Participatory Surveillance of COVID-19 in Lesotho via Weekly Calls: Protocol for Cell Phone Data Collection

Abstract

Background The increase in cell phone ownership in low- and middle-income countries (LMIC) has created an opportunity for low-cost, rapid data collection by calling participants on their cell phones. Cell phones can be mobilized for a myriad of data collection purposes, including surveillance. In LMIC, cell phone–based surveillance has been used to track Ebola, measles, acute flaccid paralysis, and diarrheal disease, as well as noncommunicable diseases. Phone-based surveillance in LMIC is a particularly pertinent, burgeoning approach in the context of the COVID-19 pandemic. Participatory surveillance via cell phone could allow governments to assess burden of disease and complements existing surveillance systems. Objective We describe the protocol for the LeCellPHIA (Lesotho Cell Phone PHIA) project, a cell phone surveillance system that collects weekly population-based data on influenza-like illness (ILI) in Lesotho by calling a representative sample of a recent face-to-face survey. Methods We established a phone-based surveillance system to collect ILI symptoms from approximately 1700 participants who had participated in a recent face-to-face survey in Lesotho, the Population-based HIV Impact Assessment (PHIA) Survey. Of the 15,267 PHIA participants who were over 18 years old, 11,975 (78.44%) consented to future research and provided a valid phone number. We followed the PHIA sample design and included 342 primary sampling units from 10 districts. We randomly selected 5 households from each primary sampling unit that had an eligible participant and sampled 1 person per household. We oversampled the elderly, as they are more likely to be affected by COVID-19. A 3-day Zoom training was conducted in June 2020 to train LeCellPHIA interviewers. Results The surveillance system launched July 1, 2020, beginning with a 2-week enrollment period followed by weekly calls that will continue until September 30, 2022. Of the 11,975 phone numbers that were in the sample frame, 3020 were sampled, and 1778 were enrolled. Conclusions The surveillance system will track COVID-19 in a resource-limited setting. The novel approach of a weekly cell phone–based surveillance system can be used to track other health outcomes, and this protocol provides information about how to implement such a system. International Registered Report Identifier (IRRID) DERR1-10.2196/31236

Comparison of Influenza-Like Illness (ILI) incidence data from the novel LeCellPHIA participatory surveillance system with COVID-19 case count data, Lesotho, July 2020 – July 2021

“…Beginning July 15, 2020, interviewers called participants weekly and asked whether they or any member of their household had experienced Influenza-Like Illness (ILI) symptoms (fever, dry cough, shortness of breath) over the past week. The response rate for this 12-month period was 75% and weekly response rates ranged from 68 to 88% [ 19 ].…”

Participatory Disease Surveillance for the Early Detection of Cholera-Like Diarrheal Disease Outbreaks in Rural Villages in Malawi: Prospective Cohort Study

“…Additionally, IVR technology is cost-effective and has the potential to improve disease surveillance and control efforts in low-income settings [35][36][37]. Furthermore, it is an easy-to-use technology that requires minimal training and can reach a wide range of people, including those in remote and rural areas, where access to healthcare and traditional disease surveillance methods may be limited.…”

“…PS using interactive voice response (IVR) technology is a promising approach for disease surveillance in rural villages in Africa for collecting timely and comprehensive data on disease incidence, symptoms, and behaviors in resource-limited settings [ 34 , 35 ]. Additionally, IVR technology is cost-effective and has the potential to improve disease surveillance and control efforts in low-income settings [ 35 - 37 ]. Furthermore, it is an easy-to-use technology that requires minimal training and can reach a wide range of people, including those in remote and rural areas, where access to health care and traditional disease surveillance methods may be limited.…”