causes weakness of the muscles of respiration and swallowing, progressing to maximum severity within 1-10 days. AFP surveillance, being one of the four cornerstone strategies of polio eradication, seeks to identify all cases of polio through a system that targets any case of AFP as a potential case of polio. The surveillance tool is an Auto-Visual AFP Detection and Reporting (AVADAR) mobile application installed on android-enabled mobile devices, provided to Health Workers and Community Informants, to aid in the detection and reporting of AFP cases within health facilities and local communities.

Screenshots of AVADAR Application

According to the project manager, Umar K. Idris, “AVADAR was designed to improve the sensitivity and quality of AFP surveillance, particularly in places with low performance indicators”.

The AVADAR project was piloted on 5 August, 2016 in the Local Government Areas (LGAs) of Oyun (Kwara state) and Kuje (FCT, Abuja) for an 8 week period. In Kuje, community informants reported 26 AFP cases within the 8 week period. This was a considerable increase compared to only 23 cases reported in the 33 week period (from January to July 2016) before implementation of the AVADAR pilot. Similarly, in Oyun there were 8 reported AFP cases within the 8 week period (August to October 2016), compared to only 4 reported cases in the 33 week period prior to AVADAR.

Building on the successes achieved, the project was scaled up to include 8 LGAs in Borno state in November 2016, with plans to further expand into other states.

“We are on the verge of expanding into Adamawa, Sokoto and Yobe. We also aim to implement it in the Lake Chad Region (Chad, Cameroon & Niger Republic), post-Ebola countries (Guinea, Liberia, Sierra Leone), as well as the Democratic Republic of Congo and South Sudan in 2017”, Idris said.

According to the Global Polio Eradication Initiative (GPEI), the absence of AFP surveillance provides a gateway for wild poliovirus to continue circulating around the world. Innovations like AVADAR have already  improved the surveillance network by providing health workers and community informants with an active surveillance tool to effectively report suspected AFP cases. The surveillance data will serve as a measure of progress towards polio eradication and allow polio program stakeholders to effectively plan and implement strategies for supplementary immunization activities (e.g. national immunization campaigns).

[youtube=://www.youtube.com/watch?v=EeSzp8H0ODQ&w=854&h=480]

To strengthen communication amongst the local health workers and community informants, eHA trained over 800 health workers and provided them with over 800 GPS-enabled smartphones and solar chargers.AVADAR has expanded the surveillance network by bringing in more community informants, health workers and designated health facilities to improve the sensitivity of AFP surveillance amongst surveillance personnel (in terms of timely detection and reporting). The AVADAR software includes an embedded 30-second video of a live child with AFP symptoms having difficulty crawling/walking, as well as an electronic data collection form for submission of detailed information on suspected AFP case patients. This video is sent as a weekly reminder to Health Workers and Community Informants (on their GPS-enabled mobile phones) responsible for reporting all suspected AFP cases in their health facilities and communities.

Combinations that Yield Low Error Rates for Dates on Touchscreen Devices

Project DESTINI - Screen Size vs. Interface vs. Single or Double Data Entry

eHealth Africa (eHA), in partnership with Biostat Global Consulting, conducted a two-day research experiment in September of 2016 at eHA’s headquarters in Kano, Nigeria. The objective of the experiment was to estimate data entry error rates for dates on touchscreen devices (smartphones + tablets) and identify a combination of factors that yield very low error rates (<1%).

eHA hired 24 data collectors who each entered approximately 600 mock vaccination dates from a packet of vaccination cards provided (Figure 1). The data collectors moved through 12 stations and inputted the mock vaccination dates, covering every possible combination of three experimental factors: device (smartphone or tablet); Open Data Kit (ODK) interface (radio button, calendar, or pinwheel); and confirmation protocol (‘double entry with required agreement’ or ‘single entry’).

Error rates varied considerably by participant. Future research is needed to recommend an optimal data entry solution to yield low data entry error rates for dates, but radio buttons are promising. The radio button data entry interface on a smartphone using double entry yielded the lowest mean estimated error rate (2.7%) out of the 12 possible combinations. In contrast, the calendar data entry interface on a smartphone using single entry (no confirmation) yielded the highest mean error rate (9.9%).

“Estimated Error Rates for 12 Experimental Combinations” depicts 95% confidence intervals for two devices (phone and tablet) with three ODK interfaces (radio, wheel, calendar) and data entry protocol (‘no confirmation’ also known as single entry; and ‘double entry’ also known as ‘double entry with required agreement’). Mean error rates per data entry protocol are listed at right for each device and interface combination. The figure indicates the average error rate (5.1%) with a vertical line.  Each two-dimensional distribution is a stack of confidence intervals, from 0.01% confidence at the peak to 95% confidence at the base. The distributions are scaled to have equal area, so the narrow ones are tall and the wide ones are short.

eHA obtained ethical approval from the Kano State Ministry of Health before conducting this experiment. eHA and Biostat Global Consulting presented these research findings at the International Conference on Questionnaire Design, Development, Evaluation, and Testing (QDET2) in November of 2016.

Error Rates for 12 Experimental Combinations

 

eHealth Africa Launches Vaccine Direct Service in Sokoto State

By Daniel Ojabo

In partnership with the Sokoto State government, eHealth Africa (eHA) just launched a vaccine delivery and immunization campaign to address supply related gaps in Sokoto State, Nigeria.

Recently concluded phase of the Vaccine Direct Delivery (VDD) campaign in Kano State saw over 7 million doses of antigens delivered and 4.6 million children immunized. Building on this success, eHA will be engaging Sokoto State as a third party logistics partner to optimize the timely delivery of vaccines and routine immunization supplies across all 23 Local Government Areas (LGAs) in the state.

According to the VDD Project Manager Adamu Lawan, “eHA is contracted to deliver vaccines to health facilities at the wards across all 23 LGAs in the state.”

VDD will be implemented to support demand creation activities and address supply related factors on routine immunization uptake. It will provide a reliable vaccine delivery service for state Primary Health Care (PHCs) facilities in the state, allowing them to run monthly Immunization Plus Days (IPDs) in addition to regular vaccination clinics for children under five.

“eHA is contracted to deliver vaccines to health facilities at the wards across all 23 LGAs in the state.

- Adamu Lawan, Project Manager

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The project, which kicked off on 13th December of 2016, is expected to run for 12 months and work with over 80 (PHCs) in Sokoto State. Health facilities will be clustered by Wards/LGAs in order to examine the effect of demand creation against improved supply over a 6-month period.

“Part of the mandate is also to help collect sharp and other wastes from the health facilities we make deliveries to, and deliver back to the cold stores,” Lawan added.

Several immunization programs across all 36 Nigerian states have seen a steady increase in vaccination coverage over the past decade. According to a 2014 report by the National Population Commission (NPC) of Nigeria and ICF Macro, full vaccination coverage of children aged 12-23 months was highest in Imo State (62.4%) and lowest in Sokoto State (1.4%).

The project will monitor and inform eHA, the Sokoto State government, and other stakeholders on the effect of improved vaccine delivery on childhood routine immunization in Sokoto State. The results of these research activities are expected to present an overall picture of the extent to which improving vaccine supply chain affects routine immunization coverage in Sokoto.

eHA will engage the state government through Routine Immunization officers who will track demand creation activities in their health facilities. Current routine immunization coverage information in Sokoto will also be documented using a desk review and analysis of District Health Information System (DHIS2) data. This research will be used to create a benchmark for evaluating the expected outcome of improving vaccine supply chain and delivery in Sokoto.

Meet the Staff - Israel Kollie

Israel launched his career with eHealth Africa’s  Liberia office (eHA-L) more than 2 years ago, at the height of Liberia’s Ebola outbreak and in the fledgling days of our Monrovia-based operations.

Eager to do his part to slow the devastating spread of the virus, Israel signed up as an eHealth Africa volunteer. Capitalizing on his data entry and analysis skills, Israel trained staff at the National Ebola Call Center and Island Clinic, contributing to the launch of electronic sample reporting systems (a giant leap beyond the clinics’ previous paper-based records).

Given his success as a Data System Trainer, Israel was quickly offered an employment contract and became eHA-L’s inaugural Information Systems team member. New responsibilities led to valuable learning opportunities for Israel. Only months later, Israel’s supervisor identified that he possessed the qualities of a systems engineer, and he eagerly accepted a promotion to Junior Software Developer.

“My skills have grown more quickly than I would ever have imagined,” said Israel. From volunteer to trainer to eHA-Liberia’s newest professional developer, Israel’s career trajectory is certainly on the rise.

From entering data and upgrading Excel files and Google sheets, Israel now contributes to an Interoperable Health Information System. The system is the first of its kind, and it will allow disease surveillance data to be shared across the Liberian government’s sub-systems. The system’s implications are staggering in terms of policy-making capacities for Liberia’s Ministry of Health. They greatly improve early disease detection capabilities, which would be extremely valuable in the event of another outbreak.

Israel has played an integral role in the prevention of future disease outbreaks in Liberia by helping revolutionize paper-based sample collection methods, digitizing lab reporting, and launching state-of-the-art disease surveillance systems.

After two years on the Information Systems team, Israel conveys his pride to be part of eHA-L. During the outbreak, Israel was eager to be one of the “frontliners” in the fight against Ebola.

“I was always proud every time I received a call from other partners for eHA to intervene using tech devices in the response,” Israel said. “This demonstrated that eHA was doing something worthwhile”, he added.

Israel has already been recognized by the Centers for Disease Control and Prevention (CDC) for exemplary volunteer service, as well as by local media outlets for his contribution to his country’s health systems. In addition to working with eHA-L full time, Israel attends courses every evening and is well on his way to becoming a professional systems engineer. eHA-L is proud to have such a dedicated individual on our team.

“My responsibilities have opened my eyes to something new. I don’t think I can be more motivated than this any time soon.” - Israel

They Thought We Were Flowers, But We Were Actually Seeds

By Taylor Snyder

When eHA-Guinea’s (eHA-G) staff first arrived in the village of Saran, they found the valley landscape to be lush, with an abundance of crops growing in wide varieties. It was October of 2015, and many women in the village were out in the fields tending to their potatoes, which were being grown in tiny individual plots of land. While connecting with the community on ways to collaborate toward strengthening their district health posts, eHA-G’s staff was inspired to also leverage their experience supporting female entrepreneurship.

eHA-G’s staff described to several village women how they could combine their small plots of potatoes into one larger vegetable plot, in order to increase revenues and simultaneously decrease the amount of time they spent working in the field. The women followed that technical advice and expanded it further by forming a cooperative, combining plots of land, working together in the field, and diversifying their crops beyond potatoes to include ginger and cabbage. This dynamic cooperative commenced in February of 2016 and is now composed of 20 smart, joyful, and dedicated women.

Working together and employing several of their natural leadership skills is saving these women time, earning them more money, and creating a team culture where they count on each other. When they were working individually, they only earned a small amount of revenue. As a result of the new cooperative, they currently have 1 million GNF in their bank account and another 600,000 GNF ready to be deposited.

From the income earned, the cooperative reinvests in buying additional crops, shares some of the profit for their own personal needs, and put the remaining balance in their cooperative’s bank account. The women previously worked with the “federation paysanne,” but are now leveraging the talents of one woman’s bookkeeping skills to manage their finances independently.

Four growing seasons of experience has lead to the cooperatives’ creation of a working schedule that achieves both their cultivation and lifestyle goals. Three days a week, they gather early in the morning to work together in the fields. While most of women are in the field, they designate two women to cook a meal for the entire team and their families.

[youtube https://www.youtube.com/watch?v=z4eFScPbpZE?rel=0&controls=0&showinfo=0&w=640&h=360]

A major setback occurred last season when, due to heavy rain, their entire agricultural production was lost. The ramifications of the lost crops meant that the group lost food sources and income. Yet, the major outcome was that it reinforced the cooperative’s mission. They realized that by working and saving money together, what could have been devastating losses to individuals was just a small setback for the larger team. 

Supporting Health Workers at the Frontline of Disease Outbreak Prevention

November is typically a time of remembrance. Here in Sierra Leone, the memories hit close to home as the country marked the one year anniversary of the end of the Ebola Virus Disease (EVD) outbreak. The resilience of the local communities is represented in the high EVD survival rates and support from government and partner organizations.

The EVD outbreak was characterized by acute challenges in field epidemiology, disease management, and disease control. Health worker education, training, and capacity building is one component essential to establishing holistic and effective disease management.

eHA Sierra Leone (eHA-SL) organizes rolling field epidemiology training programs (FETP) for district surveillance officers (DSOs) across the country. Through the support of funding from the United States Centers for Disease Control and Prevention (CDC), the FETP program is hosted by the Sierra Leone Ministry of Health and Sanitation (MoHS) and facilitated by African Field Epidemiology Network (AFENET) experts.

Every three months, the Frontline FETP trains new groups of approximately 20 public health staff in disease surveillance best practices. Participants are geographically diverse, and include participation from the national level and all 14 districts. From routine health data collection and recognition of exceptional symptoms to developing case profiles using the 5Ws (Who, What, When, Where, Why) and creating action plans, the surveillance officers are oriented and guided through data-driven decision making.

The programs includes three months of classroom sessions and field-level application. Following two weeks of workshop sessions, up to nine weeks are spent conducting field projects which enables students to practice, implement, and reinforce what they have learned. These projects include creating reports with summary tables and charts of the surveillance data routinely collected at their particular agencies. In addition, DSOs conduct monitoring, evaluation, and feedback of surveillance activities at various health reporting sites. They also have the opportunity to perform a health problem analysis and participating in a mock case or outbreak investigation.

By the end of the quarter, the DSOs are well positioned to engage in more informed practice and decision-making to investigate, identify, and thwart future disease threats. Due to the rolling nature of the program, eHA and partners are able to train public health staff from across the country regularly. With this momentum in health worker training, over the next year the fortitude and capability of the health workforce will expand to champion disease outbreak in the Sierra Leone.

Using Tech to Save Lives in Sierra Leone

Captivated audience

eHA SL Senior Software Developer, Jasper Timm

eHealth Africa (eHA) is often described as an organization which provides technological solutions to strengthen health systems. But what about the “e” in eHA? At the heart of the electronic systems are dynamic software solutions developed and managed by our global health informatics team.

In a quest to highlight achievements, share current projects, and inspire the emerging tech community, eHA’s Sierra Leone’s Information Systems Information Systems team led a “Hacks/Hackers Meetup” in Freetown this November. Hosted by local collective “Sensi Tech Innovation Hub,” the event brought together a mix of technology enthusiasts and software coders with a passion for health.

eHA disease surveillance software

Team Manager Manuel Loistl and Senior Software Developer Jasper Timm spoke to a packed house about the Information System team’s role in a variety of eHA activities. This included an overview of: how eHA created mobile applications to track Ebola patients and potential patients during the Ebola outbreak and established the 117 emergency call center’s digital interfaces to connect health workers across all regions of Sierra Leone. Currently, the team is customizing DHIS2 software into a disease surveillance system for Sierra Leone, as well as supporting software modifications in a new partnership with VaxTrac. Additionally, Jasper covered important Information Systems processes and systems necessary to generate high-quality digital solutions to meet Sierra Leone’s unique health needs.

Excitement was in the air as many participants stayed after the presentations to engage with the team and play with demos of various software solutions created for different eHA initiatives.

For future opportunities with eHA Sierra Leone’s Information Systems team, please visit our careers webpage(under Informatics). Follow us for more coverage of similar events via Twitter and Facebook.

Thinking Pink and Giving Back

Who says the weekend’s for sleeping in? On Saturday, November 5th the eHealth Africa (eHA) Sierra Leone team laced up their sneakers to participate in the 3rd annual Thinking Pink Breast Cancer Foundation mini-marathon fundraiser.

In recognition of international breast cancer awareness month in October, the run brought together athletes, breast cancer survivors, family members, and the international community. The funds provide care for women unable to afford expensive medication, treatments and procedures. eHA is proud to have participated in a signature community event which motivates health-consciousness and the importance of physical activity.

Some ran, some walked, and some crawled, but nearly ½ of the eHA Sierra Leone office participated in the event and met triumphantly at the finish line. Congratulations to all participants for taking part in such a worthy cause!

Exciting New Partnership to Strengthen Child Immunization in Sierra Leone

Remember eHA’s participation in Sierra Leone's national polio campaign?

More than simply a community exercise, this event served as an important stepping stone toward the launch of an exciting new initiative to strengthen children’s health in Sierra Leone.

eHA is proud to announce its new partnership with VaxTrac, an innovative organization which provides technologies to maximize the effectiveness of vaccination programs in developing countries. Between now and May 2017, partners will collaborate with the Child Health Division at the Ministry of Health and Sanitation (MoHS) to implement an electronic registry for children’s immunization throughout Sierra Leone.  

“eHA is excited to collaborate with MoHS and VaxTrac to implement a biometric immunization record system. We believe this project will lead to a higher number of children finishing their vaccination plans, as well as establish a robust immunization record system for Sierra Leone.” - Evelyn Castle, Executive Director and Co-Founder of eHealth Africa

Read the full announcement on VaxTrac’s website!

Digitizing Healthcare in Underserved Communities

See event photos below, and read an informative report on this incredible event held this month in Berlin.

Click here to read the full report.