The Digitization of Active Surveillance: an Insight-Based Evaluation of Interactive Visualization of Active Case Search for Polio Surveillance to Support Decision Making in Africa
Authors: Akpan Godwin , Bello Isah , Mohamed Hani Farouk , Touray Kebba , Kipterer John , Ngofa Reuben , Oyaole Daniel , Atagbaza Ajiri , Ticha Johnson , Manengu Casimir , Chikwanda Chanda , Nshuti Marie Babona , Omoleke Semeeh , Oviaesu David , Diallo Mamadou , Seaman Vincent , Mkanda Pascal 
Published: December 2020

Abstract
Background: Tracking every child for polio eradication in the African region has been an ambitious objective in respose to the recommendations of the Global Polio Eradication Initiative (GPEI) to enhance information gathering in areas with sub-optimal and challenging performance. Achieving this objective require real-time information on active surveillance. Acute Flaccid Paralysis (AFP) case searches were captured on mobile phones to monitor polio eradication programme through a digitalised platform developed by the Polio Geographic Information System Centre at WHO Regional Office for Africa. The system generated a huge dataset and influenced the development of several information products that was critical for managing the polio programme within the African region which was acknowledged by Africa Regional Certification Commission (ARCC) as a key support to acheivng eradication of wild polio virus which was celebrated in August 2020. Objective: To document and assess the impact of interactive visualisation infographic platforms to guide decision-making in achieving polio eradication in the African continentMethod: The study reviewed retrospective prototype data from a web-based interactive visualization platform sourced from real-time active case searches (ACS) conducted in the African region from June 2017-2020 using android mobile phones. The study participants used the platform via smart screens and touch wall projections for decision making and gap analyses. The study evaluated the tool using the informal user experience evaluation method combined with an automated relay monitor on the active surveillance web-based applications, which cached every visit to the geographic entity. The method employed required platform users to interrelate with ACS and AFP surveillance data via visual displays for their programmatic interventions and accountability. The study also captured their feedbacks through a structured interview and automatically-cached pages. Results: Communicating field level indicators in real-time and interactively to decision-makers is a powerful and veritable tool to solve geographical representation of surveillance gaps at the lowest level of reporting, and reach a wider diversity of audience. These interactive visualisations also solve the problem of complexity in interpretation, which can lead to an impaired understanding of surveillance blind spots, information misinterpretation, which occurs when users of the surveillance data ignore or do not know why, where, and how the data has been produced, or where and how it can be used.Conclusion: The digitalization of disease surveillance, particularly, ACS for Poliomyelitis permits decision-makers to conduct a strategic evaluation of surveillance situations and gaps via interactive visualisations. In this context, these interactive visualisations provide polio programme in Africa wih a platform to visualise interactive imageries of geographical evidence of active surveillance at focal sites using interactive charts, maps and dashboards for all polio surveillance processes. Other considerations, such as cost, ease of use, learnability, and efficiency of those tools were comparatively better than the traditional system.