425. Performance of a Smartphone Application-Based Participatory Syndromic Surveillance System for Acute Febrile Illness and Acute Gastroenteritis in Rural Guatemala
Session: Poster Abstract Session: HAI: Epidemiologic Methods
Thursday, October 5, 2017
Room: Poster Hall CD
  • Smartphone poster IDWeek 2017 - Finalb.pdf (893.1 kB)
  • Background: We studied the performance of a smartphone application-based participatory syndromic surviellance (PSS) system for collecting syndromic data (acute febrile illness [AFI] and acute gastroenteritis [AGE]) to detect dengue virus (DENV) and norovirus (NoV) on a cohort of children living in a low-resource and rural area of Guatemala.

    Methods: Randomized households were provided with a smartphone and asked to submit weekly reports using a symptom diary Application (Vigilant-e). Subjects reporting AFI or AGE answered additional questions using a decision-tree algorithm and were visited at home by a study nurse who performed a second interview and collected samples for DENV (AFI) and NoV (AGE). We analyzed risk factors associated with decreased self-reporting of syndromic data and evaluated strategies to improve self-reporting. We also assessed agreement between self-report and nurse-collected data.

    Results: From 4/2015-6/2016, 469 children in 207 households provided 471 person-years of observation. Mean weekly symptom reporting rate was 78% (range: 58-89%). Households with a poor (<70%) reporting rate using the Vigilant-e application (n=57) had a greater number of children (mean=2.8 vs 2.5, risk ratio [RR]=1.2, 95%CI=1.1-1.4) and were less likely to use text messaging at study enrollment (61% vs 77%, RR=0.6, 95%CI=0.4-0.9). Parents of female subjects were more likely to have low response rate (57% vs 44%, RR=1.4, 95%CI=1.1-1.9). Poor response rate (<70%) was associated with decreased case reporting of AGE, NoV+ AGE, AFI, and DENV+ AFI (p<0.001). Parent smartphone-reported syndromic data agreed with nurse-collected data for fever (kappa=0.57, p<0.001), vomiting (0.63, p< 0.001), and diarrhea (0.61, p<0.001), with decreased agreement as the time interval between parental report and nurse home visit increased (<1 day kappa: 0.65-0.70; >2 day kappa: 0.08-0.29).

    Conclusion: In a resource-limited area of rural Guatemala, a smartphone application-based participatory syndromic surveillance system demonstrated a high reporting rate and good agreement between parental report and nurse report during home visits. Several household-level and external factors were associated with decreased syndromic reporting. Poor reporting rate was associated with decreased syndromic and pathogen-specific case ascertainment.

    Daniel Olson, MD1, Molly Lamb, PhD2, Maria Renee Lopez, PhD3, Kathryn Colborn, PhD4, Alejandra Paniagua-Avila, MD5, Alma Zacarias, MD6, Ricardo Zambrano, MS7, Sergio Rodriguez-Castro, BS7, Celia Cordon-Rosales, PhD3 and Edwin J. Asturias, MD8, (1)Center for Global Health, Colorado School of Public Health, Aurora, CO, (2)Center for Global Health and Department of Epidemiology, Colorado School of Public Health, Aurora, CO, (3)Universidad del Valle de Guatemala, Guatemala City, Guatemala, (4)Colorado School of Public Health, Aurora, CO, (5)Fundacion Salud Integral de los Guatemaltecos, Los Encuentros, Guatemala, (6)Centers for Disease Control and Prevention - Guatemala, Coatepeque, Guatemala, (7)Integra IT, Bogota, Colombia, (8)Department of Infectious Disease, Children's Hospital Colorado/University of Colorado School of Medicine, Aurora, CO


    D. Olson, Takeda Pharmaceuticals: Consultant , Grant recipient

    M. Lamb, None

    M. R. Lopez, None

    K. Colborn, None

    A. Paniagua-Avila, None

    A. Zacarias, None

    R. Zambrano, Integra IT: Employee and Shareholder , Salary

    S. Rodriguez-Castro, Integra IT: Employee and Shareholder , Salary

    C. Cordon-Rosales, None

    E. J. Asturias, Takeda Pharmaceuticals: Consultant and Grant Investigator , Grant recipient

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.