Comparison of Influenza-Like Illness (ILI) incidence data from the novel LeCellPHIA participatory surveillance system with COVID-19 case count data, Lesotho, July 2020 - July 2021.

BACKGROUND: While laboratory testing for infectious diseases such as COVID-19 is the surveillance gold standard, it is not always feasible, particularly in settings where resources are scarce. In the small country of Lesotho, located in sub-Saharan Africa, COVID-19 testing has been limited, thus surveillance data available to local authorities are limited. The goal of this study was to compare a participatory influenza-like illness (ILI) surveillance system in Lesotho with COVID-19 case count data, and ultimately to determine whether the participatory surveillance system adequately estimates the case count data. METHODS: A nationally-representative sample was called on their mobile phones weekly to create an estimate of incidence of ILI between July 2020 and July 2021. Case counts from the website Our World in Data (OWID) were used as the gold standard to which our participatory surveillance data were compared. We calculated Spearman's and Pearson's correlation coefficients to compare the weekly incidence of ILI reports to COVID-19 case count data. RESULTS: Over course of the study period, an ILI symptom was reported 1,085 times via participatory surveillance for an average annual cumulative incidence of 45.7 per 100 people (95% Confidence Interval [CI]: 40.7 - 51.4). The cumulative incidence of reports of ILI symptoms was similar among males (46.5, 95% CI: 39.6 - 54.4) and females (45.1, 95% CI: 39.8 - 51.1). There was a slightly higher annual cumulative incidence of ILI among persons living in peri-urban (49.5, 95% CI: 31.7 - 77.3) and urban settings compared to rural areas. The January peak of the participatory surveillance system ILI estimates correlated significantly with the January peak of the COVID-19 case count data (Spearman's correlation coefficient = 0.49; P < 0.001) (Pearson's correlation coefficient = 0.67; P < 0.0001). CONCLUSIONS: The ILI trends captured by the participatory surveillance system in Lesotho mirrored trends of the COVID-19 case count data from Our World in Data. Public health practitioners in geographies that lack the resources to conduct direct surveillance of infectious diseases may be able to use cell phone-based data collection to monitor trends.

Social media use and COVID-19 vaccine status among a nationally representative population sample in Uganda.

Objectives: The effect of social media on COVID-19 vaccination behavior is sub-Saharan Africa is unclear. We conducted a study to determine social media use among a random nationally representative sample of adults in Uganda and assessed the association between recent social media use and COVID-19 vaccination uptake. Methods: We used data from the 2020 general population survey in Uganda, the Population-based HIV Impact Assessment Survey, to identify a probability sample for a mobile phone survey and included nonphone owners in the phone survey by asking phone owners to pass the phone. Results: In March 2022, of the 1022 survey participants, 213 (20%) did not own a mobile phone, 842 (80%) owned a mobile phone, of whom 199 (24%) indicated social media use, and 643 (76%) of whom did not use social media. Among all participants, the most frequent source of COVID-19 vaccine information was radio. Overall, 62% reported receiving the COVID-19 vaccination. The multivariable logistic regression model found that social media use was not associated with vaccination status. Conclusion: Social media users in this population sample from Uganda-who were mainly young, urban residents with higher educational attainment-continue to utilize TV, radio and health care workers for public health messages, thus the Government of Uganda should continue to conduct public health communication through these mediums.

Effect of COVID-19 Pandemic on Older New York City Residents Living at Home.

To describe effects of the COVID-19 pandemic on older adults living in non-institutionalized settings in New York City (NYC) we used random digit dial sampling of landlines phones to sample then interview residents 70 years and older in NYC from December 2020-March 2021. Socio-demographic, health characteristics and effects of the COVID-19 pandemic were solicited. Of 676 respondents, the average age was 78, 60% were female, and 63% had ever been tested for SARS-CoV-2, with 12% testing positive. Sixty-three percent of respondents knew someone who had been diagnosed with COVID-19 and 51% reported knowing at least one person who had died from COVID-19. Eight percent of respondents reported sometimes or often not having enough to eat, with 31% receiving food from a food pantry program. Significantly more Latinx respondents (24%) reported a positive SARS-CoV-2 test, whereas 17% of those of another race, 8% of white, and 7% of Black respondents had a positive COVID-19 test (p < 0.01). Forty-three percent of Black and 43% of Latinx respondents reported using a food pantry during COVID-19 pandemic, compared to 35% of respondents of another race and ethnicity and 18% of whites (p < 0.01). Twenty-nine percent of Latinx respondents screened for depression compared to 15% among all other races (p = 0.04). The COVID-19 pandemic has substantial health and social effects on older New Yorkers living in community settings, and experiences differed by race and ethnicity. Beyond older adults in congregate settings, those living at home have experienced wide-ranging effects of COVID-19, necessitating tailored interventions.

Participatory Surveillance of COVID-19 in Lesotho via Weekly Calls: Protocol for Cell Phone Data Collection.

BACKGROUND: The increase in cell phone ownership in low- and middle-income countries (LMIC) has created an opportunity for low-cost, rapid data collection by calling participants on their cell phones. Cell phones can be mobilized for a myriad of data collection purposes, including surveillance. In LMIC, cell phone-based surveillance has been used to track Ebola, measles, acute flaccid paralysis, and diarrheal disease, as well as noncommunicable diseases. Phone-based surveillance in LMIC is a particularly pertinent, burgeoning approach in the context of the COVID-19 pandemic. Participatory surveillance via cell phone could allow governments to assess burden of disease and complements existing surveillance systems. OBJECTIVE: We describe the protocol for the LeCellPHIA (Lesotho Cell Phone PHIA) project, a cell phone surveillance system that collects weekly population-based data on influenza-like illness (ILI) in Lesotho by calling a representative sample of a recent face-to-face survey. METHODS: We established a phone-based surveillance system to collect ILI symptoms from approximately 1700 participants who had participated in a recent face-to-face survey in Lesotho, the Population-based HIV Impact Assessment (PHIA) Survey. Of the 15,267 PHIA participants who were over 18 years old, 11,975 (78.44%) consented to future research and provided a valid phone number. We followed the PHIA sample design and included 342 primary sampling units from 10 districts. We randomly selected 5 households from each primary sampling unit that had an eligible participant and sampled 1 person per household. We oversampled the elderly, as they are more likely to be affected by COVID-19. A 3-day Zoom training was conducted in June 2020 to train LeCellPHIA interviewers. RESULTS: The surveillance system launched July 1, 2020, beginning with a 2-week enrollment period followed by weekly calls that will continue until September 30, 2022. Of the 11,975 phone numbers that were in the sample frame, 3020 were sampled, and 1778 were enrolled. CONCLUSIONS: The surveillance system will track COVID-19 in a resource-limited setting. The novel approach of a weekly cell phone-based surveillance system can be used to track other health outcomes, and this protocol provides information about how to implement such a system. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/31236.

Health services uptake among nomadic pastoralist populations in Africa: A systematic review of the literature.

The estimated 50 million nomadic pastoralists in Africa are among the most "hard-to-reach" populations for health-service delivery. While data are limited, some studies have identified these communities as potential disease reservoirs relevant to neglected tropical disease programs, particularly those slated for elimination and eradication. Although previous literature has emphasized the role of these populations' mobility, the full range of factors influencing health service utilization has not been examined systematically. We systematically reviewed empirical literature on health services uptake among African nomadic pastoralists from seven online journal databases. Papers meeting inclusion criteria were reviewed using STROBE- and PRISMA-derived guidelines. Study characteristics were summarized quantitatively, and 10 key themes were identified through inductive qualitative coding. One-hundred two papers published between 1974-2019 presenting data from 16 African countries met our inclusion criteria. Among the indicators of study-reporting quality, limitations (37%) and data analysis were most frequently omitted (18%). We identified supply- and demand-side influences on health services uptake that related to geographic access (79%); service quality (90%); disease-specific knowledge and awareness of health services (59%); patient costs (35%); contextual tailoring of interventions (75%); social structure and gender (50%); subjects' beliefs, behaviors, and attitudes (43%); political will (14%); social, political, and armed conflict (30%); and community agency (10%). A range of context-specific factors beyond distance to facilities or population mobility affects health service uptake. Approaches tailored to the nomadic pastoralist lifeway, e.g., that integrated human and veterinary health service delivery (a.k.a., "One Health") and initiatives that engaged communities in program design to address social structures were especially promising. Better causal theorization, transdisciplinary and participatory research methods, clearer operational definitions and improved measurement of nomadic pastoralism, and key factors influencing uptake, will improve our understanding of how to increase accessibility, acceptability, quality and equity of health services to nomadic pastoralist populations.

Automated and Interviewer-Administered Mobile Phone Surveys in Burkina Faso: Sociodemographic Differences Among Female Mobile Phone Survey Respondents and Nonrespondents.

BACKGROUND: The remarkable growth of cell phone ownership in low- and middle-income countries has generated significant interest in using cell phones for conducting surveys through computer-assisted telephone interviews, live interviewer-administered surveys, or automated surveys (ie, interactive voice response). OBJECTIVE: This study aimed to compare, by mode, the sociodemographic characteristics of cell phone owners who completed a follow-up phone survey with those who did not complete the survey. METHODS: The study was based on a nationally representative sample of women aged 15 to 49 years who reported cell phone ownership during a household survey in Burkina Faso in 2016. Female cell phone owners were randomized to participate in a computer-assisted telephone interview or hybrid interactive voice response follow-up phone survey 11 months after baseline interviews. Completion of the phone survey was defined as participants responding to more than 50% of questions in the phone survey. We investigated sociodemographic characteristics associated with cell phone survey completion using multivariable logistic regression models, stratifying the analysis by survey mode and by directly comparing computer-assisted telephone interview and hybrid interactive voice response respondents. RESULTS: A total of 1766 women were called for the phone survey between November 5 and 17, 2017. In both the computer-assisted telephone interview and hybrid interactive voice response samples, women in urban communities and women with secondary education or higher were more likely to complete the survey than their rural and less-educated counterparts. Compared directly, women who completed the hybrid interactive voice response survey had higher odds of having a secondary education than those who completed computer-assisted telephone interviews (odds ratio 1.7, 95% CI 1.1-2.6). CONCLUSIONS: In Burkina Faso, computer-assisted telephone interviews are the preferred method of conducting cell phone surveys owing to less sample distortion and a higher response rate compared with a hybrid interactive voice response survey.

Comparability of modern contraceptive use estimates between a face-to-face survey and a cellphone survey among women in Burkina Faso.

INTRODUCTION: The proliferation of cell phone ownership in Sub-Saharan Africa (SSA) presents the opportunity to collect public health indicators at a lower cost compared to face-to-face (FTF) surveys. This analysis assesses the equivalence of modern contraceptive prevalence estimates between a nationally representative FTF survey and a cell phone survey using random digit dialing (RDD) among women of reproductive age in Burkina Faso. METHODS: We analyzed data from two surveys conducted in Burkina Faso between December 2017 and May 2018. The FTF survey conducted by Performance Monitoring and Accountability (PMA2020) comprised a nationally representative sample of 3,556 women of reproductive age (15-49 years). The RDD survey was conducted using computer-assisted telephone interviewing and included 2,379 women of reproductive age. RESULTS: Compared to FTF respondents, women in the RDD sample were younger, were more likely to have a secondary degree and to speak French. RDD respondents were more likely to report using modern contraceptive use (40%) compared to FTF respondents (26%) and the difference remained unchanged after applying post-stratification weights to the RDD sample (39%). This difference surpassed the equivalence margin of 4%. The RDD sample also produced higher estimates of contraceptive use than the subsample of women who owned a phone in the FTF sample (32%). After adjusting for women's sociodemographic factors, the odds of contraceptive use were 1.9 times higher (95% CI: 1.6-2.2) in the RDD survey compared to the FTF survey and 1.6 times higher (95% CI: 1.3-1.8) compared to FTF phone owners. CONCLUSIONS: Modern contraceptive prevalence in Burkina Faso is over-estimated when using a cell phone RDD survey, even after adjusting for a number of sociodemographic factors. Further research should explore causes of differential estimates of modern contraceptive use by survey modes.

Does mobile phone survey method matter? Reliability of computer-assisted telephone interviews and interactive voice response non-communicable diseases risk factor surveys in low and middle income countries.

INTRODUCTION: Increased mobile phone subscribership in low- and middle-income countries (LMICs) provides novel opportunities to track population health. The objective of this study was to examine reliability of data in comparing participant responses collected using two mobile phone survey (MPS) delivery modalities, computer assisted telephone interviews (CATI) and interactive voice response (IVR) in Bangladesh (BGD) and Tanzania (TZA). METHODS: Using a cross-over design, we used random digit dialing (RDD) to call randomly generated mobile phone numbers and recruit survey participants to receive either a CATI or IVR survey on non-communicable disease (NCD) risk factors, followed 7 days later by the survey mode not received during first contact; either IVR or CATI. Respondents who received the first survey were designated as first contact (FC) and those who consented to being called a second time and subsequently answered the call were designated as follow-up (FU). We used the same questionnaire for both contacts, with response options modified to suit the delivery mode. Reliability of responses was analyzed using the Cohen's kappa statistic for percent agreement between two modes. RESULTS: Self-reported data on demographic characteristics and NCD behavioral risk factors were collected from 482 (CATI-FC) and 653 (IVR-FC) age-eligible and consenting respondents in BGD, and from 387 (CATI-FC) and 674 (IVR-FC) respondents in TZA respectively. Survey follow-up rates were 30.7% (n = 482) for IVR-FU and 53.8% (n = 653) for CATI-FU in BGD; and 42.4% (n = 387) for IVR-FU and 49.9% (n = 674) for CATI-FU in TZA respectively. Overall, there was high consistency between delivery modalities for alcohol consumption in the past 30 days in both countries (kappa = 0.64 for CATI→IVR (BGD), kappa = 0.54 for IVR→CATI (BGD); kappa = 0.66 for CATI→IVR (TZA), kappa = 0.76 for IVR→CATI (TZA)), and current smoking (kappa = 0.68 for CATI→IVR (BGD), kappa = 0.69 for IVR→CATI (BGD); kappa = 0.39 for CATI→IVR (TZA), kappa = 0.50 for IVR→CATI (TZA)). There was moderate to substantial consistency in both countries for history of checking for hypertension and diabetes with kappa statistics ranging from 0.43 to 0.67. There was generally lower consistency in both countries for physical activity (vigorous and moderate) with kappa statistics ranging from 0.10 to 0.41, weekly fruit and vegetable with kappa ranging from 0.08 to 0.45, consumption of foods high in salt and efforts to limit salt with kappa generally below 0.3. CONCLUSIONS: The study found that when respondents are re-interviewed, the reliability of answers to most demographic and NCD variables is similar whether starting with CATI or IVR. The study underscores the need for caution when selecting questions for mobile phone surveys. Careful design can help ensure clarity of questions to minimize cognitive burden for respondents, many of whom may not have prior experience in taking automated surveys. Further research should explore possible differences and determinants of survey reliability between delivery modes and ideally compare both IVR and CATI surveys to in-person face-to-face interviews. In addition, research is needed to better understand factors that influence survey cooperation, completion, refusal and attrition rates across populations and contexts.

Cell phone ownership and modern contraceptive use in Burkina Faso: implications for research and interventions using mobile technology.

OBJECTIVES: With over 420 million unique cell phone subscribers in sub-Saharan Africa, the opportunities to use personal cell phones for public health research and interventions are increasing. We assess the association between cell phone ownership and modern contraceptive use among women in Burkina Faso to understand the opportunity to track family planning indicators using cell phone surveys or provide family planning interventions remotely. STUDY DESIGN: We analyzed data from a cross-sectional, nationally representative population-based survey of women of reproductive age in Burkina Faso, the Performance Monitoring and Accountability 2020 Round 4, which was conducted between November 2016 and January 2017. RESULTS: Among the 3215 female respondents aged 15 to 49 years, 47% reported cell phone ownership. Overall, 22% of women reported current modern contraceptive use. Women who owned a cell phone were more likely to report modern contraceptive use than those who did not (29% versus 15%). Adjusted for covariates (age, wealth, education, area of residence and marital status), the odds of reporting modern contraceptive use were 68% higher among cell phone owners compared to nonowners (odds ratio=1.68, 95% confidence interval 1.3-2.1). Method mix was substantially more diverse among those who owned cell phones compared to their counterparts. CONCLUSIONS: The study shows that cell phone ownership is significantly associated with modern contraceptive use in Burkina Faso, even after adjusting for women's sociodemographic characteristics. These results suggest that cell phone ownership selectivity and associated biases need to be addressed when planning family planning programs or conducting surveys using cell phones. IMPLICATIONS: Cell phones can be used for myriad family planning purposes, from confidential data collection to contraceptive promotion and knowledge dissemination, but ownership bias is significant. A cell-phone-based intervention or population-based survey is unlikely to reach a critical mass of the population at highest risk for unintended pregnancy.

Building the Evidence Base for Remote Data Collection in Low- and Middle-Income Countries: Comparing Reliability and Accuracy Across Survey Modalities.

BACKGROUND: Given the growing interest in mobile data collection due to the proliferation of mobile phone ownership and network coverage in low- and middle-income countries (LMICs), we synthesized the evidence comparing estimates of health outcomes from multiple modes of data collection. In particular, we reviewed studies that compared a mode of remote data collection with at least one other mode of data collection to identify mode effects and areas for further research. OBJECTIVE: The study systematically reviewed and summarized the findings from articles and reports that compare a mode of remote data collection to at least one other mode. The aim of this synthesis was to assess the reliability and accuracy of results. METHODS: Seven online databases were systematically searched for primary and grey literature pertaining to remote data collection in LMICs. Remote data collection included interactive voice response (IVR), computer-assisted telephone interviews (CATI), short message service (SMS), self-administered questionnaires (SAQ), and Web surveys. Two authors of this study reviewed the abstracts to identify articles which met the primary inclusion criteria. These criteria required that the survey collected the data from the respondent via mobile phone or landline. Articles that met the primary screening criteria were read in full and were screened using secondary inclusion criteria. The four secondary inclusion criteria were that two or more modes of data collection were compared, at least one mode of data collection in the study was a mobile phone survey, the study had to be conducted in a LMIC, and finally, the study should include a health component. RESULTS: Of the 11,568 articles screened, 10 articles were included in this study. Seven distinct modes of remote data collection were identified: CATI, SMS (singular sitting and modular design), IVR, SAQ, and Web surveys (mobile phone and personal computer). CATI was the most frequent remote mode (n=5 articles). Of the three in-person modes (face-to-face [FTF], in-person SAQ, and in-person IVR), FTF was the most common (n=11) mode. The 10 articles made 25 mode comparisons, of which 12 comparisons were from a single article. Six of the 10 articles included sensitive questions. CONCLUSIONS: This literature review summarizes the existing research about remote data collection in LMICs. Due to both heterogeneity of outcomes and the limited number of comparisons, this literature review is best positioned to present the current evidence and knowledge gaps rather than attempt to draw conclusions. In order to advance the field of remote data collection, studies that employ standardized sampling methodologies and study designs are necessary to evaluate the potential for differences by survey modality.

Evaluation of Mechanisms to Improve Performance of Mobile Phone Surveys in Low- and Middle-Income Countries: Research Protocol.

BACKGROUND: Mobile phone ownership and access have increased rapidly across low- and middle-income countries (LMICs) within the last decade. Concomitantly, LMICs are experiencing demographic and epidemiologic transitions, where non-communicable diseases (NCDs) are increasingly becoming leading causes of morbidity and mortality. Mobile phone surveys could aid data collection for prevention and control of these NCDs but limited evidence of their feasibility exists. OBJECTIVE: The objective of this paper is to describe a series of sub-studies aimed at optimizing the delivery of interactive voice response (IVR) and computer-assisted telephone interviews (CATI) for NCD risk factor data collection in LMICs. These sub-studies are designed to assess the effect of factors such as airtime incentive timing, amount, and structure, survey introduction characteristics, different sampling frames, and survey modality on key survey metrics, such as survey response, completion, and attrition rates. METHODS: In a series of sub-studies, participants will be randomly assigned to receive different airtime incentive amounts (eg, 10 minutes of airtime versus 20 minutes of airtime), different incentive delivery timings (airtime delivered before survey begins versus delivery upon completion of survey), different survey introductions (informational versus motivational), different narrative voices (male versus female), and different sampling frames (random digit dialing versus mobile network operator-provided numbers) to examine which study arms will yield the highest response and completion rates. Furthermore, response and completion rates and the inter-modal reliability of the IVR and CATI delivery methods will be compared. RESULTS: Research activities are expected to be completed in Bangladesh, Tanzania, and Uganda in 2017. CONCLUSIONS: This is one of the first studies to examine the feasibility of using IVR and CATI for systematic collection of NCD risk factor information in LMICs. Our findings will inform the future design and implementation of mobile phone surveys in LMICs.