Performance of a Smartphone Application-Based Participatory Syndromic Surveillance System for Acute Febrile Illness and Acute Gastroenteritis in Rural Guatemala

We studied the performance of a smartphone application-based participatory syndromic surviellance (PSS) system for collecting syndromic data (acute febrile illness [AFI] and acute gastroenteritis [AGE]) to detect dengue virus (DENV) and norovirus (NoV) on a cohort of children living in a low-resource and rural area of Guatemala. Randomized households were provided with a smartphone and asked to submit weekly reports using a symptom diary Application (Vigilant-e). Subjects reporting AFI or AGE answered additional questions using a decision-tree algorithm and were visited at home by a study nurse who performed a second interview and collected samples for DENV (AFI) and NoV (AGE). We analyzed risk factors associated with decreased self-reporting of syndromic data and evaluated strategies to improve self-reporting. We also assessed agreement between self-report and nurse-collected data. From April 2015 to June 2016, 469 children in 207 households provided 471 person-years of observation. Mean weekly symptom reporting rate was 78% (range: 58–89%). Households with a poor (<70%) reporting rate using the Vigilant-e application (n = 57) had a greater number of children (mean = 2.8 vs. 2.5, risk ratio [RR] = 1.2, 95% CI = 1.1–1.4) and were less likely to use text messaging at study enrollment (61% vs. 77%, RR = 0.6, 95% CI = 0.4–0.9). Parents of female subjects were more likely to have low response rate (57% vs. 44%, RR = 1.4, 95% CI = 1.1–1.9). Poor response rate (<70%) was associated with decreased case reporting of AGE, NoV+ AGE, AFI, and DENV+ AFI (P < 0.001). Parent smartphone-reported syndromic data agreed with nurse-collected data for fever (kappa = 0.57, P < 0.001), vomiting (0.63, P < 0.001), and diarrhea (0.61, P < 0.001), with decreased agreement as the time interval between parental report and nurse home visit increased (<1 day kappa: 0.65-0.70; >2 day kappa: 0.08–0.29). In a resource-limited area of rural Guatemala, a smartphone application-based participatory syndromic surveillance system demonstrated a high reporting rate and good agreement between parental report and nurse report during home visits. Several household-level and external factors were associated with decreased syndromic reporting. Poor reporting rate was associated with decreased syndromic and pathogen-specific case ascertainment. D. Olson, Takeda Pharmaceuticals: Consultant, Grant recipient. R. Zambrano, Integra IT: Employee and Shareholder, Salary. S. Rodriguez-Castro, Integra IT: Employee and Shareholder, Salary. E. J. Asturias, Takeda Pharmaceuticals: Consultant and Grant Investigator, Grant recipient