Communities now lead fight against outbreak of diseases

Morogoro. Whenever a potential threat of an epidemic, such as cholera or Ebola looms in Tanzania or in a neighboring country, the government is always quick to ask people to report any suspected cases for interventions.

However, not many community members know well how and when to report such cases.

Now, as mobile phone penetration continues to take root in the country and beyond, scientists at Morogoro–based Southern African Centre for Infectious Disease Surveillance (Sacids) believe that it is now imperative to build capacity of the public on how to use smartphones to detect and report potential life-threatening disease outbreaks.

“Smart phones could be a great asset in detecting unusual diseases,” says the Sacids Executive Director, Prof Mark Rweyemamu.

“In Africa, this technology is being used for transferring money, but we’re not putting enough investment in revolutionising disease surveillance. We should consider it as the primary means of surveillance,” he said.

Last Thursday, when the Sokoine University of Agriculture (SUA) launched a digital application, AfyaData, which can be used by communities to report any suspected cases of infectious diseases, Prof Rweyemamu revealed why Tanzania is better placed to combat epidemics.

“Looking at Tanzania’s political and administrative set up, it’s possible to save our country from any possible outbreak of epidemics. Our country has leaders up to the grassroots,’’ said Prof Rweyemamu, a veterinary expert with keen interest in major animal infectious diseases, which are known as transboundary animal diseases.

So far, there are over 400 community members and researchers who have demonstrated how a network of people in communities can apply digital technology to detect infectious diseases, thanks to ongoing research and innovation by Sacids scientists.

Currently, this is taking place in five districts of the country: Ulanga, Kibaha, Malinyi, Kilosa and Ngorongoro.

How it works

A Sacids communications specialist, Mr Yunus Karsani, disclosed that a team of experts were stationed in an office where they monitor information reported by communities through a digital system. “Through this system, experts can detect an outbreak somewhere in the country and alert the authorities to intervene,’’ he told The Citizen.

But, the information has to be scrutinised, he says. “For example. If a person reports one case of profuse diarrhea and vomiting in human beings, it may not trigger an outbreak.

However, if we receive five such cases from the same area through a community health worker, this may be an indication of an outbreak,’’ he explained.

It is here that the system may deduce the most probable diagnosis and send alerts to the relevant authority through a pre-authored message that can also be sent to community reporters to help contain the outbreak, says Karsani.

Ebola or bird flu detection

Mr Karsani says that the experts can detect a possible outbreak of Ebola through the data being fed by the community members from the field.

Whenever data indicates cases of profuse diarrhea and vomiting with, say, bleeding from body openings or when birds die somewhere, this, according to him, can alert the experts of an outbreak of Ebola or avian influenza, respectively.

The App, which the users in communities can download from Google Play store, can be used to provide details that can be organised to provide the location of a problem via GPS. It can also provide the data on the extent of the problem depending on the amount of details that people in communities can feed.

Countries such as Uganda, Kenya and Thailand have showed interest to import the technology from Tanzania. The Democratic Republic of Congo (DRC), where an outbreak of Ebola has so far claimed over 27 lives, aims at borrowing the surveillance digital App and the expertise from SUA in order to get rid of the deadly epidemic once and for all.

To develop the technology, the researchers at SUA in collaboration with Sacids secured a $450,000 funding from a US-based organisation, Ending Pandemics, and the technology was developed by a team of animal, human and ICT specialists.

SUA Vice Chancellor Prof Raphael Chibunda says the development of the App is part of the university’s contribution to the country’s preparedness to combat threatening epidemics such as Rift Valley Fever, Ebola and other diseases that can spread from animals to humans.

He believes that emerging and re-emerging outbreaks can be contained by communities, but only if they are empowered to be on the frontline through communications networks.

Why animals to humans

For over the past three decades, research evidence shows that 75 per cent of all emerging infectious diseases that have affected humans originated from animals. They include HIV, Ebola, malaria and rabies, to name but a few.

Many of these diseases originated in Africa, where they continue to claim the lives of people, exacerbated by poverty, malnutrition and poor health facilities.

Yet Africa remains a continent that falls far short of infrastructure and resources needed to detect, monitor, control and prevent disease outbreaks effectively and efficiently.

Many parts of the continent, including Tanzania also lack health services needed to build local, national and regional resilience to disease outbreaks.

The other challenging fact is that the site of a disease outbreak is often in rural areas, a long way from health facilities, most of which are concentrated in towns and cities. Poor education and inconsistent communication systems can prevent information about disease outbreaks from reaching those able to diagnose and advise the local communities.

Due to this, the outbreaks of diseases often go undetected or misdiagnosed, which leads to terrible fatal effects.

That is why the experts believe that better education and communication tools such as radio and smart phones are now crucial in improving communication between the local communities and health centres, and making disease detection and prevention more robust.

Since 2008, the researchers at Sacids have been working to overhaul Africa’s capacity for detecting and preventing diseases.

They have been employing the One-Health approach, where animal, human and environmental health are tackled together, believing that they are increasingly getting interconnected.

Low cost devices

There is a notion that epidemiology and disease prevention are expensive and requires high-tech laboratories and specialist equipment, however, the Sacids researchers say there are many ways of overhauling Africa’s capacity of controlling the outbreaks at a low cost.

For the past few years, smart phone prices in Tanzania and the rest of Africa have been going down steadily. This has driven a digital revolution in many parts of the world. By 2015, almost half of the African population (557 million) subscribed to mobile services, according to reports.

The experts are now projecting that there will be 720 million smartphone users – 57 per cent of the population – by 2020.

More so, Africa has been a forerunner in using mobile technology to transform money transfer. Of the top 20 countries using mobile money transfer technology, 15 are in Africa and the Kenyan tool, M-Pesa, has taken East Africa by storm.

However, what does this mobile phone growth mean in terms of improving people’s wellbeing?

Sacids scientists have been researching on the best ways to harness smartphones to improve disease detection and control for years. They have been working with certain vulnerable groups to improve access to public health supported by mobile technology, including the Maasai in Kenya and Tanzania.

Life on the frontline

One group severely affected by climate change and diseases that spread from animals to humans (zoonotic disease) are the Maasai. The Maasai lead a semi-nomadic life, shifting from one place to another with their herds of cows, goats and sheep in search of food, water, in areas extending between borders of Kenya and Tanzania.

Visiting their communities, one gets a sense of how lives of the Maasai, their livestock, wildlife and the broader environment are intimately linked and interdependent.

They have a unique way of life, however, this faces numerous threats. Climate change is altering weather patterns and access to water considering that the region has experienced severe droughts in recent years.

In 2016, El Niño caused heavy early rains followed by severe drought, something that led to outbreaks of human and animal diseases.

Urban development is encroaching on Maasai lands and migration routes, and competition of limited grazing and water is intensifying. This has forced the pastoralists to move closer to the wildlife and this triggers the outbreaks of diseases.

Cultural practices

Their cultural practices further expose them to zoonotic diseases. Livestock trading and consumption is central to the Maasai culture.

The Maasai are known for drinking unpasteurized milk and eating undercooked meat, which exposes them to diseases like Rift Valley Fever.

Many are forced to travel long distances to sell their animals at markets and often cross national borders. This, at times is linked to differences in the quality and extent of health services in Tanzania and Kenya. What happens at markets? Animals are slaughtered at the market and then body parts contaminated with parasites are dumped randomly where they are often eaten by dogs, which then carry parasites to the communities.

Solution

The answer to their problems, according to Prof Rweyemamu, lies in the palm of their hands—the mobile phones.

Prof Rweyemamu and his team believe that the Maasai’s knowledge of diseases, disease vectors and climate is extensive, spanning centuries of indigenous experience. However, some diseases are better treated with conventional medicine.

Most of the Maasai are unable to access drugs for animals or humans reliably because of their nomadic lifestyle, which makes them rely on herbs, most of which are ineffective in the long run. Most Maasai live in rural areas, far from labs and specialist equipment for detecting and diagnosing disease. One solution to closing this communication gap and increasing public education about diseases lies in the smartphone.

Mobile phones, an urban issue?

Until recently, mobile phones were being regarded as an urban phenomenon. But, this is no longer the case. Details availed to The Citizen by Sacids show that about 40 per cent of the Maasai own mobile phones, mostly cheap smartphones imported from China.

These phones, the experts say, may be cheap, but have the power to transform the Maasai’s ability to detect, report and treat diseases, potentially preventing large outbreaks and safeguarding human lives and livestock.

How they do it

When they suspect a disease outbreak, the Maasai can use their smartphones to photograph an animal’s symptoms and send these images to health experts for analysis and, if necessary, assistance.

These experts can then diagnose the disease and respond to the Maasai’s messages with suggestions for treatment, control and future prevention.

Now, with the development of Afyadata manager, which was launched in Morogoro last week, it means the process becomes easier. So, a Maasai can send the data in the smartphone-based tool that analyses field data and then sends feedback to the data collector where it is analysed immediately. The system is intelligent enough to detect any abnormal pattern: if an abnormal pattern is discovered, an alert is then sent to higher authorities.

This is an open source tool other institutions and governments can download, adapt and use it easily, and for free.

This, according to Mr Karsani, knocks out the need for diagnostics via complex laboratories and expensive transport and resources. Yet, the long distances between rural grazing spots and urban clinics are minimised.

This, instead, works through a click of a camera phone and a message. These distances are no longer a barrier to disease detection and control.

One health approach saves

Health services in many countries across Africa are underfunded, poorly equipped and fall far short of the basics needed to serve a rapidly growing population.

Decades of underfunding, poor transport networks, outdated equipment, substandard facilities and inadequate drug supplies have left many health services in a woeful state.

Low budgets and political short-termism lead many governments to resist funding health systems and disease research properly until they are forced to – that is, until a crisis occurs.

The Ebola crisis of 2014-2016 is one example of this. The outbreak revealed the devastation wrought when governments fail to ensure robust health systems and local mechanisms for detecting and monitoring disease.

The World Bank estimates the West African Ebola epidemic cost Guinea, Liberia and Sierra Leone $1.6 billion. It also leaves African countries relying on external organizations to carry out disease research.

“The natural reaction is to react to a catastrophe rather than prevent a catastrophe. But prevention is far cheaper and safer for all,” says Prof – Professor Rweyemamu.