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

In 2013-14 CAR experienced a period of violent conflict between religious and ethnic communities which compromised the health care system, including the disease surveillance system as shown by changes in the level of completeness of disease reporting from 2011 to 2015 (Fig. 1) . In some districts of the country, that conflict continues to the present day, while in other districts, such as Mambéré-Kadéi (MK), tensions persist, but only scattered episodes of violence have occurred. During the period of the PAP study (2015-2016), differences in the level of security within the district of MK due to religious violence and non-targeted armed conflict were modest: higher in the more distant sub-districts of Gadzi and Amada Gaza (European Interagency Security Forum (EISF) risk level 'medium') and lower in those districts near to the district capital of Bérbérati (EISF risk level 'low') [12] .