title: Integrating malaria surveillance with climate data for outbreak detection and forecasting: the EPIDEMIA system.
abstract: Early indication of an emerging malaria epidemic can provide an opportunity for proactive interventions. Challenges to the identification of nascent malaria epidemics include obtaining recent epidemiological surveillance data, spatially and temporally harmonizing this information with timely data on environmental precursors, applying models for early detection and early warning, and communicating results to public health officials. Automated web-based informatics systems can provide a solution to these problems, but their implementation in real-world settings has been limited.
  
  
  
  The Epidemic Prognosis Incorporating Disease and Environmental Monitoring for Integrated Assessment (EPIDEMIA) computer system was designed and implemented to integrate disease surveillance with environmental monitoring in support of operational malaria forecasting in the Amhara region of Ethiopia. A co-design workshop was held with computer scientists, epidemiological modelers, and public health partners to develop an initial list of system requirements. Subsequent updates to the system were based on feedback obtained from system evaluation workshops and assessments conducted by a steering committee of users in the public health sector.
  
  
  
  The system integrated epidemiological data uploaded weekly by the Amhara Regional Health Bureau with remotely-sensed environmental data freely available from online archives. Environmental data were acquired and processed automatically by the EASTWeb software program. Additional software was developed to implement a public health interface for data upload and download, harmonize the epidemiological and environmental data into a unified database, automatically update time series forecasting models, and generate formatted reports. Reporting features included district-level control charts and maps summarizing epidemiological indicators of emerging malaria outbreaks, environmental risk factors, and forecasts of future malaria risk.
  
  
  
  Successful implementation and use of EPIDEMIA is an important step forward in the use of epidemiological and environmental informatics systems for malaria surveillance. Developing software to automate the workflow steps while remaining robust to continual changes in the input data streams was a key technical challenge. Continual stakeholder involvement throughout design, implementation, and operation has created a strong enabling environment that will facilitate the ongoing development, application, and testing of the system.
authors.affiliation: Geospatial Sciences Center of Excellence, South Dakota State University, Brookings, SD, USA.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Merkord
authors.affiliation: Department of Electrical Engineering and Computer Science, South Dakota State University, Brookings, SD, USA.
authors.forename: Yi
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Health, Development, and Anti-Malaria Association, Addis Ababa, Ethiopia.
authors.forename: Abere
authors.initials: A
authors.lastname: Mihretie
authors.affiliation: Amhara National Regional State Health Bureau, Bahir Dar, Ethiopia.
authors.forename: Teklehaymanot
authors.initials: T
authors.lastname: Gebrehiwot
authors.affiliation: School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia.
authors.forename: Worku
authors.initials: W
authors.lastname: Awoke
authors.affiliation: Health, Development, and Anti-Malaria Association, Addis Ababa, Ethiopia.
authors.forename: Estifanos
authors.initials: E
authors.lastname: Bayabil
authors.affiliation: Geospatial Sciences Center of Excellence, South Dakota State University, Brookings, SD, USA.
authors.forename: Geoffrey M
authors.initials: GM
authors.lastname: Henebry
authors.affiliation: Gamby College of Medical Science, Bahir Dar, Ethiopia.
authors.forename: Gebeyaw T
authors.initials: GT
authors.lastname: Kassa
authors.affiliation: Amhara National Regional State Health Bureau, Bahir Dar, Ethiopia.
authors.forename: Mastewal
authors.initials: M
authors.lastname: Lake
authors.affiliation: Geospatial Sciences Center of Excellence, South Dakota State University, Brookings, SD, USA. michael.wimberly@sdstate.edu.
authors.forename: Michael C
authors.identifier: 0000-0003-1549-3891
authors.initials: MC
authors.lastname: Wimberly
mesh_terms: D002980:Climate; D004196:Disease Outbreaks; D062665:Epidemiological Monitoring; D005002:Ethiopia / Q000453:epidemiology; D005544:Forecasting; D006801:Humans; D008288:Malaria / Q000453:epidemiology* / Q000469:parasitology; D011159:Population Surveillance / Q000379:methods*; D012984:Software
keywords: Early detection; Early warning; Environmental data; Forecasting; Malaria informatics system; Remote sensing; Risk map; Surveillance