For the World Health Organization (WHO) and ministries of health working to combat and forever put an end to the debilitating poliovirus, access to accurate and time-sensitive information makes a world of difference. ODK is currently being used by WHO and governments in several countries across WHO's Eastern Mediterranean and Africa Regions, including Jordan, Somalia, and South Sudan, as a key tool in mass polio vaccination campaign quality control.
Although these countries are now officially 'polio free', they are considered to be at high risk of reinfection. Deteriorating health systems and disruption to routine immunization services due to conflict and insecurity in many countries in these Regions continue to create gaps in population immunity against polio. High levels of population movement, including the displacement and movement of millions of people across borders, continues to increase risks of polio importation. To safeguard children, therefore, WHO and governments in these Regions are working to boost and maintain immunity levels against the virus through mass supplementary immunization activities, or vaccination campaigns. And ODK is helping them do that.
At the heart of the Middle East, Jordan hosts hundreds of thousands of refugees from Syria -- a country with a shattered health system and suboptimal immunization coverage. Since the outbreak of polio in Syria in late 2013, after 15 years of absence in the Middle East, WHO has supported the Ministry of Health of Jordan (and other neighboring countries) in carrying out national and subnational vaccination campaigns to repeatedly reach millions of children across the country, irrespective of nationality, with oral polio vaccine. To ensure maximum coverage, during and after campaigns, independent monitors visit samples of households to gauge whether any child under five years of age was not vaccinated, and if not, why. This information, collected through a customized ODK survey, is crucial as it informs targeted 'mop-up' campaigns to reach missed children. Reasons for non-vaccination are also recorded to inform strategic public communications.
Jordanian Royal Medical Services and WHO conduct post-campaign monitoring in Amman, Jordan, using mobile tablets with ODK. Photo courtesy of Emma Sykes, WHO.
"Polio is highly virulent and can spread very quickly," said Dr. Fuad Shamsan, polio technical officer for WHO Jordan. "Missed children, particularly pockets of missed children, pose a real threat as they may be non- or under-immunized and therefore vulnerable to infection. This also allows the virus to circulate," he said. "Through campaign monitoring using mobile tablets equipped with ODK, we can easily collect geographic, demographic, and behavioral data and securely and instantly share this with relevant partners to organize swift and appropriate follow-up action. This technology has helped us determine where to focus our efforts, so that we reach as many children as possible in campaigns," he added.
Outside of the Middle East, in Somalia and South Sudan, polio is also but a recent memory. Following an explosive outbreak in the Horn of Africa in April 2013, these countries have remained on high alert, and have continued to conduct repeat campaigns and rigorous monitoring. ODK has been a welcome technological advancement.
"This new system of data collection replaces a paper-based system and has had a number of benefits for the polio program [in Somalia and South Sudan]," said Mohammad Mohammedi, polio technical support officer based in WHO's Regional Centre for Emergencies and Polio Eradication in Amman. "Given the sheer number of children that polio teams must reach, and the corresponding amounts of data to be collected, cleaned, and manually transferred into central databases, human error was considerable. ODK has helped us minimize this error through standardized method of data collection and survey responses, and has sped up information transfer making coordination of campaigns and the job of vaccinators a whole lot easier. In short, the software is saving us valuable time and helping to improve campaign effectiveness," he said.
Given success with use of the software to date, WHO and health partners are looking at how they can expand applications of ODK for polio and other health interventions in its Eastern Mediterranean Region. Afghanistan and Pakistan -- the two countries in the world where polio remains endemic -- recently adopted the use of ODK in their monitoring of vaccination campaigns. Jordan has successfully piloted and rolled out a tablet-based, ODK-driven approach to patient data collection which allows for automatic generation of early warning alerts for cases of priority communicable diseases including acute flaccid paralysis -- a major indicator for polio. It is hoped that other countries in the region will adopt similar systems.
"We'd like to thank Nafundi [funded by a grant from the Gates Foundation] for their support of our projects utilizing ODK, and for joining in the fight against polio," said Mohammedi. "Until virus transmission is stopped in Afghanistan and Pakistan, countries remain at risk, and this type of innovative support to the program is greatly appreciated," he said.
WHO Jordan has also used ODK for case-based, integrated disease surveillance of mental health, non-communicable, and communicable diseases. Watch this video to learn more.