==== Front
Online J Public Health InformOnline J Public Health InformOJPHIOnline Journal of Public Health Informatics1947-2579University of Illinois at Chicago Library  ojphi-10-e18210.5210/ojphi.v10i1.8973ISDS 2018 Conference AbstractsTablet-based participatory syndromic surveillance at Simhashta
festival in India Diwan Vishal *
1

2
Hulth Anette 
2
Manickam Ponnaiah 
3
Balagurusamy Viduthalai virumbi 
3
Agnihotri Deepak 
1
Parashar Vivek 
1
Pathak Ashish 
1

2
Sahu Kantilal 
4
Mahadik Vijay K. 
1
1 Public Health and Environment, R.D. Gardi Medical
College, Ujjain, India; 2 Karolinska Institutet,
Stockholm, Sweden;3  National Institute of
Epidemiology, Chennai,
India; 4 Department of Health and Family
Welfare, Bhopal, India* Vishal Diwan E-mail: vishaldiwan@hotmail.com30 5 2018 2018 10 1 e182ISDS Annual Conference Proceedings 2018. This is an Open Access
article distributed under the terms of the Creative Commons
Attribution-Noncommercial 3.0 Unported License (http://creativecommons.org/licenses/by-nc/3.0/), permitting all
non-commercial use, distribution, and reproduction in any medium, provided the
original work is properly cited.Keywords 
Mass Gatheringsparticipatorysyndromic surveillanceIndiaTablet based
==== Body
Objective
To develop, test and study tablet-based participatory syndromic surveillance system
for common infectious disease conditions at community level in Simhashta religious
mass gathering in Ujjain, India, 2016.

Introduction
Infectious disease surveillance for generating early warnings to enable a prompt
response during mass gatherings has long been a challenge in India 1,2 as
well as in other parts of the world 3,4,5. Ujjain, Madhya Pradesh in
Central India hosted one of the largest religious festival in the world called
‘Simhasth kumbh mela’ on the banks of River Kshipra, where
more than 50 million attendees came for holy dip during April 22 to May 21, 2016.
The attendees included pilgrims (residents and visitors), observers, officials and
volunteers. We developed an android application with automated summary reports and
an interactive dashboard for syndromic surveillance during the gathering.

Methods
We established the participatory surveillance at all 22 sectors of the festival area,
and at 20 out-patient hospitals and 12 pharmacies. We trained 55 nursing and social
work graduate trainees to collect data from all these settings. The data collectors
visited designated spots daily during a fixed time and collected age, gender,
residence and self-reported symptoms from consenting attendees during the festival
period. The application automatically added date, time and location of interview to
each record and data was transmitted to a web server. We monitored the data in the
interactive dashboard and prepared summary report on a periodic basis. Daily summary
report of self-reported symptoms by time, place and person was shared daily evening
with the festival surveillance authority.

Results
Of the total 93,020 invited pilgrims, 91% participated in the surveillance. Almost
90% of those were from outside the festival city, 60% were men and 57% were aged 15
to 44 years. Almost 50% of them self-reported presence of at least one symptom. Most
frequently reported symptoms were dehydration due to heat (13%), cold (13%), fever
(7%) and loose stool (5%). During the festival period of over one month,
surveillance data indicated increasing trends of self-reported cough and fever and
declining trends of self-reported dehydration (Figure-1). The designated public
health authorities for the festival did make use of the information for appropriate
action. This tablet- based application was able to collect, process and visualise
around 2500 records per day from the community without any data loss.

Conclusions
To our knowledge, this is the first report from India documenting real-time
surveillance of the community using hand-held devices during a mass gathering.
Despite some implementation issues and limitations in the approach and data
collected, the use of digital technology provided well-timed information avoiding
tedious manual work and reduced a good amount of human resources and logistics
involved in reporting symptoms with a traditional paper- based method in such a
large population. In retrospect, the main utility of the surveillance output was
that of giving reassurance to the officials, as no major outbreaks occurred during
the event. We believe that this experience and further analyses will provide input
for the establishment and use of such a surveillance system during mass gatherings.
The team of investigators propose improving the methods and tools for future
use.

Acknowledgments
We are grateful for the Department of Health and Family Welfare, Government of Madhya
Pradesh for study permission, R.D. Gardi Medical College, Ujjain for financial
Support. We are also thankul to study participants and project team
==== Refs
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