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

The main page of the app (Fig. 2 ) displays four tabs: to activate the Alert, Weekly Report, Monthly Report, and Archive functions; the Monthly Report function was not utilized in this pilot. The electronic format of the Alert and Report functions was developed to mirror the existing paper-based disease surveillance report forms in French and designed with a graphical user interface to facilitate data entry, reduce typing, and ensure zero-reporting ( Fig. 2b ) [16] . Once data has been entered in all 40 required fields (case and death numbers for 20 conditions), users have simply to touch the Submit Report tab (paper airplane icon), and the notifications are sent in the form of 20 individual SMS, in a predetermined standardized format using a comma separator to the server which visually displays the data on a dashboard (Fig. 3 ). Only reports with data entered in all fields (including the reporting of zeros) are able to be sent by the app. All Alerts and Weekly Reports were reviewed by the Director of Surveillance as soon after receipt as possible. Weekly reports were considered: i) Complete if case and death numbers for all 20 conditions were received in the server; ii) Incomplete when some, but not all, of the information on the 20 conditions were received by the server; iii) Rejected if the Director of Surveillance identified an error in the reports after reviewing them and checking the details of suspected cases with the respective health center by means of an open text SMS or telephone call; or iv) Validated when the content of completed reports was deemed to be correct by the Director of Surveillance. With respect to Alerts, the Director of Surveillance investigated the reported cases by telephone with the reporting health facility, however validation of Alerts is not a step included in the app.