Using mobile technology to conduct epidemiological investigations

Introduction: The aim of this study was to report the experience of an epidemiological fi eld survey for which data were collected and analyzed using tablets. Methods: The devices used Epi Info 7 (Android version), which has been modeled a database with variables of the traditional form. Results: Twenty-one households were randomly selected in the study area; 75 residents were registered and completed household interviews with socioeconomic and environmental risk variables. Conclusions: This new technology is a valuable tool for collecting and analyzing data from the fi eld, with advantageous benefi ts to epidemiological surveys.

To ensure effi ciency, agility, and accuracy, it is essential that public health services are instrumented with basic epidemiological information generated by new technological tools.With the global trend of generating technologies in various sectors, public health tools can incorporate dynamic information, which can also be accessible to the individual user/ health systems (1) .These new technologies promote the collection of information in a short time, thus enabling quick thinking in cases of necessary intervention strategies (2) .This new array of technologies may be applied to mobile systems, particularly smartphones (3) , with features such as remote web access, a Global Positioning System (GPS) signal, huge data storage, and a text editor.Morris (4) demonstrated a few applications that could be used on mobile phones for the collection of public health information.The use of these devices has as great advantage, enabling direct contact between the health authorities and users and allowing participants to feel more involved in territorial health/diseases processes.Ardanza (2) presented other experiences with mobile phone use; in particular, this instrument was used to promote health information in remote areas of African countries.
Modern smartphones with Android (operating system developed by Google), iOS (operating system developed by Apple), and Windows Mobile operating platforms may be implemented in epidemiological fi eld studies, particularly since GPS integration allows for spatial data to be included in the registration interfaces.In addition, data transcription errors are minimized, and there is remote and real-time communication between the information collected in the fi eld and an online storage (3) (5) (6) (7) (8) .
In August 2012, the Centers for Disease Control and Prevention released a new version of Epi Info software for epidemiological studies, with support for mobile platforms (smart phones and tablets) using the Android operating system.This version allows for those with no programming skills to develop their own forms to collect data on tablets, thereby providing improved processes related to this activity.
The aim of this paper is to report the experience of an epidemiological fi eld survey for which socioeconomic and environmental data were collected and analyzed using tablets with the Epi Info 7 mobile platform, with remote transmission of information in real time.This partial, exploratory, cross-sectional test was part of a larger survey being conducted by the Schistosomiasis Lab and Reference Service (Aggeu Magalhães Research Center/ FIOCRUZ) located in Praia do Forte Orange, Itamaracá, Pernambuco, where there is a record of schistosomiasis transmission spanning more than 20 years (9) (10) (11) (12) .
To use Epi Info 7 to collect data on Android tablets, it was necessary to download the application via the website (http://epiinfoandroid.codeplex.com/)to ensure compatibility with OS version 4.0 or higher.The main features of the application are: 1) data collection in a structured form; 2) capture of coordinate pairs for georeferencing of data collection; 3) data export format of comma separated values (CSV); 4) cloud synchronization with data visualization arranged in dashboards; and 5) statistical calculator for epidemiologists.The Epi 7 Android app is hosted in a virtual repository, and the download source is unoffi cial (not been Play Store).For correct installation, allow downloads from unknown sources was enabled in the settings menu of the Android device.The forms were constructed in the desktop environment of Epi Info (Figure 1) and exported via USB connection to the tablets (Figure 1).The variables were transformed into a bank for entry programming and data analysis; this allowed for the production of lists, frequency distributions, statistical analysis, graphs, and maps.In the present study, χ 2 hypothesis testing was performed to estimate the value of the variable dispersion assessing the association between variables.

To enable the remote transmission of information in real time, chips connection via 3G was
To test the mobile technology in question, 21 households were randomly selected in the study area; 75 residents were registered and completed household interviews with socioeconomic and environmental risk variables.The traditional method of collecting and recording data in fi eld surveys (use of clipboards, paper forms, pencil/pen, etc.) was entirely replaced by GPS devices and cameras.
New technologies may be used as tools for collecting and analyzing data from the fi eld, with advantageous benefi ts to epidemiological investigations.This promotes the accurate and effi cient collection of data and is a safe, practical, and fast way to transmit the information in real time, allowing for instant visualization of scenarios in exploratory studies.For the transmission of data in real time and synchronization, it was necessary to hire two services: 1) a data plan where a chip is necessary to connect via 3G; and 2) a storage and data management service in the cloud service Microsoft Azure.The cost of hiring data service plans may be replaced if there is a Wi-Fi connection when fi eld teams return to base, or by installing hotspots in vehicles at the fi eld.With regard to the costs of hiring the Azure cloud service, there is a possibility that the gratuity limit space does not exceed 1 GB of storage.In it there are possibilities are confi gured table where the real-time query can be made by viewing the data in that fi eld are fi lled.

LealCFIGURE 1 -
FIGURE 1 -Epi Info questionnaire on the desktop (A) and tablet (B).Epi Info data analysis (C).