1. Methods and tools for epidemiological biosurveillance in data-limited settings Presenter: Kathryn H. Jacobsen, MPH, PhD Associate Professor of Epidemiology, George Mason University kjacobse@gmu.edu

2. Framework Complex Models Operational Use Field Data Data limitations in: Conflict & post-conflict areas Disaster areas Places with under-developed public health systems

3. Data Needs How quickly can we set up a system to collect health surveillance data in places with… – No current map – No population census data – No electronic medical records – Almost no public health information system for reporting of infectious diseases – Limited access to laboratory testing

4. Data Collection Components 1.Geography (mapping) 2.Demography (household surveys) 3.Epidemiology (syndromic surveillance / laboratory testing)

5. Principles Accessible technology: Nearly all of these data collection activities can be conducted by local partners with smartphones and free, open-source apps – Reduces IP concerns about data collection devices – Data are stored on a secure server – Protects IP related to data integration and interpretation Partner technical support: This work can complement local public health information efforts

6. Community-Participatory GIS (PGIS) of Neighborhoods & Streets Start with images from open sources Local residents walk streets (red) and section boundaries (blue) with GPS- equipped smartphones Add named features to a GIS Add additional points of interest to the GIS

7. Community-Participatory GIS (PGIS) of Neighborhoods & Streets All partners have immediate access to key spatial information Facilitates communication by providing a common language for place names clinic gas station bar bank

8. Household Health Survey Access to utilities (water, electricity) Household health Use of the healthcare system (preferred providers) All data entered directly into a smartphone linked to the GIS (with care taken to protect the confidentiality of personal information) Participation rate: Pre-survey community meetings Local interviewers Red dots are for illustration only.

9. Community-based Surveillance System Local volunteers report new cases of diseases of interest in person or via text message (incentive: cell phone minutes + free testing at locally-run NGO hospital)

10. Syndromic Surveillance Syndromic (symptom-based) data collection activities – SMS reporting of weekly cases in an assigned “catchment area” via cell phone from community health volunteers (CHVs) in urban and rural areas – SMS reporting from nationwide military units improved weekly reporting compliance from 76% to 100% of Sierra Leone’s military medical units over a year GPS-linked environmental testing (water, chickens/birds, etc.)

11. Framework Complex Models Operational Use Smartphone Open-source apps Once teams are familiar with the smartphone technology, the data collection process can be very time (and cost) efficient.

12. Disclaimer: The views expressed herein are those of the presenter and are not representative of the Department of the Navy or the Department of Defense.