Contribution of Auto-Visual AFP Detection and Reporting (AVADAR) on polio surveillance in South Sudan.

Introduction: the last wild polio virus in South Sudan was documented in 2009. Nonetheless, it was one of the last four countries in the WHO African region to be accepted as a polio-free country in June 2020. In line with this, to accelerate the polio-free documentation process, the country has piloted Auto Visual AFP Detection and Reporting (AVADAR) in three counties. This study examined the contribution of the AVADAR surveillance system to the traditional Acute Flaccid Paralysis (AFP) surveillance system to document lessons learnt and best practices. Methods: we performed a retrospective descriptive quantitative study design to analyze secondary AVADAR surveillance data collected from June 2018 to December 2019 and stored at the WHO AVADAR server. Results: the AVADAR community surveillance system has improved the two main AFP surveillance indicators in the piloted counties and made up 86% of the total number of true AFP cases detected in these counties. The completeness and timeliness of weekly zero reporting were 97% and 94%, respectively and maintained above the standard throughout the study, while the two main surveillance indicators in the project area were improved progressively except for the Gogrial West County. In contrast, main surveillance indicators declined in some of the none-AVADAR implementing counties. Conclusion: the AVADAR surveillance system can overcome the logistical and remoteness barriers that can hinder the early detection and reporting of cases due to insecurity, topographical, and communication barrier in rural and hard-to-reach areas to accomplish and sustain the two main surveillance indicators, along with the completeness and timeliness of weekly zero reporting. We recommend extending this application-based surveillance system to other areas with limited resources and similar challenges by incorporating other diseases of public health concern.

Auto Visual AFP Detection and Response (AVADAR) Improved Polio Surveillance in Lake Chad Polio Outbreak Priority Districts.

The Auto Visual AFP Detection and Response (AVADAR) is a community-based digital platform that deals with the collection and distribution of real-time information. AVADAR makes it possible to report suspected cases of paralysis in the field at the central level. Once a suspected Acute Flaccid Paralysis (AFP) case is detected, a series of reports are sent to the following stakeholders: the nearest training officer, the district focal point, the district AVADAR team, the regional focal point, the central level of the Ministry of Health (MoH) and World Health Organization Country Office (WCO) by SMS and email. The health worker will go to the field to join the community informant who notified the case for a clinical investigation. At the end of this investigation, the health worker via a smartphone will submit an investigation report validating or invalidating the suspected case notified as a true case of AFP or False case. A small server called a gateway is positioned at the central level to ensure the information link between community informants and health workers in each district. A large server is placed in Geneva at Novel-T which allows all countries to connect and view the data in real time. The geolocation of all alerts and investigations of AFP cases is the cornerstone of AVADAR data.

AVADAR (Auto-Visual AFP Detection and Reporting): demonstration of a novel SMS-based smartphone application to improve acute flaccid paralysis (AFP) surveillance in Nigeria.

BACKGROUND: Eradication of polio requires that the acute flaccid paralysis (AFP) surveillance system is sensitive enough to detect all cases of AFP, and that such cases are promptly reported and investigated by disease surveillance personnel. When individuals, particularly community informants, are unaware of how to properly detect AFP cases or of the appropriate reporting process, they are unable to provide important feedback to the surveillance network within a country. METHODS: We tested a new SMS-based smartphone application (App) that enhances the detection and reporting of AFP cases to improve the quality of AFP surveillance. Nicknamed Auto-Visual AFP Detection and Reporting (AVADAR), the App creates a scenario where the AFP surveillance network is not dependent on a limited number of priority reporting sites. Being installed on the smartphones of multiple health workers (HWs) and community health informants (CHIs) makes the App an integral part of the detection and reporting system. RESULTS: Results from two phases of tests conducted in Nigeria point to the effectiveness of the App in the surveillance of AFP. CONCLUSION: We posit that appropriate use of the App can soon bring about a worldwide eradication of poliomyelitis.