Real-Time Biosurveillance Pilot in India and Sri Lanka

Abstract

The latter parts of 2007 and early months of 2008 witnessed an alarming number of deaths due to a Leptospriosis outbreak in Sri Lanka [Agampodi et al, 2008]. This disease presents with flu-like symptoms, and it is not easy to identify because other more common diseases with similar symptoms tend to emerge naturally during the monsoon seasons. The scattered number of patient complaints went unnoticed, during the rainy season, until a few deaths were reported by individual hospitals. An unusual number of flu­like symptoms concentrated in particular geographic areas (North Central and North Western Province in Sri Lanka) could have signalled the epidemiologists of an abnormal event. The present day paper­-based disease surveillance and notification systems in Sri Lanka and India [Prashant and Waidyanatha, 2009], confined to a set of notifiable diseases, often require 15­-30 days to communicate data and for the central Epidemiology Unit to process it. This latency does not allow for timely detection of disease outbreaks, and it limits the ability of the health system to effectively respond and mitigate their consequences. The Real­Time Biosurveillance Program (RTBP) is a pilot aiming to introduce modern technology to health departments in Tamil Nadu, India, and Sri Lanka to complement the existing disease surveillance and notification systems. The processes involve digitizing all clinical health records and analysing them in near real­time to detect unusual events to forewarn health workers before the diseases reach epidemic states. Health records from health facilities, namely the patient case disease, syndrome, and demographic information, are collected through
the m­HealthSurvey mobile phone application [Kannan and Sheebha, 2009] and fed in to the TCube Web Interface [Ray et al, 2008], which is a browser based software tool that uses the TCube data structure for fast retrieval and display of large scale multivariate time series and spatial information. Interface allows the user to execute complex queries quickly and to run various types of comprehensive statistical tests on the loaded data [Sabhnani et al, 2005, Dubrawski et al, 2007]. The Sahana Messaging/Alerting Module is used to disseminate detected adverse events to targeted health officials and health workers. The Sahana Alerting module adopts the global content standard: Common Alerting Protocol (CAP) for structuring the messages that are transported via SMS, Email, and Web [Gow and Waidyanatha, 2009]. Evaluation of the RTBP involves a replication study and parallel cohort study. This paper discusses the technologies used in the pilot and the initial findings in relation to usability of the system.