Electronic infectious disease surveillance in Sub-Saharan Africa

The ESIDA project involves an interdisciplinary research team that is developing an electronic health information and surveillance system to detect infectious disease outbreaks in Sub-Saharan Africa at an early stage and contain the uncontrolled spread of diseases.

Arzt mit einem Patienten

Digital data transfer enables real-time information exchange.

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Due to the increased human intervention in nature and advancing climate change, the size and number of regions that are at risk of infectious disease outbreaks is also increasing. In addition, global mobility can contribute to a quicker spread of diseases. The Covid-19 pandemic has shown how dangerous disease outbreaks can be if they are not detected at an early stage.

Health experts and policy-makers can therefore not afford to waste time and must work together to systematically contain infectious diseases. This requires the short-term pooling of information on the origins, characteristics and dynamics of the respective infectious disease. Digital communication technologies hold considerable potential for enabling the exchange of the required information. They can be used to rapidly collect and share information in real time, thus providing a basis for decision-makers to immediately initiate appropriate measures.

Developing countries often have limited capacities when it comes to robust systems for the electronic collection and monitoring of disease outbreaks. As a result, infections often spread unnoticed. The interdisciplinary research team behind the ESIDA (Epidemiological Surveillance for Infectious Diseases in Sub-Saharan Africa) project aims to change this by developing an electronic health information and monitoring system. It stands as a model of the Sub-Saharan region. The information collected on the rates of infection, symptoms and causes will increase the precision of diagnostics for the targeted treatment of patients, thus preventing the widespread outbreak of infectious disease.

Two approaches for collecting and pooling information

As a first step, the ESIDA team will determine whether the local infrastructure allows for the joint use of data. Information on the electricity supply, network coverage or use of mobile phones will serve to derive best practices for gathering and sharing information on disease outbreaks, including in areas that are difficult to reach and where access to health care is poor. Another aim is to develop health and non-health-related Open Data sources which support the surveillance and evaluation of local infection events.

The telecommunications infrastructure which has grown rapidly in the target region in recent years holds great promise, particularly with regard to mobile communications. A mobile communications system will be used as a network for first responders in the communities such as pharmacies and medical professionals as support for disease detection and treatment. This will enable the real-time processing and pooling of information collected on disease symptoms and causes via digital data transfer. Data protection is a key priority in this context: the team will gather as much information as necessary but as little as possible to raise awareness of data protection and increase the acceptance of similar projects in the region.

Apart from the mobile communications approach, the research team will combine information on infectious diseases with relevant contextual data regarding the affected region. For example, certain environmental incidents and demographic characteristics can provide more accurate information on the causes of a disease.

Schematische Darstellung der Umweltereignisse

These components for collecting, combining and assessing information will be studied individually and in their combination to develop new approaches of data-driven health information and surveillance systems for early detection of infectious outbreaks.

Juliane Bönecke

In order to identify the relevant characteristics at local level, the ESIDA team will conduct an epidemiological investigation in the affected region and consult scientific literature. Based on these knowledge sources, the researchers will compile the factors that influence emerging infectious diseases in the region. For example, certain environmental incidents or demographic characteristics can increase the occurrence of infections or accelerate their spread. The ESIDA team will focus on a number of model diseases in the initial stage. The data collected on the disease and its context is automatically evaluated using specific criteria to help medical stakeholders assess symptoms and improve their overall assessment of local infection outbreaks. The aim is to enable local stakeholders to use information across regions if an outbreak is confirmed so that physicians and political authorities can respond to the outbreak at an early stage.

Multi-level networking

The ESIDA project is carried out in collaboration between the Bernhard Nocht Institute for Tropical Medicine (BNITM), Hamburg University of Applied Sciences (HAW Hamburg), Universität Hamburg (University of Hamburg) (UHH) and the Medical Center Hamburg-Eppendorf (UKE) in Germany as well as the Nelson Mandela African Institution of Science and Technology (NM-AIST) and the East African Community (EAC) in Tanzania. They are working together to establish an interdisciplinary research and education network and share information on disease characteristics and opportunities of digital data transfer. As an intergovernmental organization, the EAC plays a key role in this project. During the demonstration phase, the research team will focus exclusively on Tanzania. After the successful conclusion of the project, the EAC will liaise with stakeholders in other countries in Sub-Saharan Africa to enable the transfer of the ESIDA project results.

In addition to creating a cross-border network, ESIDA brings together stakeholders who cooperate across disciplines, including epidemiology, clinical research, biosafety, public health, environmental sciences as well as computer and data sciences.

„In these times in particular, cooperation with local partners provides us with the great opportunity to learn our lesson from the current pandemic and work across disciplines. We are now seeing once again that humans, animals and the environment have an enormous impact on each other and that this plays a significant role in the emergence of infectious disease outbreaks. We would like to see that this awareness is sustained because it is only a matter of time until the next epidemic occurs“.

Juliane Bönecke from the ESIDA coordination team

Another focus of ESIDA: haemorrhagic fevers

In a first step, the ESIDA team will focus on so-called model diseases to develop its strategy. Model diseases are defined as infectious diseases with the potential for increased future outbreaks in the investigated region which have been the subject of sufficient international research. One example is haemorrhagic fevers such as dengue fever which is becoming increasingly relevant for public health in Sub-Saharan Africa due to advancing urbanization and climate change. Haemorrhagic fevers will therefore also be considered during the development of the information and surveillance system. In addition, the researchers will take diseases into account for which sufficient and easily accessible data has been collected so that the system developed by the team can be validated at a later date.