Performance of a Large-Scale Implementation of a Participatory Influenza-Like-Illness Surveillance System in Guatemala

A few words about this work

Shortly after we finalized an exciting mHealth pilot project, we came up with the idea of testing different incentives that could improve performance of crowdsourcing data in Guatemala.

We found interesting results that were presented in the International Conference on Emerging Infectious Diseases (August 26-29, 2018 Atlanta, GA, United States). If you are interested, you can download the poster here: Poster ICEID Format 20180627

Our work was highlighted in a CDC Spotlight that can be found here: 


Date: August 28, 2018

Authors: José Tomás Prieto (1,2); Jorge Jara (1), Andrés Espinosa-Bode (3); Susan Cornelia Kaydos-Daniels (3,4)

Affiliations: 1 Centro de Estudios en Salud, Universidad del Valle de Guatemala, Guatemala; 2 Centers for Disease Control and Prevention, Public Health Informatics Fellowship Program (PHIFP), Atlanta, GA; 3 Centers for Disease Control and Prevention, Division of Global Health Protection, Central America Region office, Guatemala; 4 Centers for Disease Control and Prevention, Influenza Division, Central America Region office, Guatemala

Background: Public participation in surveillance of influenza-like-illness (ILI) symptoms could strengthen limited and delayed information from hospital- and laboratory-based surveillance in Latin America. In 2017, we validated and published results on the use of text messages and an app to collect ILI surveillance information (Prieto et al., 2017). In this study, we evaluate effectiveness of the approach during an influenza season in a large-scale implementation in Guatemala.

Methods: We created a system capable of capturing ILI reports from two sources, a mobile-accessible web-based survey and the smartphone app “Nuestra Gripe” (“Our Flu” in Spanish). Our ILI case definition was as follows: measured fever and cough or sore throat, with onset within the last 7 days. We sent 119,738 text-messages to invite people to submit weekly reports about: respondents’ location, age, symptoms of ILI, health-seeking behavior, and history of influenza vaccination. Half of participants were offered influenza prevention tips; the other half the chance to participate in ten lotteries of ~15 dollars of phone credit. We used descriptive statistics to characterize electronic reports and used the chi2 test to study the association between the number of participants who accepted to participate and study groups. We hypothesized that there would be a weak to moderate positive correlation between the number of electronically identified ILI cases and the number of reported, laboratory-confirmed cases of influenza . The study protocol was approved by UVG (protocol 149-09-2016), the Guatemalan Ministry of Health (resolution 03-2017), and the CDC (CGH HSR Tracking 2017-140).

Results: Following the transmission of invitation text-messages, 398 unique numbers in group 1 (0.7%, 398/59 785) and 677 unique numbers in group 2 (1.1%, 677/59 785) accepted to participate. In total, 1075 respondents submitted a report through the web-based survey; 39.7% (427/1075) reported symptoms of ILI. Around one tenth of respondents with symptoms of ILI (13.3%, 57/427) reported history of influenza vaccination within the current year. Respondents reported from 21 out of 22 Guatemalan departments. The median age was 30 (range: 14-71). We recorded 180 downloads of the app and collected 381 reports through it, 87 of them indicating symptoms of ILI.

Discussion: Crowdsourced ILI data could strengthen surveillance of influenza in Guatemala. The fact that we received reports originating in almost all of the country departments shows promising representativeness of the system. Acceptability was low as anticipated during the study design; participating in a monthly lottery of phone credit may be more attractive than receiving health-promoting information for participants.