We calculated the mean number of animal-bite injuries reported quarterly in each study region to examine the capacity of the two surveillance systems to detect and record dog bites that occurred in the study area. Data collected from January 2005 to December 2010 were summarised to calculate the quarterly bite numbers for the paper-based system and data from June 2011 to January 2012 were summarised for the mobile phone-based system. Case detection capacity was evaluated by comparing the number of cases detected per surveillance system used through time in the study area through. We summarized the number of cases detected quarterly (Table 3.2).
3.2.4 Data completeness
We evaluated the surveillance systems reporting data completeness by comparing patient‟s information recorded that was collected whilst attending clinics for PEP, such as
demographic and geographical information (Table 3.1). Individual records were coded in order to calculate the percentage of missing values (NA) between 0 percent and 100 percent for both the surveillance systems.
3.2.5 Timeliness
We evaluated the surveillance system timeliness in reporting patient information by examining and comparing the time intervals between date of clinic presentation and reported date. These intervals were calculated to allow comparison of the speed of
reporting across the different regions within the study area through the two systems (Figure 3.2). Timeliness refers to the time taken by the primary healthcare facilities to report the animal-bite injuries to the authorities, here described in figure 3.2 as the time between the date of clinic presentation and the date reported. Exposure date is defined as the date when animal-bite injury victim(s) encounter the animal-bite exposure, while we define visit date as the date when victim(s) attend the healthcare facilities seeking PEP. Reporting date is defined as the date when the data on animal bite-injuries were notified to the authorities.
Traditional paper-based surveillance normally reports summaries of numbers of events at the end of the week; later individual paper forms are collated and processed annually. Therefore, to establish a comparison of individual records reporting between the
surveillance systems, we assigned an annual event date for the paper-based surveillance system as the date reported and for those events that were reported by the mobile phone surveillance, the date of reporting was used. The annual reporting date was assigned for the paper-based surveillance system with all the events that were recorded in a clinic on the same year assigned to the same reporting date corresponding to the end of the year. We assume all the events that were recorded at the hospitals and clinics since 2005–2010 were collected and processed annually [116].
3.2.6 System costs and Stakeholders’ perceptions
To assess and compare the costs of the surveillance systems, we conducted stakeholder questionnaires to collect data on the costs and budgets that were used to build and run the surveillance systems. The questionnaires were designed for people who coordinate and supervise the public health surveillance activities including data collection for reports and planning disease control activities. The questionnaires were administered only for those stakeholders and sectors already using both paper-based and mobile phone-based
surveillance systems. The questionnaires gathered key information such as the scales over which these surveillance systems were implemented (households, village/street, district and regions). Specifically we focused on: what was the surveillance unit per population, whether training of personnel was required for the surveillance and what supervision if any was necessary and how often it was provided, what was the size of the collected
data/reports, how frequently data were collected and how data were collected and
processed. Using the information from these questionnaires we aimed to gather an accurate picture of the annual costs of both paper and mobile phone based surveillance systems including capital costs, annual personnel costs, and annual running costs. We compiled these data and estimated the reported annual cost for each surveillance system. The cost was converted to US dollars values based on conversion at exchange rate of 1.00 USD = 1,638.62 TZS.
3.3 Results
3.3.1 Case detection capacity
In evaluating the capacity of the surveillance systems to detect animal-bite injuries, the mobile phone-based surveillance system had more reported animal bite injuries than those reported by the paper-based surveillance system (Table 3.1). Fewer cases were reported from January 2005 up to June 2006 and again during 2010 (Figure 3.2). Between June 2011 and January 2013, the mobile phone-based surveillance system was in operation and more animal bite injuries were reported, with the results characterized in Table 3.2 and Figure 3.3.
Table 3.2. Mean quarterly numbers of animal-bite injuries detected in each study region captured by the two surveillance systems. Numbers in brackets are the minimum and maximum number of bites reported quarterly. Data from January 2005 to December 2010 are included from the traditional paper-based surveillance system versus data from June 2011 to January 2013 for the mobile phone based surveillance system.
Regions Tradition paper-based surveillance system Mobile phone-based surveillance system Coast 30 (0-107) 61 (39-90) Dar es Salaam 22 (0-243) 125 (81-185) Lindi 2 (0-21) 54 (36-84) Morogoro 56 (0-187) 191 (146-230) Mtwara 1(0-1) 79(25-85) North Pemba 0 3 (0-6) South Pemba 0 3 (0-6)
Figure 3.3. Numbers of animal bites injuries reported by paper-based versus mobile phone- based surveillance systems from Jan 2005-Jan 2010 and June 2011-Jan 2013 respectively. These timeseries illustrate inconsistencies of reporting by the two systems. Fewer injuries were reported by paper-based surveillance, compared to those reported by the mobile phone based surveillance.