Feasibility of Electronic Health Information and Surveillance System (eHISS) for disease symptom monitoring: A case of rural Ghana

<div><p>Introduction</p><p>The current surge of mobile phone use in many African countries creates the opportunity to provide caregivers with limited access to the health care system with vital health recommendations. At the same time such communication system can be utilised to collect tempero-spatial data on disease symptoms.</p><p>Objective</p><p>We assessed the feasibility of an mHealth system among caregivers with children under-five years, designed as a health information and surveillance tool in a rural district of Ghana.</p><p>Methods</p><p>A mobile phone-based <i>electronic health information and surveillance system</i> was piloted from February to December 2015. Toll-free numbers were provided to 1446 caregivers, which they could call to receive health advice in case their children showed disease symptoms. The system was setup to evaluate the illness of a sick child. Symptoms reported via the system were evaluated and compared to clinician’s report after follow-up. Cogency of the reported symptoms was assessed using Cohen’s kappa coefficient.</p><p>Results</p><p>A total of 169 children with disease symptoms were identified based on phone calls from caregivers. The predominant reported symptoms were fever (64%; n = 108), cough (55%; n = 93) and diarrhoea (33%; n = 55). Temporal pattern of symptomatic cases revealed a peak saturation in the month of September, with fever registering the highest number of symptoms observed. Reported symptoms and clinician’s report revealed a very good agreement for fever (95%, kappa = 0.89); good for diarrhoea (87%, kappa = 0.73) and moderate for cough (76%, kappa = 0.49).</p><p>Conclusion</p><p>This pilot concept, has demonstrated the practicality of using mobile phones for assessing childhood disease symptoms and encouraging caregivers to seek early treatment for their children if needed. The strategy to use mobile phones in disease surveillance and treatment support is a promising strategy especially for areas with limited access to the health care system.</p></div

Temporal patterns of symptoms reported.

<p>Temporal pattern of symptoms identified by the system based on phone calls from caregivers. Symptom saturation was observed in May-October.</p

Flowchart of calls made to the eHISS system and individuals included into the study.

<p>Flowchart of calls made to the eHISS system and individuals included into the study.</p

Socio-demographic characteristics of registered caregivers and experience with IVR (N = 1446).

<p>Socio-demographic characteristics of registered caregivers and experience with IVR (N = 1446).</p

Cohen’s kappa coefficient for inter-rater agreement between data obtained from the IVR system and clinician’s report.

<p>Cohen’s kappa coefficient for inter-rater agreement between data obtained from the IVR system and clinician’s report.</p

Clinical characteristics of study participants.

BackgroundThe human immunodeficiency virus (HIV) has caused a lot of havoc since the early 1970s, affecting 37.6 million people worldwide. The 90-90-90 treatment policy was adopted in Ghana in 2015 with the overall aim to end new infections by 2030, and to improve the life expectancy of HIV seropositive individuals. With the scale-up of Highly Active Antiretroviral Therapy, the lifespan of People Living with HIV (PLWH) on antiretrovirals (ARVs) is expected to improve. In rural districts in Ghana, little is known about the survival probabilities of PLWH on ARVs. Hence, this study was conducted to estimate the survival trends of PLWH on ARVs.MethodsA retrospective evaluation of data gathered across ARV centres within Tatale and Zabzugu districts in Ghana from 2016 to 2020 among PLWH on ARVs. A total of 261 participants were recruited for the study. The data was analyzed using STATA software version 16.0. Lifetable analysis and Kaplan-Meier graph were used to assess the survival probabilities. “Stptime” per 1000 person-years and the competing risk regression were used to evaluate mortality rates and risk.ResultsThe cumulative survival probability was 0.8847 (95% CI: 0.8334–0.9209). The overall mortality rate was 51.89 (95% CI: 36.89–72.97) per 1000 person-years. WHO stage III and IV [AHR: 4.25 (95%CI: 1.6–9.71) p = 0.001] as well as age group (50+ years) [AHR: 5.02 (95% CI: 1.78–14.13) p = 0.002] were associated with mortality.ConclusionSurvival probabilities were high among the population of PLWH in Tatale and Zabzugu with declining mortality rates. Clinicians should provide critical attention and care to patients at HIV WHO stages III and IV and intensify HIV screening at all entry points since early diagnosis is associated with high survival probabilities.</div

Inclusion of PLWH for analysis.

BackgroundThe human immunodeficiency virus (HIV) has caused a lot of havoc since the early 1970s, affecting 37.6 million people worldwide. The 90-90-90 treatment policy was adopted in Ghana in 2015 with the overall aim to end new infections by 2030, and to improve the life expectancy of HIV seropositive individuals. With the scale-up of Highly Active Antiretroviral Therapy, the lifespan of People Living with HIV (PLWH) on antiretrovirals (ARVs) is expected to improve. In rural districts in Ghana, little is known about the survival probabilities of PLWH on ARVs. Hence, this study was conducted to estimate the survival trends of PLWH on ARVs.MethodsA retrospective evaluation of data gathered across ARV centres within Tatale and Zabzugu districts in Ghana from 2016 to 2020 among PLWH on ARVs. A total of 261 participants were recruited for the study. The data was analyzed using STATA software version 16.0. Lifetable analysis and Kaplan-Meier graph were used to assess the survival probabilities. “Stptime” per 1000 person-years and the competing risk regression were used to evaluate mortality rates and risk.ResultsThe cumulative survival probability was 0.8847 (95% CI: 0.8334–0.9209). The overall mortality rate was 51.89 (95% CI: 36.89–72.97) per 1000 person-years. WHO stage III and IV [AHR: 4.25 (95%CI: 1.6–9.71) p = 0.001] as well as age group (50+ years) [AHR: 5.02 (95% CI: 1.78–14.13) p = 0.002] were associated with mortality.ConclusionSurvival probabilities were high among the population of PLWH in Tatale and Zabzugu with declining mortality rates. Clinicians should provide critical attention and care to patients at HIV WHO stages III and IV and intensify HIV screening at all entry points since early diagnosis is associated with high survival probabilities.</div

Symptoms reported by age of child.

<p>Symptoms reported by age of child.</p

Kaplan Meier’s survival estimates.

BackgroundThe human immunodeficiency virus (HIV) has caused a lot of havoc since the early 1970s, affecting 37.6 million people worldwide. The 90-90-90 treatment policy was adopted in Ghana in 2015 with the overall aim to end new infections by 2030, and to improve the life expectancy of HIV seropositive individuals. With the scale-up of Highly Active Antiretroviral Therapy, the lifespan of People Living with HIV (PLWH) on antiretrovirals (ARVs) is expected to improve. In rural districts in Ghana, little is known about the survival probabilities of PLWH on ARVs. Hence, this study was conducted to estimate the survival trends of PLWH on ARVs.MethodsA retrospective evaluation of data gathered across ARV centres within Tatale and Zabzugu districts in Ghana from 2016 to 2020 among PLWH on ARVs. A total of 261 participants were recruited for the study. The data was analyzed using STATA software version 16.0. Lifetable analysis and Kaplan-Meier graph were used to assess the survival probabilities. “Stptime” per 1000 person-years and the competing risk regression were used to evaluate mortality rates and risk.ResultsThe cumulative survival probability was 0.8847 (95% CI: 0.8334–0.9209). The overall mortality rate was 51.89 (95% CI: 36.89–72.97) per 1000 person-years. WHO stage III and IV [AHR: 4.25 (95%CI: 1.6–9.71) p = 0.001] as well as age group (50+ years) [AHR: 5.02 (95% CI: 1.78–14.13) p = 0.002] were associated with mortality.ConclusionSurvival probabilities were high among the population of PLWH in Tatale and Zabzugu with declining mortality rates. Clinicians should provide critical attention and care to patients at HIV WHO stages III and IV and intensify HIV screening at all entry points since early diagnosis is associated with high survival probabilities.</div

Mortality rates and their determinants.

BackgroundThe human immunodeficiency virus (HIV) has caused a lot of havoc since the early 1970s, affecting 37.6 million people worldwide. The 90-90-90 treatment policy was adopted in Ghana in 2015 with the overall aim to end new infections by 2030, and to improve the life expectancy of HIV seropositive individuals. With the scale-up of Highly Active Antiretroviral Therapy, the lifespan of People Living with HIV (PLWH) on antiretrovirals (ARVs) is expected to improve. In rural districts in Ghana, little is known about the survival probabilities of PLWH on ARVs. Hence, this study was conducted to estimate the survival trends of PLWH on ARVs.MethodsA retrospective evaluation of data gathered across ARV centres within Tatale and Zabzugu districts in Ghana from 2016 to 2020 among PLWH on ARVs. A total of 261 participants were recruited for the study. The data was analyzed using STATA software version 16.0. Lifetable analysis and Kaplan-Meier graph were used to assess the survival probabilities. “Stptime” per 1000 person-years and the competing risk regression were used to evaluate mortality rates and risk.ResultsThe cumulative survival probability was 0.8847 (95% CI: 0.8334–0.9209). The overall mortality rate was 51.89 (95% CI: 36.89–72.97) per 1000 person-years. WHO stage III and IV [AHR: 4.25 (95%CI: 1.6–9.71) p = 0.001] as well as age group (50+ years) [AHR: 5.02 (95% CI: 1.78–14.13) p = 0.002] were associated with mortality.ConclusionSurvival probabilities were high among the population of PLWH in Tatale and Zabzugu with declining mortality rates. Clinicians should provide critical attention and care to patients at HIV WHO stages III and IV and intensify HIV screening at all entry points since early diagnosis is associated with high survival probabilities.</div