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 (Preprint)

Abstract

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