Outcomes of the Deployment of the Auto-Visual Acute Flaccid Paralysis Detection and Reporting (AVADAR) System for Strengthening Polio Surveillance in Africa From 2017 to 2018: Evaluation Study

Abstract

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.

Software Tools to Facilitate Community-Based Surveillance: A Scoping Review

“…After excluding 55 studies, 16 articles were selected for review (Supplement). [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses flow diagram to outline the screening process (Figure). 37 During review, an additional 3 articles found from the reference lists of the articles were also included.…”

Evaluating AVADAR Mobile Health Intervention Using a Multi-prong Approach

“…Routine AFP surveillance across most African countries has been fraught with challenges, often linked to limited access to hard-to-reach areas, inability of health workers to correctly and accurately identify AFP cases, poor reporting methods, as well as delays and bottlenecks associated with AFP surveillance data reporting(4) (5). The Auto-Visual AFP Detection and Reporting (AVADAR) application (app) is a digital health intervention designed and developed in 2016 by the Bill and Melinda Gates Foundation (BMGF), in conjunction with the World Health Organization (WHO), the Novel-T and the eHealth Africa (eHA) as a supplemental community surveillance system that harnesses SMS technology and automated alerting, and combines it with corresponding investigations by community informants (CIs) who are systematically and geographically selected for improved active case search and reporting of AFP cases (6) (7). The app, installed on the smartphones of health workers and community informants, widens the AFP surveillance network outside that of the priority reporting sites in order to improve the sensitivity and quality of AFP surveillance, more so in areas (particularly districts) with low performance indicators.…”