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FIELD ACTION REPORT
Open Access

Introduction of Mobile Health Tools to Support Ebola Surveillance and Contact Tracing in Guinea

Jilian A Sacks, Elizabeth Zehe, Cindil Redick, Alhoussaine Bah, Kai Cowger, Mamady Camara, Aboubacar Diallo, Abdel Nasser Iro Gigo, Ranu S Dhillon and Anne Liu
Global Health: Science and Practice December 2015, 3(4):646-659; https://doi.org/10.9745/GHSP-D-15-00207
Jilian A Sacks
aEarth Institute at Columbia University, New York, NY, USA
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  • For correspondence: apl2127{at}columbia.edu
Elizabeth Zehe
aEarth Institute at Columbia University, New York, NY, USA
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  • For correspondence: apl2127{at}columbia.edu
Cindil Redick
aEarth Institute at Columbia University, New York, NY, USA
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Alhoussaine Bah
bMillennium Promise, New York, NY, USA
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Kai Cowger
bMillennium Promise, New York, NY, USA
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Mamady Camara
cMillennium Promise, Conakry, Guinea
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Aboubacar Diallo
cMillennium Promise, Conakry, Guinea
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Abdel Nasser Iro Gigo
cMillennium Promise, Conakry, Guinea
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Ranu S Dhillon
aEarth Institute at Columbia University, New York, NY, USA
dBrigham and Women’s Hospital, Boston, MA, USA
eNational Ebola Coordination Unit, Conakry, Guinea
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Anne Liu
aEarth Institute at Columbia University, New York, NY, USA
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Figures & Tables

Figures

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  • FIGURE 1.
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    FIGURE 1.

    Flow of Information Using Paper‐Based Contact Tracing System in Guinea

  • FIGURE 2.
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    FIGURE 2.

    Contact Tracer Performance Dashboard

    Numbers at the top depict the numbers of contacts for the day that: (1) received a household visit from the contact tracer; (2) were visited by the contact tracer but were unavailable; (3) were last visited by the contact tracer 1 day ago; (4) were last visited by the contact tracer 2 days ago; (5) were last visited by the contact tracer 3 or more days ago; (6) have never received a monitoring visit since being registered in CommCare; (7) are active in the system and should receive a daily visit; (8) were newly registered in the system. The username of the contact tracer is displayed in the column on the far left but the names have been removed to maintain confidentiality. The filters on the right include: the name of the contact tracer; the region, prefecture, and sub‐prefecture of the contact; the status of the contact (either active or not active); and whether the contact was registered more than 21 days ago. A user with appropriate permissions can then click on any bar in the graph to view the underlying specifics, i.e., the name of the contact, the date of the visit, whether they displayed any symptoms, etc.

  • FIGURE 3.
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    FIGURE 3.

    Weekly Key Performance Indicator Dashboard

    Four graphs are depicted, each showing data for the date specified, in this case, July 21– July 27, 2015. The top graph labeled “Les Suspects” shows the number of contacts who are calculated as suspected of having Ebola based on the display of symptoms, the number of contacts who have been transferred to a health center to be tested for Ebola, and the number of contacts who have been closed in the system because they were confirmed as having Ebola. The next graph labeled “Réticence” depicts instances of contact resistance during the initial registration visit and during the daily monitoring visit, as well as contacts who have been closed from the system and who will no longer be monitored because of resistance. The graph labeled “Les Visites Quotidiennes” depicts the number and proportion of contacts who are active and who have received their daily monitoring visit compared with those who were not visited for the day. The bottom graph titled “Les Contacts” shows the numbers of newly registered and closed contacts per day. The filters on the right allow the user to restrict the data to a specific contact tracer based on the username or to a specific prefecture or sub‐prefecture. With proper access permissions, the user can click on any bar in the graphs to view the underlying specifics of the data, i.e., the username of the contact tracer and the name of the contact.

  • FIGURE 4.
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    FIGURE 4.

    Contacts Lost to Follow‐Up Dashboard

    This graph shows the number of days that have passed since contacts were available and visited by the contact tracer and were available at the household to be monitored for symptoms. (Note: Once a contact has not been seen for 3 or more days, they are considered lost to follow‐up by surveillance management teams.) The column on the left indicates the sub‐prefecture or commune where the contacts reside. The numbers in the colored boxes show the number of contacts who were unavailable for the daily contact tracing visit since 1 day ago (left column), 3 days ago (middle column), and 7 days ago (right column). The filters on the far right enable the user to restrict the data to contacts who reside in a specific region, prefecture, or sub‐prefecture. The user can also click in an individual box to see the specific details for the contacts, i.e., the assigned contact tracer, name of the contact, source‐case name, household head name, method of exposure, date the contact was registered, date the contact was last available to be monitored by the contact tracer, etc.

  • Figure5
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    Contact tracers in Conakry, Guinea, attend a refresher training on the CommCare software.

  • Figure6
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    A government health manager in Conakry, Guinea, uses the Tableau dashboards to review new contacts registered in her commune.

Tables

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    TABLE 1 Limitations of Paper-Based Contact Tracing System
    LimitationProcess Impact
    Paper-based contact tracing system creates delays between data collection and consumption.→Impedes rapid response and decision making around contact tracing strategy.
    Human error is common with data entry, as is misunderstanding of data and communication gaps.→Data become unreliable, out of date, and inconsistent.
    Efforts for data cleaning, data entry, and data compilation are time-intensive.→Takes away from time and resources needed for data analysis and troubleshooting.
    • View popup
    TABLE 2 Mobile Contact Tracing Program Implementation Steps and Challenges
    StageStepApproximate TimeKey PartnersPrerequisites for DeploymentKey Challenges
    Preparationa1. Design of Application1 weekDimagi• Vetted contact tracing protocols available from CDC, WHO, and GoG• Availability of standard contact tracing protocol
    2. Development of Dashboards4 weeksTableau Foundation, Tableau consultants, Dimagi• Data requirements and desired indicators available from GoG and partners
    • Stable Internet and electricity available in country to access dashboards
    • Interoperability of Dimagi’s data infrastructure and Tableau system
    Deploymenta3. Procurement and Configuration of Equipment2 weeksEricsson, UNFPA, Blue Zones• Logistics protocols in place for accepting and processing equipment donations
    • Telecommunications network identified for highest coverage in different prefectures
    • Manpower to configure phones
    • Logisticians to help clear donated equipment
    • Cash flow availability for voice and data plans
    4. Training of Trainers2 daysbUNFPA, GoG• Trainers pre-identified and hired by GoG• Quality of some trainers
    5. Training of Contact Tracers and Supervisors2–3 daysbUNFPA, GoG• Contact tracers and supervisors pre-identified and hired by GoG
    • Contact tracers trained on contact tracing protocol
    • Supervisors trained on contact tracing protocol and supervision activities
    • Accountability of supervisors to supporting CommCare troubleshooting needs
    • Gaps in training on basic contact tracing protocols
    • Technological literacy level of some contact tracers
    6. Deployment of Mobile Application1 dayUNFPA, GoG• Completion of contact tracer training
    • Distribution of smartphones, chargers, SIM cards, and other equipment to contact tracers
    • Contact tracer consent on proper-use protocols for smartphones and other equipment
    • Quality, timely make-up trainings for contact tracers who were not able to attend initial training and were still expected to monitor contacts using smartphones
    • Abuse of phone and/or data by contact tracers for personal use
    Adaptation7. Data Validation1 daybUNFPA, GoG• Contact tracing data from paper forms available and vetted• Availability of up-to-date paper-based data
    • Quality of data from paper-based databases
    8. Modification of CommCare Application1 weekbDimagi• Feedback on application content available from local partners and users based on use during pilot phase• Conversion of nuanced field protocols to automated skip logic and prompts
    • Distribution of heavy multimedia files
    • Coordination of updates where application was already deployed
    9. Training and Deployment of Information Officers1–4 weeksb depending on applicantsGoG• Interest and willingness from GoG to work with information officers within commune or prefecture‐level offices
    • Internet access in government offices where information officers would be working
    • Space for information officers to work in government offices
    • Availability of qualified applicants in rural areas
    • Management of expectations with GoG, with some information officers having to support directly on supervision
    • Some transportation gaps in rural areas where information officers had to support on direct supervision
    • Abbreviations: CDC, US Centers for Disease Control and Prevention; GoG, Government of Guinea; UNFPA, United Nations Population Fund; WHO, World Health Organization.

    • ↵a Many of these steps occurred concurrently.

    • ↵b Per prefecture.

    • View popup
    TABLE 3 Mobile Contact Tracer Program Deployment in Guinea as of May 2015
    PrefectureTraining Date(s)Number of Contact Tracers TrainedNumber of Supervisors Trained
    BoffaApril 20–24, 20157225
    ConakryNov 11–17, 201410513
    Jan 20, 2015NA9
    April 28–May 11, 2015NA38
    CoyahNov 30–Dec 2, 2014278
    DubrékaDec 5–9, 20143610
    ForécariahMar 30–April 2, 201512630
    Total366133
    • View popup
    TABLE 4 Use of the Mobile Contact Tracer System in Guinea as of May 2015
    PrefectureNo. of Months Since Initial DeploymentTotal No. of Active Contact TracersaTotal No. of Contacts Monitored in CommCare
    Boffa0.5577
    Conakry5.5896,151
    Coyah5.023750
    Dubréka4.525619
    Forécariah1.0681,565
    Total2109,162
    • ↵a Defined as having registered contacts using CommCare.

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Global Health: Science and Practice: 3 (4)
Global Health: Science and Practice
Vol. 3, No. 4
December 01, 2015
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Introduction of Mobile Health Tools to Support Ebola Surveillance and Contact Tracing in Guinea
Jilian A Sacks, Elizabeth Zehe, Cindil Redick, Alhoussaine Bah, Kai Cowger, Mamady Camara, Aboubacar Diallo, Abdel Nasser Iro Gigo, Ranu S Dhillon, Anne Liu
Global Health: Science and Practice Dec 2015, 3 (4) 646-659; DOI: 10.9745/GHSP-D-15-00207

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Introduction of Mobile Health Tools to Support Ebola Surveillance and Contact Tracing in Guinea
Jilian A Sacks, Elizabeth Zehe, Cindil Redick, Alhoussaine Bah, Kai Cowger, Mamady Camara, Aboubacar Diallo, Abdel Nasser Iro Gigo, Ranu S Dhillon, Anne Liu
Global Health: Science and Practice Dec 2015, 3 (4) 646-659; DOI: 10.9745/GHSP-D-15-00207
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