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[MUSIC PLAYING]

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ERIC MAFUTA: To increase
acute flaccid paralysis case

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detection rates in this
context and address challenges

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to the surveillance
system in this area,

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some innovation were used.

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The first innovation is maps.

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Mapping in public
health is not new.

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You can remember the
general snow mapping

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that marked a critical
turn in the use of map

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to understand geographic
pattern and disease.

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Geographic information
system technology

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is increasingly used by
public health professional

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to better understand how
geographical relationship

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affect disease transmission
patterns, access to health

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care, and health outcome.

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For example, in some provinces
in the Democratic Republic

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of the Congo, the impact
of the polio campaign

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to control outbreaks was low.

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Detailed maps and information of
entire section of the provinces

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were not known or unavailable.

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Therefore, potential population
eligible for vaccination

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services and living on
islands or along tributary

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up to the river,
the Congo river,

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were not included in
immunization microplan

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and not reached by a
routine immunization

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or by supplementary
immunization activity services.

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So some author publish,
in 2008 and 2018,

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Google map in DRC outbreak.

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They used geocoded data of
cases and have information

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from different outbreak, use
also data from the population,

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to try to identify
at-risk population,

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those who are living in
floating highland population

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along the river or
hard-to-reach population.

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This research was
done near Mbandaka.

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Mbandaka is in the
north part of the DRC,

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which were after,
in 2016 and 2017,

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a site for Ebola outbreak.

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What they have was it
shows spatial distribution

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of polio cases that show
that the outbreak follow

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the course of the Congo River.

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This raised suspicion
that the river

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could play an important role in
the propagation of the outbreak

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to the neighboring districts.

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This helped to set
the strategy that

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includes mobile population
on both canoe or rafts,

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population of seasonal
village, and fixed population

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on highland and stilt village.

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The overall result of
using Google Earth map

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was a better
allocation of resources

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and an improved dispatch of
vaccination and surveillance

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teams.

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This similar process
was carried out

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for Haut-Lomami and
Tanganyika, provinces situated

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in the southwest of
the Democratic Republic

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of the Congo, where
several outbreak occurs.

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Health professional
work to map health area,

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health facilities,
using various strategy.

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The results map, that we
will show in the next slides,

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has multiple use
for microplanning

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or for study sampling frame.

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You can see in this map that
there is some location where

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we have polio virus outbreak.

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And this can help people and
health population, health

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professional, to make
plans to allocate resources

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or to make surveillance.

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We can also use mapping in
environmental surveillance.

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The environmental surveillance
consist of monthly waste water

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grab samples,
collected from area

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with a history of
wild polio cases,

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inadequate
immunization coverage,

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or perceived risk of
importation of wild polio virus.

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The collection and the
test of sewage sample

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supplements the acute flaccid
paralysis surveillance

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by identifying polio
transmission in the absence

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of detected cases.

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So in this graph
and photography,

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you can see digital level
in the relief, where

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we can detect water
catchment, drainage line,

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or draining catchments.

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We can also estimate
the population

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to try to figure out which
is the draining slope.

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And we can have all
this information

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and their geolocation that can
help to improve the water waste

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collection site selection.

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The second innovation that
can be used for surveillance

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is phone.

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The surveillance system
require that detected

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case are promptly
reported and investigated

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by disease service personnel.

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The use of mobile technology for
health in developing country,

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such as Nigeria and DRC,
appear to be a new innovation

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way of reaching people and
collecting and reporting data,

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given its extension
in this area.

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By simply using an
application, such as eSurv,

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for electronic surveillance
on their smartphone,

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health workers and
dedicated community members

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can send message
about polio cases

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to the surveillance officer that
can centrally generate maps.

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In their control room,
public health experts

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can quickly analyze data,
visualize surveillance map,

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and conduct active case
research and risk assessment

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at the health facility level.

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And here we have example
from the Nigeria,

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where you can see
the point where there

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are location of polio cases.

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And also, we can have a
map with different color

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that can show where there is
a problem of surveillance.

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For example, here
we have the use

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of the eSurv for real-time
tracking of APV cases.

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It's acute flaccid
paralysis cases.

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So we have information
from the community.

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They use their smartphone
with this application.

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And the information is sent
to the disease surveillance

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notification officer, which
collects all this information

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on a smartphone.

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And this information
can be gathered

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for a local government area, a
ward, a reporting site level.

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And this can be used too for
other disease in the integrated

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disease surveillance system.

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Another tool that we have using
phone is Open Data Kits, ODK.

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The ODK is an application that
can be used for real-time data

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collection on mobile phone.

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It's a free and open
source set of tools

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that allow to collect data,
to manage data from the field.

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And the ODK can help to collect
even GPS, location, and photo.

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So you can extract data and
analyze for decision making.

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We have also for phone
what we call AVADAR.

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It's the audio-visual acute
flaccid paralysis detection

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and reporting, which is a
SMS, short message system,

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based smartphone
application that

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was designed to address
problem with detection

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and reporting of polio cases.

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By using their phone, health
workers and community members

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can send weekly
reports on the presence

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or the absence of polio cases
in their respective area.

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And this generates an
instant notification,

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with a minimal set
of information,

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directly to the disease
surveillance notifier officer

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responsible for the area
and the upper level.

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This improve investigation
of cases and prompt response.

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In conclusion, new
technology and innovation,

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such as map and phones, can
be used to improve or address

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challenges encountered in
polio eradication activities.

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These strategy work better
in one context cooperatively

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to others and are
still implementation

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barrier that are not safe.

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So before I conclude
my session, I

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would like you to keep in
mind some few question.

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First, why might some of these
strategy work better in one

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context and not in another?

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What implementation barrier
are solved and not solved

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for mapping of phone
in the surveillance?

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Is there some location in
your respective country

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where you think this
technology can be used and why?

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And are there other
technology you

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know that can be adapted to
the surveillance of polio

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or of another health problem?

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Thank you, for joining us.

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[MUSIC PLAYING]

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