In 2011, Punjab saw its worst dengue outbreak ever, with 359 deaths and more than 21,000 cases, of which about 17,000 were in Lahore.
“We were obviously not prepared and realised we needed to develop smart systems to prevent and contain localised outbreaks very quickly,” said Umar Saif, chairman of Pakistan’s Punjab Information Technology Board (PITB).
Realising that they didn’t have the time, money and human resources to set up conventional disease surveillance systems, Saif, a computer engineer by training, and his team developed an android app and an online dashboard, as he puts it, “almost overnight”.
PITB’s dengue activity tracking system uses real-world field testing of aedes egypti (mosquito that transmits dengue) larvae and confirmed cases of dengue from hospitals to predict where outbreaks are likely to happen.
“The focus is on three big interventions: giving smartphones to field staff responsible for identifying and cleaning mosquito-breeding hotspots, actively looking for aedes larvae in neighbourhoods to help predict outbreaks, and using hospital data to identify dengue patients so that the health department could move in quickly to their homes and neighbourhoods for indoor residual spraying to kill mosquitoes,” says Saif, speaking to HT from Lahore.
Using the app, fieldworkers upload “before and after” photographs of the work they did each day. These photographs are GPS-tagged and time-stamped, which lowers absenteeism and makes it easy to verify prevention activities such as spraying and clearing breeding grounds. The work as pictorial evidence that is next pinned on a map to mark places that have been missed or need emergency interventions.
Thus, within days of the 2011 outbreak, Punjab government had real time access to three GPS-tagged data streams: prevention activities, entomological data on larvae clusters, and case-detection tagged data on homes and neighbourhoods experiencing outbreaks.
“When there is an upward rise in aedes egypti larvae and patients, the algorithm spits out names of places that are at high risk of an outbreak and an SMS is automatically sent to the official in charge of control. They immediately trace the cause and focus on elimination by sending field workers to the affected neighbourhoods to spray and clear aedes egypti breeding grounds,” says Saif.
Besides providing evidence of work in progress, using android phones is a cheap and effective data-collecting too.
“The phones cost less that US$ 50, and with Pakistan’s 135 million cellphone penetration, connectivity even in remote and rural areas is not an issue,” says Saif, whose work won him the MIT Technology Review’s Innovators Under 35 award in 2011.
While there was some initial resistance to the GPS-tagging among field-workers, android phones soon found accepted even by those who were initially hostile to them.
“Android phones have a social value beyond work- workers talked to friends and family, took pictures with it, their children played games on it… so they all take care of their phones,” says Saif.
In 2013, Lahore had 18 cases and 8 deaths. Though sceptics say dengue outbreaks occur in four-year cycles and it’s too early to establish that Punjab has successfully averted outbreaks, Saif insists the near absence of disease in 2012, 2013 and 2014 is not a coincidence.
“Since 2011, there are several thousands of different prevention and tracking activities happening on the ground that are clearly working,” says Saif.
So impressed was Pakistan government with the dengue activity tracking system that it’s now using smartphones for polio surveillance. Pakistan is the world’s worst affected country this year, accounting for 246 of the 291 confirmed cases from across nine countries in Asia and Africa. In comparison, the next badly polio-affected country is Afghanistan, with 20 cases.
Since last month, Punjab’s more than 3,700 polio vaccinators have been connected to the surveillance system using an algorithm very similar to that used for dengue. GPS-tagging now allows government to track how many homes has been visited by vaccinators and more important, how many have been missed, and the information is analysed on dashboards. As in dengue, if a certain number of children are not vaccinated, an automatic alert is sent out to the supervisor or line manager.
It may just be that it will be the ubiquitous- android cellphone that will finally help eliminate polio from Pakistan and the world!