TRACnet: A National Phone-based and Web-based Tool for the Timely Integrated Disease Surveillance and Response in Rwanda

Abstract

Objective (1) To describe the implementation of the electronic system for in-tegrated disease surveillance in Rwanda. (2) To present the sensitiv-ity and specificity of the electronic reporting system to detect potential outbreaks Introduction In Rwanda, communicable diseases are the mostly predominant representing 90% of all reported medical consultations in health cen-ters. The country has often faced epidemics including emerging and re-emerging infectious diseases. To enhance its preparedness to iden-tify and respond to outbreaks and prevent epidemics, the Government of Rwanda has developed and deployed an electronic Integrated Dis-ease Surveillance and Response (eIDSR) working with Voxiva with funding from the U.S. Centers for Disease Control and Preven-tion(CDC). Methods The eIDSR is built on Rwanda's existing national phone and web-based HIV-reporting system, " TRACnet " that has been operating na-tionwide since 2004. Data is collected for 23 communicable diseases under surveillance in Rwanda categorized into immediately and weekly reportable. If a lab test is required, the sample is taken and sent to laboratory for testing. Immediate, Weekly, Lab request and lab results forms are completed before submitting data in the system. Data is entered using phone or web based application and is stored in the central database. Results The design of eIDSR module was completed in November 2011. As of September 2012, 252 out of 457 health facilities in Rwanda have been trained and are using the electronic system (over 50% of coverage); the national roll out is still going on with complete cov-erage planned for December 2012. The system sends SMS reminders for due and overdue reports. The timeliness and completeness of re-porting are 98% and 100% respectively. Notifications are sent to the concerned personnel when the threshold for outbreak detection is reached. When lab results are available and entered in the system, the results are automatically communicated to the health centers origi-nating samples. Data is automatically summarized in predefined ta-bles, graphs, dashboards and maps. As of September 3rd, 2012, a total of 5813 reports including 1325 immediate reports and 4488 weekly reports were submitted elec-tronically. Out of 1325 immediate reports submitted, 406 potential outbreaks were detected and immediately notified and 7 of them were confirmed for cholera, rubella, Influenza-like illness (H1N1), measles and food poisoning. From these data, the eIDSR system shows a sen-sitivity of 100% and a specificity of 70% for outbreak detection. The early notification of probable outbreaks stimulated the early investi-gations and the quick response to outbreaks within the country and across the borders. Conclusions The electronic disease surveillance system has improved timeli-ness and completeness of reporting and extremely supports early de-tection and notification of outbreaks for timely response. This system should be a model for the East African region as it has demonstrated advantages in the cross-border disease surveillance. Acknowledgments The government of Rwanda for having adopted ICT as pivotal for De-velopment. MoH/ Rwanda Biomedical Center for promoting innovations in Health sector including m Health technology. The US Centers for Disease Con-trol and Prevention (CDC) for funding TRACnet under the Cooperative Agreement. Voxiva &other stakeholders who worked to implement