title: Collecting syndromic surveillance data by mobile phone in rural India: implementation and feasibility.
abstract: BACKGROUND
  Infectious disease surveillance has long been a challenge for countries like India, where 75% of the health care services are private and consist of both formal and informal health care providers. Infectious disease surveillance data are regularly collected from governmental and qualified private facilities, but not from the informal sector. This study describes a mobile-based syndromic surveillance system and its application in a resource-limited setting, collecting data on patients' symptoms from formal and informal health care providers.
  
  
  METHODS
  The study includes three formal and six informal health care providers from two districts of Madhya Pradesh, India. Data collectors were posted in the clinics during the providers' working hours and entered patient information and infectious disease symptoms on the mobile-based syndromic surveillance system.
  
  
  RESULTS
  Information on 20,424 patients was collected in the mobile-based surveillance system. The five most common (overlapping) symptoms were fever (48%), cough (38%), body ache (38%), headache (37%), and runny nose (22%). During the same time period, the government's disease surveillance program reported around 22,000 fever cases in one district as a whole. Our data - from a very small fraction of all health care providers - thus highlight an enormous underreporting in the official surveillance data, which we estimate here to capture less than 1% of the fever cases. Additionally, we found that patients from more than 600 villages visited the nine providers included in our study.
  
  
  CONCLUSIONS
  The study demonstrated that a mobile-based system can be used for disease surveillance from formal and informal providers in resource-limited settings. People who have not used smartphones or even computers previously can, in a short timeframe, be trained to fill out surveillance forms and submit them from the device. Technology, including network connections, works sufficiently for disease surveillance applications in rural parts of India. The data collected may be used to better understand the health-seeking behaviour of those visiting informal providers, as they do not report through any official channels. We also show that the underreporting to the government can be enormous.
authors.affiliation: Department of Public Health and Environment, R.D. Gardi Medical College, Ujjain, India.|International Center for Health Research, R.D. Gardi Medical College, Ujjain, India.|Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; vishaldiwan@hotmail.com.
authors.forename: Vishal
authors.initials: V
authors.lastname: Diwan
authors.affiliation: Department of Public Health and Environment, R.D. Gardi Medical College, Ujjain, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Agnihotri
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Anette
authors.initials: A
authors.lastname: Hulth
mesh_terms: D000328:Adult; D040421:Cell Phone; D003141:Communicable Diseases / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003625:Data Collection / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D062486:Public Health Surveillance / Q000379:methods*; D019035:Rural Health Services; D012424:Rural Population / Q000706:statistics & numerical data*
keywords: India; infections; informal providers; mobile technology; syndromic surveillance
references.citation: Soc Sci Med. 2013 Nov;96:297-304
references.pmid: 23484865
references.citation: J Glob Infect Dis. 2012 Apr;4(2):120-7
references.pmid: 22754248
references.citation: PLoS One. 2013;8(2):e54978
references.pmid: 23405101
references.citation: Emerg Infect Dis. 2013 Nov;19(11):1811-8
references.pmid: 24188144
references.citation: Indian J Med Res. 2011 Nov;134(5):627-38
references.pmid: 22199101
references.citation: BMC Public Health. 2010;10 Suppl 1:S11
references.pmid: 21143821
references.citation: Parasitology. 2012 Dec;139(14):1831-42
references.pmid: 22717001
references.citation: Health Policy. 2007 Dec;84(2-3):269-76
references.pmid: 17540472
references.citation: PLoS Med. 2008 Mar 25;5(3):e72
references.pmid: 18366250
references.citation: Lancet. 2011 Nov 26;378(9806):1833-4
references.pmid: 22118433
references.citation: BMC Public Health. 2009;9:242
references.pmid: 19607669
references.citation: Indian J Public Health. 2008 Jul-Sep;52(3):136-43
references.pmid: 19189835
references.citation: Qual Health Res. 2008 Jun;18(6):756-66
references.pmid: 18503017
references.citation: PLoS One. 2013;8(4):e62749
references.pmid: 23626853
references.citation: MMWR Recomm Rep. 2001 Jul 27;50(RR-13):1-35; quiz CE1-7
references.pmid: 18634202
references.citation: Health Policy. 2004 May;68(2):211-22
references.pmid: 15063020
references.citation: BMC Public Health. 2013;13:575
references.pmid: 23764137
references.citation: Health Policy. 2009 Nov;93(1):41-7
references.pmid: 19559495
references.citation: Indian J Public Health. 2010 Jul-Sep;54(3):131-6
references.pmid: 21245582