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

<div><p>Background</p><p>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.</p><p>Methods</p><p>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.</p><p>Results</p><p>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.</p><p>Conclusions</p><p>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.</p></div

The vaccination of 35,000 dogs in 20 working days using combined static point and door-to-door methods in Blantyre, Malawi

An estimated 60,000 people die of rabies annually. The vast majority of cases of human rabies develop following a bite from an infected dog. Rabies can be controlled in both human and canine populations through widespread vaccination of dogs. Rabies is particularly problematic in Malawi, costing the country an estimated 13 million USD and 484 human deaths annually, with an increasing paediatric incidence in Blantyre City. Consequently, the aim of this study was to vaccinate a minimum of 75% of all the dogs within Blantyre city during a one month period. Blantyre's 25 administrative wards were divided into 204 working zones. For initial planning, a mean human:dog ratio from the literature enabled estimation of dog population size and dog surveys were then performed in 29 working zones in order to assess dog distribution by land type. Vaccination was conducted at static point stations at weekends, at a total of 44 sites, with each operating for an average of 1.3 days. On Monday to Wednesday, door-to-door vaccination sessions were undertaken in the areas surrounding the preceding static point stations. 23,442 dogs were vaccinated at static point stations and 11,774 dogs were vaccinated during door-to-door vaccinations. At the end of the 20 day vaccination programme, an assessment of vaccination coverage through door-to-door surveys found that of 10,919 dogs observed, 8,661 were vaccinated resulting in a vaccination coverage of 79.3% (95%CI 78.6-80.1%). The estimated human:dog ratio for Blantyre city was 18.1:1. Mobile technology facilitated the collection of data as well as efficient direction and coordination of vaccination teams in near real time. This study demonstrates the feasibility of vaccinating large numbers of dogs at a high vaccination coverage, over a short time period in a large African city

Vaccinate-assess-move method of mass canine rabies vaccination utilising mobile technology data collection in Ranchi, India

BACKGROUND: Over 20 000 people die from rabies each year in India. At least 95 % of people contract rabies from an infected dog. Annual vaccination of over 70 % of the dog population has eliminated both canine and human rabies in many countries. Despite having the highest burden of rabies in the world, there have been very few studies which have reported the successful, large scale vaccination of dogs in India. Furthermore, many Indian canine rabies vaccination programmes have not achieved high vaccine coverage. METHODS: In this study, we utilised a catch-vaccinate-release approach in a canine rabies vaccination programme in 18 wards in Ranchi, India. Following vaccination, surveys of the number of marked, vaccinated and unmarked, unvaccinated dogs were undertaken. A bespoke smartphone ‘Mission Rabies’ application was developed to facilitate data entry and team management. This enabled GPS capture of the location of all vaccinated dogs and dogs sighted on post vaccination surveys. In areas where coverage was below 70 %, catching teams were re-deployed to vaccinate more dogs followed by repeat survey. RESULTS: During the initial vaccination cycle, 6593 dogs were vaccinated. Vaccination coverage was over 70 % in 14 of the 18 wards. A second cycle of vaccination was performed in the 4 wards where initial vaccination coverage was below 70 %. Following this second round of vaccination, coverage was reassessed and found to be over 70 % in two wards and only just below 70 % in the final two wards (66.7 % and 68.2 %, respectively). CONCLUSION: Our study demonstrated that mobile technology enabled efficient team management and rapid data entry and analysis. The vaccination approach outlined in this study has the potential to facilitate the rapid vaccination of large numbers of dogs at a high coverage in free roaming dog populations in India. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-015-1320-2) contains supplementary material, which is available to authorized users

Additional file 1: of Vaccinate-assess-move method of mass canine rabies vaccination utilising mobile technology data collection in Ranchi, India

Complete dataset of dogs vaccinated during study. (XLSX 1444 kb

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

<p>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.</p

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

<p>Cumulative frequency of data entries from 01/11/2014 to 22/04/2018.</p

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

<p>Flow diagram showing flow of data through the web and smartphone systems.</p

Table of summarised data by country showing the number of Mission Rabies App entries by category and the total number of vaccinations, education classes and children taught for the period 01/11/2014 to 22/04/2018.

<p>Table of summarised data by country showing the number of Mission Rabies App entries by category and the total number of vaccinations, education classes and children taught for the period 01/11/2014 to 22/04/2018.</p

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

<p>Bar graph of annual number of entries recorded on the Mission Rabies App in Haiti, India and Malawi by year.</p

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

<p>Icons indicate how users interact with the system, by laptop or smartphone.</p