@Article{info:doi/10.2196/jmir.8041,
author="Olson, Daniel
and Lamb, Molly
and Lopez, Maria Renee
and Colborn, Kathryn
and Paniagua-Avila, Alejandra
and Zacarias, Alma
and Zambrano-Perilla, Ricardo
and Rodr{\'i}guez-Castro, Sergio Ricardo
and Cordon-Rosales, Celia
and Asturias, Edwin Jose",
title="Performance of a Mobile Phone App-Based Participatory Syndromic Surveillance System for Acute Febrile Illness and Acute Gastroenteritis in Rural Guatemala",
journal="J Med Internet Res",
year="2017",
month="Nov",
day="09",
volume="19",
number="11",
pages="e368",
keywords="mobile phone; app; participatory; syndromic surveillance; norovirus; dengue; acute febrile illness; diarrhea; Guatemala",
abstract="Background: With their increasing availability in resource-limited settings, mobile phones may provide an important tool for participatory syndromic surveillance, in which users provide symptom data directly into a centralized database. Objective: We studied the performance of a mobile phone app-based participatory syndromic surveillance system for collecting syndromic data (acute febrile illness and acute gastroenteritis) to detect dengue virus and norovirus on a cohort of children living in a low-resource and rural area of Guatemala. Methods: Randomized households were provided with a mobile phone and asked to submit weekly reports using a symptom diary app (Vigilant-e). Participants reporting acute febrile illness or acute gastroenteritis answered additional questions using a decision-tree algorithm and were subsequently visited at home by a study nurse who performed a second interview and collected samples for dengue virus if confirmed acute febrile illness and norovirus if acute gastroenteritis. We analyzed risk factors associated with decreased self-reporting of syndromic data using the Vigilant-e app and evaluated strategies to improve self-reporting. We also assessed agreement between self-report and nurse-collected data obtained during home visits. Results: From April 2015 to June 2016, 469 children in 207 households provided 471 person-years of observation. Mean weekly symptom reporting rate was 78{\%} (range 58{\%}-89{\%}). Households with a poor (<70{\%}) weekly reporting rate using the Vigilant-e app during the first 25 weeks of observation (n=57) had a greater number of children (mean 2.8, SD 1.5 vs mean 2.5, SD 1.3; risk ratio [RR] 1.2, 95{\%} CI 1.1-1.4), were less likely to have used mobile phones for text messaging at study enrollment (61{\%}, 35/57 vs 76.7{\%}, 115/150; RR 0.6, 95{\%} CI 0.4-0.9), and were less likely to access care at the local public clinic (35{\%}, 20/57 vs 67.3{\%}, 101/150; RR 0.4, 95{\%} CI 0.2-0.6). Parents of female enrolled participants were more likely to have low response rate (57.1{\%}, 84/147 vs 43.8{\%}, 141/322; RR 1.4, 95{\%} CI 1.1-1.9). Several external factors (cellular tower collapse, contentious elections) were associated with periods of decreased reporting. Poor response rate (<70{\%}) was associated with lower case reporting of acute gastroenteritis, norovirus-associated acute gastroenteritis, acute febrile illness, and dengue virus-associated acute febrile illness (P<.001). Parent-reported syndromic data on the Vigilant-e app demonstrated agreement with nurse-collected data for fever (kappa=.57, P<.001), vomiting (kappa=.63, P<.001), and diarrhea (kappa=.61, P<.001), with decreased agreement as the time interval between parental report and nurse home visit increased (<1 day: kappa=.65-.70; ≥2 days: kappa=.08-.29). Conclusions: In a resource-limited area of rural Guatemala, a mobile phone app-based participatory syndromic surveillance system demonstrated a high reporting rate and good agreement between parental reported data and nurse-reported data during home visits. Several household-level and external factors were associated with decreased syndromic reporting. Poor reporting rate was associated with decreased syndromic and pathogen-specific case ascertainment. ",
issn="1438-8871",
doi="10.2196/jmir.8041",
url="http://www.jmir.org/2017/11/e368/",
url="https://doi.org/10.2196/jmir.8041",
url="http://www.ncbi.nlm.nih.gov/pubmed/29122738"
}