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In autumn 2017, Nigeria suspected an outbreak of human monkey pox. Immediately, epidemiologists adapted their online disease surveillance system and travelled to Nigeria to support the locals.

Deploying SORMAS in Nigeria: challenges and accomplishments

SORMAS in action at the Nigeria Centre for Disease Control in the city of Abuja. © Nigeria Centre for Disease Control

The 2014 Ebola outbreak in West Africa revealed an urgent need of efficient disease surveillance systems, because it became evident that the outcome of an epidemic also depends on how fast disease control measures are implemented. HZI scientists from the Department of Epidemiology, led by Gérard Krause, teamed up with Nigerian scientists and developed a mobile-based application, which allows real-time data collection and application of disease control measures called Surveillance, Outbreak Response Management and Analysis System (SORMAS).

On 20 September 2017, the World Health Organization was notified of a suspected outbreak of human monkey pox in Nigeria. During that time, SORMAS could monitor nine infectious diseases occurring in Africa – monkey pox did not belong to them. “We had to develop a new disease model within two weeks – including tests and implementation,” Daniel Tom-Aba from the HZI says. Since internet access is a critical issue due to limited networks during fieldwork, the scientists could also use SORMAS to collect data offline. A team from the HZI travelled to Nigeria to deploy SORMAS and train potential users. They visited cities like Abuja as well as several affected states. ”Within a few weeks we had to train a vast number of specialists – about 50 to 60 per state, which would not have been possible without support from the Nigerian field team,” HZI researcher Kristin Schlinkmann says.

Current disease surveillance systems in Africa are paper-based. Case reports have to be transferred by personnel from one facility to another and the data is manually typed into spread sheets. This method causes significant delay and is error-prone. “SORMAS allows medical specialists to enter the data directly and share it online between medical facilities, thus enabling to monitor the situation in real life, to follow up individual cases and to exchange the data between doctors, laboratories and epidemiology officers,” HZI scientist Bernhard Silenou says. By that, the data evaluation is no longer retrospective and SORMAS makes bi-directional communication possible. “In the long-term, SORMAS will not only improve surveillance, but also reduce the daily workload of epidemiologists,” Schlinkmann adds.

Despite of the fact that many people in Nigeria speak English, explaining technical details turned out to be challenging: Especially in the remote regions, where people mainly speak local languages like Hausa, the HZI scientists had to rely on translation by Nigerian colleagues. Travelling to those regions was a challenge itself. Tom-Aba says: “We had to use local planes every other day and often experienced turbulences or engine smoke. I almost got into an accident twice.”
SORMAS already covers 15 federal states with 36 million people, but the HZI scientists aim to further implement it and collect data on other infectious diseases, such as SCM meningitis. Silenou shares his vision: “The idea of SORMAS is so elegant that I hope to bring it one day to my home country, Cameroon, and, eventually, to all Africa.”

Author: Tatyana Dubich

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Cover page of HZI staff magazine "InFact", issue 01/2018 © HZI

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