SMS-based smartphone application for disease surveillance has doubled completeness and timeliness in a limited-resource setting – evaluation of a 15-week pilot program in Central African Republic (CAR)

El-Khatib, Ziad; Shah, Maya; Zallappa, Samuel N; Nabeth, Pierre; Guerra, José; Manengu, Casimir T; Yao, Michel; Philibert, Aline; Massina, Lazare; Staiger, Claes-Philip; Mbailao, Raphael; Kouli, Jean-Pierre; Mboma, Hippolyte; Duc, Geraldine; Inagbe, Dago; Barry, Alpha Boubaca; Dumont, Thierry; Cavailler, Philippe; Quere, Michel; Willett, Brian; Reaiche, Souheil; de Ribaucourt, Hervé; Reeder, Bruce

Since 1998, the World Health Organization (WHO) Regional Office for Africa and Member States have adopted the Integrated Disease Surveillance and Response (IDSR) strategy [1] . The Technical Guidelines to support this strategy emphasize the identification of priority diseases using standardized case definitions, reporting mechanisms, epidemiological data analysis and field investigation, outbreak response, communication and feedback [1] . Completeness and timeliness of disease reporting are essential attributes of an effective disease surveillance system [1] [2] [3] . Yet, in low-resource settings it is challenging for health facilities to deliver paper-based surveillance reports to national authorities in a timely manner [4, 5] . Smartphone applications (known as apps) have been developed to support data transmission between health facilities and district offices in a number of low-income countries, including several in sub-Saharan Africa [2, 6, 7] . Apps have the potential to improve surveillance [8, 9] and to hasten control of potential epidemics. To our knowledge, apps have been used to collect and transmit data on a limited number of diseases [3, 5, 7] or in an emergency context [10, 11] but not on a large portfolio of health conditions in a context of post-conflict insecurity. This report describes the implementation and evaluation of an app surveillance system for the notification of Alerts and transmission of Weekly Reports on 20 conditions from 21 health facilities in the southwestern part of Central African Republic (CAR), in a pilot study entitled "Projet d'Alerte Précoce" (PAP; Early Warning Project, in French).