Digital monitoring of Rabies risk cases across species for the University of Glasgow and Tanzania.

Facilitating One Health processes on the DHIS2 platform

Client: University of Glasgow
Project size: £70 000
Timeline: 2022-

The University of Glasgow is a world-leading academic institution based in the UK and working globally in epidemiological research. Fjelltopp has partnered with the University of Glasgow School of Biodiversity, One Health & Veterinary Medicine during the COVID-19 pandemic in a technical consultancy and data engineering role.

In Tanzania, the University of Glasgow has partnered with the Ifakara Health Institute (IHI), a research and public health organisation. Ifakara Health Institute works mainly with malaria, but has programs in rabies research as well. The rabies epidemiological projects in Tanzania serve two purposes: research for finding new ways to understand and combat the disease, as well as offering a public health service that allows people exposed to rabies to get better access to prevention measures, information and care.

Context

Rabies is a rare disease in Tanzania but still endemic and a cause of human deaths. Rabies spreads among animals and an infected animal may infect a human via exposure, i.e. a bite. Rabies is difficult to completely erase from its natural reservoirs among wild animal populations, but monitoring it and stopping its spread among animals that spend time with humans, such as domestic animals, are important steps to lower the risk of human infection.

If a human is exposed to rabies, timely diagnosis and treatment is of essence. Once rabies has progressed enough after weeks or months from the infection, it is untreatable and leads to death. The potential human cost of rabies is therefore high. The benefits of functional management of the spread and rapid treatment of rabies in reducing human suffering are thus also very high.

Due to humans being mainly infected by animals, the tracking of rabies needs to consider both animals and humans. This is often a challenge, since healthcare is focused only on humans and, for example, agricultural organisations only on animals. The One Health approach, where animal and human health is considered in a cross disciplinary manner, is an internationally recognised approach that is in use in Tanzania. The process for tracking bite cases, the human patients, and possibly rabies carrying animals is called Integrated Bite Case Management (IBCM) and is based on international guidelines.

Due to its presence only in rural areas and the low number of annual cases, rabies is rarely treated as a priority disease in Tanzania. The Ministry of Health tracks animal bite cases with their DHIS2 based healthcare reporting system, but does not offer electronic tools for IBCM. The Ifakara Health Institute has an existing Open Data Kit based solution in place for supporting the IBCM process.

Solutions

  • Fjelltopp identified sustainability risks with an existing Open Data Kit based digital solution for the IBCM process and provided an emergency backup system. This backup system used a similar ODK-based technology stack as the live one. This is so staff wouldn’t have to be trained if the backup was rolled out. The risks of the existing solution were realised during the contract and the backup solution was rolled out successfully with only a minor disturbance to the IBCM workflow.
  • Fjelltopp has provided ongoing support for the backup solution to mature it from an emergency solution into a sustainable digital solution.
  • Fjelltopp has investigated DHIS2 as an alternative solution for the IBCM tool. The Tracker features of DHIS2 are suitable for a comprehensive IBCM digital system.
  • Fjelltopp has implemented two DHIS2 Tracker programs as well as DHIS2 registers for human bite victims and animals investigated for rabies.
  • Fjelltopp has built an integration pipeline for existing IBCM data collected by Open Data Kit to be integrated into DHIS2.

Results

  • Despite the sudden permanent outage of the previous IBCM digital system, the Fjelltopp team was able to minimise the disturbance to the healthcare process by deploying our emergency ODK system. All disturbances to the services were cleared within a week.
  • The DHIS2 implementation of IBCM is being tested by a cross disciplinary team of healthcare workers and veterinarians.
  • The infrastructure-as-code based DHIS2 deployment pipeline allows the in-country team to test all changes to the DHIS2 system in a cloud-based test environment. Only the live system hosting the live data is maintained by the in-country partner.

Skills

  • DHIS2: server infrastructure, program configuration, API usage
  • Open Data Kit: server infrastructure, project configuration, form development
  • Infrastructure as code: Ansible, Kubernetes, continuous integration

What our client said about us

“Working with Fjelltopp has been a pleasure. The team is responsive to our technical needs, has quickly picked up the complexities of our substantive work, and has been forward-thinking by identifying solutions that our clients will appreciate.”

Dr Mary Mahy, Epidemiology Team Lead, UNAIDS Geneva

If you are looking to implementing public health surveillance systems with widely used open source tools such as ODK or DHIS2, contact us now.

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