A Participatory System for Preventing Pandemics of Animal Origins: Pilot Study of the Participatory One Health Disease Detection (PODD) System

Evaluation of a multi-component early warning system for pastoralist populations in Doolo zone, Ethiopia: mixed-methods study

BACKGROUND

This study evaluated an early warning, alert and response system for a crisis-affected population in Doolo zone, Somali Region, Ethiopia, in 2019-2021, with a history of epidemics of outbreak-prone diseases. To adequately cover an area populated by a semi-nomadic pastoralist, or livestock herding, population with sparse access to healthcare facilities, the surveillance system included four components: health facility indicator-based surveillance, community indicator- and event-based surveillance, and alerts from other actors in the area. This evaluation described the usefulness, acceptability, completeness, timeliness, positive predictive value, and representativeness of these components.

METHODS

We carried out a mixed-methods study retrospectively analysing data from the surveillance system February 2019-January 2021 along with key informant interviews with system implementers, and focus group discussions with local communities. Transcripts were analyzed using a mixed deductive and inductive approach. Surveillance quality indicators assessed included completeness, timeliness, and positive predictive value, among others.

RESULTS

1010 signals were analysed; these resulted in 168 verified events, 58 alerts, and 29 responses. Most of the alerts (46/58) and responses (22/29) were initiated through the community event-based branch of the surveillance system. In comparison, one alert and one response was initiated via the community indicator-based branch. Positive predictive value of signals received was about 6%. About 80% of signals were verified within 24 h of reports, and 40% were risk assessed within 48 h. System responses included new mobile clinic sites, measles vaccination catch-ups, and water and sanitation-related interventions. Focus group discussions emphasized that responses generated were an expected return by participant communities for their role in data collection and reporting. Participant communities found the system acceptable when it led to the responses they expected. Some event types, such as those around animal health, led to the community's response expectations not being met.

CONCLUSIONS

Event-based surveillance can produce useful data for localized public health action for pastoralist populations. Improvements could include greater community involvement in the system design and potentially incorporating One Health approaches.

Global prioritization of endemic zoonotic diseases for conducting surveillance in domestic animals to protect public health

Zoonotic diseases (zoonoses) originating from domestic animals pose a significant risk to people's health and livelihoods, in addition to jeopardizing animal health and production. Effective surveillance of endemic zoonoses at the animal level is crucial to assessing the disease burden and risk, and providing early warning to prevent epidemics in animals and spillover to humans. Here we aimed to prioritize and characterize zoonoses for which surveillance in domestic animals is important to prevent human infections at a global scale. A multi-criteria qualitative approach was used, where disease-specific information was obtained across literature of the leading international health organizations. Thirty-two zoonoses were prioritized, all of which have multi-regional spread, cause unexceptional human infections and have domestic animal hosts as important sources or sentinels of zoonotic infections. Most diseases involve multiple animal hosts and/or modes of zoonotic transmission, where a lack of specific clinical signs in animals further complicates surveillance. We discuss the challenges of animal health surveillance in endemic and resource-limited settings, as well as potential avenues for improvement such as the multi-disease, multi-sectoral and digital surveillance approaches. Our study will support global capacity-building efforts to strengthen the surveillance and control of endemic zoonoses at their animal sources. This article is part of the theme issue 'Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs'.

Striving for long term sustainability - is it time we changed our approach to animal health in low- and middle-income countries?

Animal health and agricultural productivity in low- and middle-income countries have been the focus of research for development (R4D) projects for decades, with varying levels of success when considering the long-term sustainability of interventions. Many of these projects have been funded, designed and implemented by researchers from high income countries, and therefore risk neglecting the cultural nuances and complex country histories that can influence their success. This opinion piece suggests three broad recommendations: (1) implementing culturally congruent practices to improve disease control and prevention practices at the village level; (2) promoting public-private partnerships to improve control of transboundary animal diseases; and (3) improving national animal health and veterinary services and their governance to improve disease surveillance, control and prevention. Development researchers need to consider implementing these approaches in future projects to improve the suitability and sustainability of interventions and acknowledging the current technical capacity of host countries. Foreign donor organisations need to ensure their funding guidelines and reporting requirements allow for these recommendations to be adequately implemented.

A long-term negative effect of monetary incentives on the participatory surveillance of animal disease: a pilot study in Chiang Mai, Thailand

BACKGROUND

In general, animal diseases have a significant impact on public health; accordingly, an effective animal disease surveillance system is an important control system that requires efficient and engaging participants in the long run. The purpose of this study is to assess the impact of monetary and social motivation on animal disease surveillance. We hypothesized that there are two sorts of motivation based on Fiske's relational theory (1992): monetary incentives (monetary markets) and nonmonetary incentives (social markets).

METHODS

In Chiang Mai Province, Northern Thailand, we analyzed data from a pilot project that began in 2014 and used a mobile application to report on signs that identify animal health problems. A total of 67 participants from 17 different areas in the central part of the province participated in this study. Participants in this study were divided into two groups: those who received monetary incentives and those who received social incentives.

RESULTS

According to the findings, the monetary market group's effort was significantly higher than that of the social market group during the time when the volunteers in the monetary market group were paid. However, in the long run, the monetary market group reported significantly less than the social market group. Social incentive, on the other hand, was more efficient once the payment period ended.

CONCLUSIONS

Social incentive outperformed monetary motivation in terms of efficiency and sustainability in the long run. Not only did the volunteers who were offered monetary incentive put in less effort than those who were offered the social incentive, but they were also not remotivated by the social incentive after the payment period had ended.

A call for citizen science in pandemic preparedness and response: beyond data collection

The COVID-19 pandemic has underlined the need to partner with the community in pandemic preparedness and response in order to enable trust-building among stakeholders, which is key in pandemic management. Citizen science, defined here as a practice of public participation and collaboration in all aspects of scientific research to increase knowledge and build trust with governments and researchers, is a crucial approach to promoting community engagement. By harnessing the potential of digitally enabled citizen science, one could translate data into accessible, comprehensible and actionable outputs at the population level. The application of citizen science in health has grown over the years, but most of these approaches remain at the level of participatory data collection. This narrative review examines citizen science approaches in participatory data generation, modelling and visualisation, and calls for truly participatory and co-creation approaches across all domains of pandemic preparedness and response. Further research is needed to identify approaches that optimally generate short-term and long-term value for communities participating in population health. Feasible, sustainable and contextualised citizen science approaches that meaningfully engage affected communities for the long-term will need to be inclusive of all populations and their cultures, comprehensive of all domains, digitally enabled and viewed as a key component to allow trust-building among the stakeholders. The impact of COVID-19 on people’s lives has created an opportune time to advance people’s agency in science, particularly in pandemic preparedness and response.

Designing a rabies control mobile application for a community-based rabies surveillance system during the COVID-19 pandemic in Bali, Indonesia

Background and Aim: Rabies remains a public health concern in Indonesia, and the coronavirus disease (COVID-19) pandemic has stymied rabies prevention and control efforts. There is a need to transform the rabies program to be adaptable to pandemic situations to improve program coverage on dog vaccination and rabies surveillance. This study aimed to create a rabies control (RaCon) mobile application for a community-based rabies surveillance system during COVID-19 in Bali, Indonesia. Materials and Methods: We employ the Design Science Research methodology. Surveillance officers, veterinarians, community leaders, outreach workers, and dog owners participated in a series of offline in-depth interviews and focus group discussions. The RaCon prototype was evaluated using the Post-Study System Usability Questionnaire (PSSUQ) framework, which included the system's usefulness, information quality, and interface quality. In this study, we used both a qualitative (n=50) and quantitative (n=342) approach. Results: According to the findings of this study, integrating public health and animal health into the rabies surveillance system are critical to supporting the One Health approach and encouraging community engagement in rabies programs. The RaCon prototype is expected to include features such as pet ownership, case report, news and announcements, nearest vet, health information, outbreak radar, emergency call, and app feedback. The RaCon prototype passed both qualitative and quantitative evaluations, indicating that it could be used to support the rabies surveillance system, particularly in the COVID-19 situation. Conclusion: The RaCon prototype was accepted by the users and got positive feedback in terms of the system's usefulness, information quality, and interface quality dimension. As a result, this prototype has the potential to be integrated into the rabies surveillance system in Bali, particularly to strengthen the community-based rabies surveillance system. Even though this prototype received positive feedback, this study focuses solely on the design development and evaluation of its user interface. As a result, further development is required before incorporating RaCon into the rabies prevention and control program.

EpiHacks, a Process for Technologists and Health Experts to Cocreate Optimal Solutions for Disease Prevention and Control: User-Centered Design Approach

Background

Technology-based innovations that are created collaboratively by local technology specialists and health experts can optimize the addressing of priority needs for disease prevention and control. An EpiHack is a distinct, collaborative approach to developing solutions that combines the science of epidemiology with the format of a hackathon. Since 2013, a total of 12 EpiHacks have collectively brought together over 500 technology and health professionals from 29 countries.

Objective

We aimed to define the EpiHack process and summarize the impacts of the technology-based innovations that have been created through this approach.

Methods

The key components and timeline of an EpiHack were described in detail. The focus areas, outputs, and impacts of the twelve EpiHacks that were conducted between 2013 and 2021 were summarized.

Results

EpiHack solutions have served to improve surveillance for influenza, dengue, and mass gatherings, as well as laboratory sample tracking and One Health surveillance, in rural and urban communities. Several EpiHack tools were scaled during the COVID-19 pandemic to support local governments in conducting active surveillance. All tools were designed to be open source to allow for easy replication and adaptation by other governments or parties.

Conclusions

EpiHacks provide an efficient, flexible, and replicable new approach to generating relevant and timely innovations that are locally developed and owned, are scalable, and are sustainable.

Subdistrict-Level Reproductive Number for Foot and Mouth Disease in Cattle in Northern Thailand

Foot and mouth disease (FMD) is an important contagious transboundary disease that causes a significant economic loss for several countries. The FMD virus (FMDV) can spread very rapidly by direct and indirect transmission among susceptible animals. The complexity and magnitude of FMDV transmission at the initial stages of the epidemic can be expressed by the basic reproductive number (R ₀), and furthermore, control strategies can be assessed by the estimation of the effective reproductive number. In this study, we aimed to describe FMD outbreaks among smallholder cattle farms by subdistricts in the northern Thailand and compute the effective reproductive number for outbreaks caused by FMDV serotype O and overall serotypes, including serotype O, serotype A, and unidentified serotype, at the subdistrict level (R _sd ) using an epidemic doubling time method. Field data of FMD outbreaks during 2015-2017 that affected 94 subdistricts in northern Thailand were assessed to estimate the R _sd . Results showed that 63.38% (90/142) of the FMD outbreak episodes in cattle were caused by FMDV serotype O. The average doubling time and the R _sd estimated of the outbreaks caused by FMDV serotype O and overall serotype were 2.80 and 4.67 months, and 1.06 and 1.04, respectively. Our results indicated that transmission of FMD in cattle at the subdistrict level in northern Thailand was not controlled (R _sd > 1), which indicates the endemicity of the disease in the region. Although control measures are in place, the results from this study highlighted the need for enhancing FMD monitoring and control strategies in northern Thailand.

Electronic data collection, management and analysis tools used for outbreak response in low- and middle-income countries: a systematic review and stakeholder survey

BACKGROUND

Use of electronic data collection, management and analysis tools to support outbreak response is limited, especially in low income countries. This can hamper timely decision-making during outbreak response. Identifying available tools and assessing their functions in the context of outbreak response would support appropriate selection and use, and likely more timely data-driven decision-making during outbreaks.

METHODS

We conducted a systematic review and a stakeholder survey of the Global Outbreak Alert and Response Network and other partners to identify and describe the use of, and technical characteristics of, electronic data tools used for outbreak response in low- and middle-income countries. Databases included were MEDLINE, EMBASE, Global Health, Web of Science and CINAHL with publications related to tools for outbreak response included from January 2010-May 2020. Software tool websites of identified tools were also reviewed. Inclusion and exclusion criteria were applied and counts, and proportions of data obtained from the review or stakeholder survey were calculated.

RESULTS

We identified 75 electronic tools including for data collection (33/75), management (13/75) and analysis (49/75) based on data from the review and survey. Twenty-eight tools integrated all three functionalities upon collection of additional information from the tool developer websites. The majority were open source, capable of offline data collection and data visualisation. EpiInfo, KoBoCollect and Open Data Kit had the broadest use, including for health promotion, infection prevention and control, and surveillance data capture. Survey participants highlighted harmonisation of data tools as a key challenge in outbreaks and the need for preparedness through training front-line responders on data tools. In partnership with the Global Health Network, we created an online interactive decision-making tool using data derived from the survey and review.

CONCLUSIONS

Many electronic tools are available for data -collection, -management and -analysis in outbreak response, but appropriate tool selection depends on knowledge of tools' functionalities and capabilities. The online decision-making tool created to assist selection of the most appropriate tool(s) for outbreak response helps by matching requirements with functionality. Applying the tool together with harmonisation of data formats, and training of front-line responders outside of epidemic periods can support more timely data-driven decision making in outbreaks.

The Importance of Citizen Scientists in the Move Towards Sustainable Diets and a Sustainable Food System

To enhance sustainability, the food system requires significant shifts in the production, processing and supply of food. Ideally, a sustainable food system should operate, not only to protect the biosphere, but also to provide nutritious, high-quality food, and to support social values, an equitable economy, and human and animal health. It should also be governed responsibly within a supportive policy environment. Implementing these shifts is a task of immense scale; but citizen participation/engagement has the potential to help make sustainability a reality through distributed learning, dynamic sensing, and knowledge generation. Technological advancements in sensing and data processing have enabled new forms of citizen participation in research. When food system research is embedded within society it can help us to understand which changes towards sustainability work and which do not. Indeed, citizen engagement in food systems research has the potential to help bring citizens on side, supporting the growth of a food culture of resilience and of sustainable practises (including dietary change). This commentary provides examples of how existing research and alternative food production systems and agroecological practises may provide possible frameworks for citizen participation in food system studies. We highlight potential future food and citizen science approaches. Widening citizen participation and encouraging the involvement of other food system actors, including those in local, national and international governance, is essential to capture the full potential of citizen science in enabling transition to a sustainable food system. For the research community citizen science offers engagement and empowerment of wider communities with science; collecting and analysing data; and creating viable solutions to food system and diet issues.

Participatory Disease Surveillance: Engaging Communities Directly in Reporting, Monitoring, and Responding to Health Threats

BACKGROUND

Since 2012, the International Workshop on Participatory Surveillance (IWOPS) has served as an informal network to share best practices, consult on analytic methods, and catalyze innovation to advance the burgeoning method of direct engagement of populations in voluntary monitoring of disease.

OBJECTIVE

This landscape provides an overview of participatory disease surveillance systems in the IWOPS network and orients readers to this growing field of practice.

METHODS

Authors reviewed participatory approaches that include human and animal health surveillance, both syndromic (self- reported symptoms) and event-based, and how these tools have been leveraged for disease modeling and forecasting. The authors also discuss benefits, challenges, and future directions for participatory disease surveillance.

RESULTS

There are at least 23 distinct participatory surveillance tools or programs represented in the IWOPS network across 18 countries. Organizations supporting these tools are diverse in nature.

CONCLUSIONS

Participatory disease surveillance is a promising method to complement both traditional, facility-based surveillance and newer digital epidemiology systems.