Background As we move toward a polio-free world, the challenge for the polio program is to create an unrelenting focus on smaller areas where the virus is still present, where children are being repeatedly missed, where immunity levels are low, and where surveillance is weak. Objective This article aimed to describe a possible solution to address weak surveillance systems and document the outcomes of the deployment of the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) project. Methods This intervention was implemented in 99 targeted high-risk districts with concerns for silent polio circulation from eight countries in Africa between August 1, 2017, and July 31, 2018. A total of 6954 persons (5390 community informants and 1564 health workers) were trained and equipped with a smartphone on which the AVADAR app was configured to allow community informants to send alerts on suspected acute flaccid paralysis (AFP) and allow health worker to use electronic checklists for investigation of such alerts. The AVADAR and Open Data Kit ONA servers were at the center of the entire process. A dashboard system and coordination teams for monitoring and supervision were put in place at all levels. Results Overall, 96.44% (24,142/25,032) of potential AFP case alerts were investigated by surveillance personnel, yielding 1414 true AFP cases. This number (n=1414) reported through AVADAR was higher than the 238 AFP cases expected during the study period in the AVADAR districts and the 491 true AFP cases reported by the traditional surveillance system. A total of 203 out of the 1414 true AFP cases reported were from special population settings, such as refugee camps and insecure areas. There was an improvement in reporting in silent health areas in all the countries using the AVADAR system. Finally, there were 23,473 reports for other diseases, such as measles, diarrhea, and cerebrospinal meningitis, using the AVADAR platform. Conclusions This article demonstrates the added value of AVADAR to rapidly improve surveillance sensitivity. AVADAR is capable of supporting countries to improve surveillance sensitivity within a short interval before and beyond polio-free certification.
Background The Auto-Visual AFP Detection and Reporting (AVADAR) digital health intervention programme is a programme that was introduced to Africa in 2016. The programme adopts the use of the AVADAR SMS – based smartphone application (app) in community-based AFP surveillance activities in order to enhance the detection and reporting of AFP (polio) cases and improve AFP surveillance quality. As at 2020, the AVADAR application is being used in 11 African countries. The need to conduct regular and relevant evaluations of the AVADAR programme is very essential towards improving polio eradication programme performance and effectiveness in Africa. Hence, this study aimed to review and evaluate the quality of the AFP cases reported through the AVADAR intervention and as well evaluate the documentation process of AVADAR alerts and investigations, and the assimilation of AFP cases found via AVADAR into the national databases. Methods This study reviewed and evaluated the quality of AVADAR-involved AFP case reporting and documentation process in 7 of the 11 African countries implementing the AVADAR programme (Cameroon, Chad, the DRC, Liberia, Mali, Niger, and South Sudan). Case validations of all AFP cases reported via AVADAR app, iterations of methods used for peer reviewing AVADAR reporting and documentation, informal interview of community informants (CIs) and health workers (HWs), as well as the development of interactive dashboard to showcase the results of peer reviews, were the approaches used for the review and evaluation process. Results Thirty-nine districts, cutting across the participating 7 African countries were selected for the study. A total of 581 AFP cases were reviewed in the selected districts; of which 496 AFP cases were physically seen with 384 cases confirmed as true AFP cases by the peer reviewers. Thematic findings obtained the interview with CIs and HWs identified key areas (communication, multi-disease reporting, and periodic evaluation) that needs to be improved in the AVADAR surveillance system. Also, the interactive dashboard gave a summary of the peer review outcomes at few glances. Conclusions The findings of the AVADAR AFP peer reviews revealed the app’s efficacy in reporting AFP cases and improving surveillance indicators at district level. However, its documentation at health facility level needs to be re-emphasized and improved via a systematic accountability framework implementation for the actors in the reporting cycle. In order to significantly improve AFP surveillance, we recommend on-going commitment to improve knowledge and collaboration between all AVADAR surveillance reporting teams involved in identifying children presenting with AFP. Keywords: AVADAR, Mobile Health, Peer Review, Acute Flaccid Paralysis, surveillance , Africa
BACKGROUND Acute Flaccid Paralysis (AFP) surveillance is the bedrock of polio case detection. The Auto Visual AFP Detection and Reporting (AVADAR) is a digital health intervention designed as a supplemental community surveillance system. OBJECTIVE This paper describes the design and implementation process that made AVADAR a successful disease surveillance strategy at the community level. METHODS This paper outlines the methods for the design and implementation of the AVADAR application. It explains the co-design of the application, the implementation of a helpdesk support structure, the process involved in trouble shooting the application, the benefits of utilizing a closed user group for telecommunication requirements, and the use of a consented video. We also describe how these features combined led to user acceptance testing using black box methodology. RESULTS A total of 198 community informants across two provinces, four districts and 32 settlements were interviewed about application performance, usability, security, load, stress and functionality testing black box components. The responses showed most community participants giving positive reviews. Data from the Blackbox testing yielded optimum acceptance ratings from over 90% of the users involved in the testing. A total of 22380 AFP Alerts were sent out by community informants and 21589 (95%) were investigated by health workers or WHO AVADAR coordinators. Overall there was 93% assimilation at regional level. About 83% of investigations were done in the vicinity of the alerts in 2018 compared to 77% in 2017. CONCLUSIONS AVADAR implementation model offers a simplistic step by step model that includes community participation as an integral tool for the successful deployment of a mobile based surveillance reporting tool. AVADAR can be a veritable source of project planning data and a mobile application for other interventions that target using community participation to influence health outcomes.
BACKGROUND As the world moves towards a polio free world, the challenge for the Polio Programme now is to create an unrelenting focus on the smaller areas where the virus is still present, where children are being repeatedly missed, where immunity levels are low, and where surveillance is weak OBJECTIVE This article describes one possible solution to address weak surveillance systems and documents the outcomes of the deployment of the Auto-Visual AFP Detection and Reporting (AVADAR) project. METHODS This intervention was implemented in 99 targeted high-risk districts with concerns for silent polio circulation, in eight countries in Africa between 1st August 2017 and 31st July 2018. A total of 6954 persons; 5390 community informants and 1564 health workers were trained and equipped with a smart phone on which the AVADAR application was configured to facilitate Community Informants (CI) sending alerts on suspected AFP and health workers’ use of electronic checklists for investigation of such alerts. The AVADAR and ONA servers were at the center of the entire process. A dashboard system and coordination teams for monitoring and supervision were put in place at all levels RESULTS A total of 96% of potential AFP case alerts were investigated by surveillance personnel yielding 1414 true AFP cases. This number (1414) reported through AVADAR was higher than the 238 AFP cases expected during the study period in the AVADAR districts and the 491 true AFP cases reported by the traditional surveillance system. A total of 203 out of the 1414 true AFP cases reported were from special population settings such as refugee camps and insure areas. There was an improvement in reporting in silent health areas in all the countries conducting AVADAR . Finally there were a total of 23473 reports for other diseases such as measles, diarrhoea and cerebrospinal meningitis using the AVADAR platform. CONCLUSIONS This premiere article demonstrates the added value of AVADAR to rapidly improve surveillance sensitivity. AVADAR is therefore capable of supporting countries to improve surveillance sensitivity within a short time interval before and beyond polio- free certification
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