Using mobile technology to optimize disease surveillance and healthcare delivery at mass gatherings: a case study from India's Kumbh Mela.
Planning for mass gatherings often includes temporary healthcare systems to address the needs of attendees. However, paper-based record keeping has traditionally precluded the timely application of collected clinical data for epidemic surveillance or optimization of healthcare delivery. We evaluated the feasibility of harnessing ubiquitous mobile technologies for conducting disease surveillance and monitoring resource utilization at the Allahabad Kumbh Mela in India, a 55-day festival attended by over 70 million people.



We developed an inexpensive, tablet-based customized disease surveillance system with real-time analytic capabilities, and piloted it at five field hospitals.



The system captured 49 131 outpatient encounters over the 3-week study period. The most common presenting complaints were musculoskeletal pain (19%), fever (17%), cough (17%), coryza (16%) and diarrhoea (5%). The majority of patients received at least one prescription. The most common prescriptions were for antimicrobials, acetaminophen and non-steroidal anti-inflammatory drugs. There was great inter-site variability in caseload with the busiest hospital seeing 650% more patients than the least busy hospital, despite identical staffing.



Mobile-based health information solutions developed with a focus on user-centred design can be successfully deployed at mass gatherings in resource-scarce settings to optimize care delivery by providing real-time access to field data.
Department of Medicine, Department of Epidemiology and Biostatistics, and Center for Vulnerable Populations, University of California, San Francisco, CA 94158, USA.|Division of Cardiology, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA.
Dhruv S
DS
Kazi
Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA02115, USA.
P Gregg
PG
Greenough
Capture Proof, San Francisco, CA94110, USA.
Rishi
R
Madhok
Department of Emergency Medicine, University of California, San Diego, CA92103, USA.
Aaron
A
Heerboth
Maharashtra Government Ministry of Health, Mumbai, Maharashtra400102, India.
Ahmed
A
Shaikh
Harvard TH Chan School of Public Health, Boston, MA 02115, USA.|FXB Center for Health and Human Rights, Harvard University, Cambridge, MA 02138, USA.
Jennifer
J
Leaning
Harvard TH Chan School of Public Health, Boston, MA 02115, USA.|FXB Center for Health and Human Rights, Harvard University, Cambridge, MA 02138, USA.|Weill Cornell Global Emergency Medicine Division, Weill Cornell Medicine, New York, NY 10065, USA.
Satchit
S
Balsari
D000293:Adolescent; D000328:Adult; D003139:Common Cold / Q000453:epidemiology; D034201:Computers, Handheld; D003371:Cough / Q000453:epidemiology; D003441:Crowding; D003695:Delivery of Health Care / Q000379:methods*; D003967:Diarrhea / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005334:Fever / Q000453:epidemiology; D006693:Holidays; D006801:Humans; D007194:India / Q000453:epidemiology; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000453:epidemiology; D011159:Population Surveillance / Q000379:methods*; D017216:Telemedicine / Q000379:methods*; D055815:Young Adult
Kumbh Mela; mHealth; mass gatherings; mobile phones; primary care; tablet; user-centered design
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