One million dog vaccinations recorded on mHealth innovation used to direct teams in numerous rabies control campaigns

Abstract

Background: Canine transmitted rabies kills an estimated 59,000 people annually, despite proven methods for elimination through mass dog vaccination. Challenges in directing and monitoring numerous remote vaccination teams across large geographic areas remain a significant barrier to the up-scaling of focal vaccination programmes to sub-national and national level. Smartphone technology (mHealth) is increasingly being used to enhance the coordination and efficiency of public health initiatives in developing countries, however examples of successful scaling beyond pilot implementation are rare. This study describes a smartphone app and website platform, "Mission Rabies App", used to co-ordinate rabies control activities at project sites in four continents to vaccinate over one million dogs.

Methods: Mission Rabies App made it possible to not only gather relevant campaign data from the field, but also to direct vaccination teams systematically in near real-time. The display of user-allocated boundaries on Google maps within data collection forms enabled a project manager to define each team's region of work, assess their output and assign subsequent areas to progressively vaccinate across a geographic area. This ability to monitor work and react to a rapidly changing situation has the potential to improve efficiency and coverage achieved, compared to regular project management structures, as well as enhancing capacity for data review and analysis from remote areas. The ability to plot the location of every vaccine administered facilitated engagement with stakeholders through transparent reporting, and has the potential to motivate politicians to support such activities.

Results: Since the system launched in September 2014, over 1.5 million data entries have been made to record dog vaccinations, rabies education classes and field surveys in 16 countries. Use of the system has increased year-on-year with adoption for mass dog vaccination campaigns at the India state level in Goa and national level in Haiti.

Conclusions: Innovative approaches to rapidly scale mass dog vaccination programmes in a sustained and systematic fashion are urgently needed to achieve the WHO, OIE and FAO goal to eliminate canine-transmitted human deaths by 2030. The Mission Rabies App is an mHealth innovation which greatly reduces the logistical and managerial barriers to implementing large scale rabies control activities. Free access to the platform aims to support pilot campaigns to better structure and report on proof-of-concept initiatives, clearly presenting outcomes and opportunities for expansion. The functionalities of the Mission Rabies App may also be beneficial to other infectious disease interventions.

Fig 1. Illustration of user access structure to data within the Mission Rabies App at different levels within existing projects in India.

Icons indicate how users interact with the system, by laptop or smartphone.

Fig 2. Example of data entry form as displayed on the smartphone handset.

‘RQ’ indicates a required field making entry of data compulsory before form completion.

Fig 3. Illustration of maps and data as viewed by the project manager on the web platform and smartphone handsets.

The project manager assigns coloured regions to vaccination teams in the web platform, shown here in the computer illustration. These regions are then displayed on each team’s smartphone and used to intensively work within that region (smartphone inserts). Once the region is complete, the project manager then reviews the uploaded vaccination data on maps in the web platform to decide where to direct teams to next. NB Due to the copyright of Google Maps used as basemaps in the Mission Rabies App and web platforms, maps have been recreated in QGIS for this illustration. Displayed boundaries were created by Mission Rabies during project planning.

Fig 4. Flow diagram showing flow of data through the web and smartphone systems.

Fig 5. Cumulative frequency of data entries from 01/11/2014 to 22/04/2018.

Fig 6. Map showing total number of app entries by country.

Created in R Studio using ggplot. Country boundaries are openly available from http://gadm.org.

Fig 7. Map showing the movement of two groups of education teams ahead of two vaccination teams in Goa from March to June 2017.

Created in QGIS using data from the Mission Rabies App. Goa administrative boundaries were recreated by Mission Rabies from government administrative maps.

Fig 8. Bar graph of annual number of entries recorded on the Mission Rabies App in Haiti, India and Malawi by year.