Browsing by Author "Brinkel, Johanna"

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Digital Technologies to Enhance Infectious Disease Surveillance in Tanzania: A Scoping Review
(MDPI, 2023-02-06) Mustafa, Ummul-khair; Kreppel, Katharina; Brinkel, Johanna; Sauli, Elingarami
Mobile phones and computer-based applications can speed up disease outbreak detection and control. Hence, it is not surprising that stakeholders in the health sector are becoming more interested in funding these technologies in Tanzania, Africa, where outbreaks occur frequently. The objective of this situational review is, therefore, to summarize available literature on the application of mobile phones and computer-based technologies for infectious disease surveillance in Tanzania and to inform on existing gaps. Four databases were searched—Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase), PubMed, and Scopus—yielding a total of 145 publications. In addition, 26 publications were obtained from the Google search engine. Inclusion and exclusion criteria were met by 35 papers: they described mobile phone-based and computer-based systems designed for infectious disease surveillance in Tanzania, were published in English between 2012 and 2022, and had full texts that could be read online. The publications discussed 13 technologies, of which 8 were for community-based surveillance, 2 were for facility-based surveillance, and 3 combined both forms of surveillance. Most of them were designed for reporting purposes and lacked interoperability features. While undoubtedly useful, the stand-alone character limits their impact on public health surveillance
Evaluation of the acceptability of ESIDA app, a smartphone-based clinical decision support application to improve infectious disease outbreak detection in Tanzania: clinician perspectives
(Mustafa et al. BMC Public Health, 2025) Mustafa, Ummul; Elingarami, Sauli; Kreppel, Katharina; Boenecke, Juliane; Brinkel, Johanna
Epidemic-prone infectious diseases (EPIDs) such as dengue fever, coronavirus disease 2019 (COVID-19), leptospirosis, Marburg virus disease, measles and cholera, to name a few, place a significant burden on the Tanzanian population and health system. Clinicians working in primary health facilities (PHFs), such as dispensaries, health centres, and basic hospitals, play a vital role in detecting cases and outbreaks. However, they often face challenges, including insufficient knowledge of these diseases and a lack of supporting resources, including surveillance guidelines, standard case definitions, and, most importantly, access to confirmatory diagnostic tests. Although Tanzania reports outbreaks of infectious diseases almost every year, a significant number of cases go undetected and contribute to delayed response and recurrent outbreaks. Smartphone-based clinical diagnostic decision support systems (CDSS) have been proven to help bridge case detection gaps. The Epidemiological Surveillance for Infectious Diseases in Sub-Saharan Africa (ESIDA) project proposed developing the ESIDA app, a smartphone-based CDSS, to aid clinicians in the detection of EPIDs. Before developing the app, the ESIDA project evaluated its acceptability among clinicians, the primary target users. The aim was to gather insights to inform the app development, ensuring its design and features are relevant and applicable in Tanzania context.In-depth interviews were conducted with 21 clinicians, including medical doctors and clinical officers from public and private facilities in the Dar es Salaam region, which has reported frequent outbreaks of dengue and cholera. Data were collected and analyzed using the Unified Theory of Acceptance and Use of Technology (UTAUT) model. Clinicians were positive about the proposed ESIDA app and intended to use it once it was available. The facilitators and barriers to acceptability focused on performance expectancy, effort expectancy, facilitating conditions and social influence. Expected benefits, ease of use, and government involvement emerged as facilitators of acceptability, while high internet costs, workload, time constraints, infrastructure gaps, and patient resistance were identified as potential barriers. The development of the ESIDA app should prioritize maximizing system performance and benefits. They must also be user-friendly and in line with social norms. The necessary infrastructure must be in place for effective implementation.
Health professionals’ knowledge on dengue and health facility preparedness for case detection: A cross-sectional study in Dar es Salaam, TanzaniaHealth professionals’ knowledge on dengue and health facility preparedness for case detection: A cross-sectional study in Dar es Salaam, Tanzania
(PLOS, 2023-11-21) Mustafa, Ummul-khair; Sauli, Elingarami; Brinkel, Johanna; Kreppel, Katharina
Dengue presents a growing public health concern in the Dar es Salaam region of Tanzania, marked by the recurring incidence of outbreaks. Unfortunately, there is little information available on the region’s preparedness in terms of health care workers’ knowledge on dengue as well as the availability of reagents and equipment essential for diagnosing and monitoring of dengue infections. To elucidate this, 78 health facilities were visited in Temeke district and structured questionnaires were distributed to 324 health care workers. The aim was to evaluate health care workers’ knowledge on dengue and to assess the availability of reagents and equipment essential for diagnosing and monitoring of dengue infections. Content validity of the questionnaire was achieved through extensive literature review and it exhibited high reliability (Cronbach Alpha coefficient = 0.813). Cumulative scores for responses on knowledge questions by health care workers were computed. Characteristics such as level of education, place of work and gender were tested for association with these scores using chi-square tests and logistics regression. Almost all health care workers (99.7%) were aware of dengue disease. However, less than half (46.9%) had knowledge scores of or over 40%. Clinicians had approximately four times higher knowledge scores than other cadres (AOR, 3.637; p-value≤ 0.0001), and those who worked in private facilities had twice the knowledge score than those working in government institutions (AOR, 2.071; p-value = 0.007). Only 8.6%, 35.6% and 14.7% of respondents reported the availability of dengue rapid tests, medical guidelines and refresher training respectively, showing a lack of health facilities readiness for the detection of dengue infections. Based on findings from this study, we recommend government authorities to build capacity of health care workers, to improve their understanding of dengue. We also urge the government and stakeholders to work together to ensure availability of diagnostic tests and other tools needed for diagnosis and surveillance of dengue
Integrated rapid risk assessment for dengue fever in settings with limited diagnostic capacity and uncertain exposure: Development of a methodological framework for Tanzania
(Public Library of Science, 2025-03-28) Belau, Matthias; Boenecke, Juliane; Ströbele, Jonathan; Himmel, Mirko; Dretvić, Daria; Mustafa, Ummul-Khair; Kreppel, Katharina; Sauli, Elingarami; Brinkel, Johanna; Clemen, Ulfia; Clemen, Thomas; Streit, Wolfgang; May, Jürgen; Ahmad, Amena; Reintjes, Ralf; Becher, Heiko
Background Dengue fever is one of the world’s most important re-emerging but neglected infectious diseases. We aimed to develop and evaluate an integrated risk assessment framework to enhance early detection and risk assessment of potential dengue outbreaks in settings with limited routine surveillance and diagnostic capacity. Methods Our risk assessment framework utilizes the combination of various methodological components: We first focused on (I) identifying relevant clinical signals based on a case definition for suspected dengue, (II) refining the signal for potential dengue diagnosis using contextual data, and (III) determining the public health risk associated with a verified dengue signal across various hazard, exposure, and contextual indicators. We then evaluated our framework using (i) historical clinical signals with syndromic and laboratory-confirmed disease information derived from WHO’s Epidemic Intelligence from Open Sources (EIOS) technology using decision tree analyses, and (ii) historical dengue outbreak data from Tanzania at the regional level from 2019 (6,795 confirmed cases) using negative binomial regression analyses adjusted for month and region. Finally, we evaluated a test signal across all steps of our integrated framework to demonstrate the implementation of our multi-method approach. Results The result of the suspected case refinement algorithm for clinically defined syndromic cases was consistent with the laboratory-confirmed diagnosis (dengue yes or no). Regression between confirmed dengue fever cases in 2019 as the dependent variable and a site-specific public health risk score as the independent variable showed strong evidence of an increase in dengue fever cases with higher site-specific risk (rate ratio = 2.51 (95% CI = [1.76, 3.58])). Conclusions The framework can be used to rapidly determine the public health risk of dengue outbreaks, which is useful for planning and prioritizing interventions or for epidemic preparedness. It further allows for flexibility in its adaptation to target diseases and geographical contexts.