African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES)

项目摘要 中风是全球死亡和残疾的主要原因;但其精确的 低收入和中等收入国家（LMIC）的负担并不明显， 非洲监控系统在LMIC几乎不存在， 最需要的是，为了可靠地确定和跟踪中风的实际负担， 其流行病学趋势和结果。与其他地区不同， 对非洲中风负担的估计来自全球中风负担， 疾病（GBD），这主要是来自模型使用不可靠或缺乏 数据开发可扩展的可持续的严格主动电子监控系统 利用现有的移动医疗技术， 基于社区的卒中实际负担和决定因素的实时数据 在非洲这将改善早期通知和介绍在适当的照顾 设施;并为制定、实施和评价有效的 非洲社区中风预防、其他干预措施和政策， 其他低收入、中等收入和贫困地区，承担了全球80%以上的中风负担。 非洲严格创新中风流行病学的总体目标 监督（ARISES）是部署和验证第一种可扩展的mHealth 基于社区的交互式卒中信息和监测系统（SISS） 对中风的人口负担进行可靠的测量和实时跟踪; 同时建立可持续的能力来提高中风知识， 两个既存人口监测点的早期表现和结果 (DSS)：尼日利亚的一个城市和一个农村地区。 为了实现这一目标，我们将利用我们以前创建的资源，包括 1)一个中风视频纪录片，用于提高中风识字率和识别率， 2）适合文化的舞蹈套路， 中风，3）社区筛查中风的象形工具，以及4）特殊的 用于精确严格的中风表型分析的软件。1095年， 在尼日利亚的家庭，我们试点测试了电子监控的关键组成部分， 包括临床医生可用于引出报告的文本消息平台的系统 中风事件的远程和移动健康平台， 成员可以通知卫生工作者有关中风发生或死亡的情况。大约99% 的社区成员可方便地使用移动的电话;而超过95%的社区成员 通过电话或短信表达沟通的方便性，愿意 报告中风事件，和/或通过电子监测监测其健康状况 系统为了确保几乎全部病例纳入和准确的分母人群， 我们会继续绘制社区地图，更新人口数字， 人口概况，并建立一个新颖的多管齐下的'冷热追求'的情况下， 选择性决策支持系统集成中的逐户调查确定技术 传统和非传统护理系统的可持续性。我们还将整合 将SISS纳入可持续护理矩阵，以改善DSS中的卒中结局。 新型电子监控、社区参与和 ARISES中的中风护理矩阵使其成为一个整体模型，可扩展到其他 在美国和LMIC的低资源设置，以提高易用性，准确性和 中风负担流行病学指数的产生频率， 提高中风知识，预防，早期表现和结果使用 移动健康

PROJECT SUMMARY Stroke is a leading cause of death and disability globally; but its precise burden is not clear in Low-and Middle-Income Countries (LMIC) particularly in Africa. Surveillance systems are almost non-existent in LMIC, where they are needed most, for reliable determination and tracking of the actual burden of stroke, its epidemiological trends and outcomes. Unlike other regions, the few available estimates of the burden of stroke in Africa come from the Global Burden of Diseases (GBD), which are mostly derived from models using unreliable or scanty data. Developing a scalable sustainable rigorous active e-Surveillance system that takes advantage of available mobile-health technology will provide reliable real-time community-based data on the actual burden and determinants of stroke in Africa. This will improve early notification and presentation in an appropriate care facility; and inform the development, implementation and evaluation of effective community-based stroke prevention, other interventions and policies in Africa and other LMIC regions, which bear over 80% of the global burden of stroke. The overall goal of African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) is to deploy and validate a first-of-its-kind scalable mHealth community-based interactive Stroke Information and Surveillance System (SISS) for reliable measurement and real-time tracking of the population burden of stroke; while simultaneously building sustainable capacity for improving stroke literacy, early presentation and outcome in two pre-existing demographic surveillance sites (DSS): one urban and one rural area in Nigeria. To achieve this, we will leverage resources we previously created including 1) a stroke video documentary for improving stroke literacy and recognition in communities, 2) a culturally-appropriate dance routine for sensitization about stroke, 3) a pictographic tool for screening stroke in communities, and 4) a special software for accurate rigorous phenotyping of stroke. Furthermore, in 1,095 households in Nigeria, we pilot-tested the key components of the e-Surveillance system including text messaging platform which clinicians can use to elicit reports of stroke events remotely and a mHealth platform through which community members can notify health-workers about stroke occurrence or death. About 99% of the community members had easy access to mobile phones; while over 95% expressed ease of communicating via phone calls or text messages, willingness to report stroke events, and/or have their health monitored via the e-Surveillance system. To ensure near-total case inclusion and accurate denominator population, we will continue to map the community sites, update population figures and demographic profiles, and institute a novel multipronged ‘hot and cold pursuit’ case ascertainment technique with door-to-door surveys in the selected DSS integrating orthodox and non-orthodox care systems for sustainability. We will also integrate the SISS into a sustainable care matrix to improve stroke outcome in the DSS. The integration of the novel e-Surveillance, community engagement, and stroke care matrix in ARISES makes it a holistic model, which is scalable to other low resource-settings in the USA and LMIC to improve the ease, accuracy and frequency of production of epidemiological indices of stroke burden while also improving stroke literacy, prevention, early presentation and outcome using mHealth.