For at least 100 years, epidemics of meningococcal meningitis have occurred frequently but unpredictably in a region of the Sahel and sub-Sahel known as the African meningitis belt. Information on transmission of meningococcal infection in the area was scarce with earlier studies giving very varied results because they had been restricted to a single site or had been conducted at different times of the year.
MenAfriCar (the African Meningococcal Carriage Consortium) is a global research effort to study meningococcal meningitis carriage in households in Africa and document the impact of a new vaccine (PsA-TT) on reducing transmission of serogroup A meningococcal meningitis. The study is believed to be the first multi-centre and multi-country longitudinal meningococcal carriage study in the world.
Funded by the Wellcome Trust and The Bill and Melinda Gates Foundation, MenAfriCar required data capture system for the longitudinal cohort study in seven African countries within the African meningitis belt of Ethiopia, Chad, Nigeria, Niger, Ghana, Mali and Senegal.
The data capture software needed to efficiently collate data from thousands of study participants into one format and be able to store these records locally and share the information with those involved in the project in London, including the London School of Hygiene and Tropical Medicine (LSHTM) .
Various systems for data management that required construction of local and a central database were considered, including OpenClinica. After preliminary tests at several African centres, TeleForm was selected. TeleForm allows study forms to be specially designed, scanned after completion, automatically read through a combination of OCR (Optical Character Recognition), ICR (Intelligent Character Recognition) and OMR (Optical Mark Recognition) and barcode recognition and then verified before being exported to a local database.
ePC provided document scanners and laptops with TeleForm Desktop pre-installed. Data managers and field managers from the seven centres received the equipment at a TeleForm training workshop in Mali.
To ensure that all centres use the same paper CRF, they were created in the CRF designer in both English and French (see example below) and included choice fields, constrained print fields, cornerstones, image zones and ID blocks. The forms are printed and taken into the field with labels, which are populated automatically with study IDs and printed in self-adhesive label sheets for use in the laboratory.
Once completed, the forms are scanned into the data capture software using a high-speed document scanner, verified and uploaded to a local database and the main trial database in London. Users can retrieve the data and original paper CRF images from the main study database.
ePC will also continue to provide technical support and consultancy throughout the lifecycle of the project, which will run for several years.
A primary objective of the MenAfriCar consortium has been the collection of comparable data across the centres. A consistent form template and training has allowed field workers and local data managers to gain experience and confidence in completing forms and using the data capture software which has led to accurate data being processed.
Prior to the launch of the study, our requirements changed frequently and deadlines were very tight. ePC have been very supportive in dealing with these design changes. This is not a typical project but ePC have risen to the challenge and I am happy with the progress achieved so far.Arouna Woukeu, IT Manager, London School of Hygiene and Tropical Medicine (LSHTM)
Initial challenges associated with slow and intermittent internet were overcome with centres acquiring higher bandwidth, dedicated internet connectivity or uploading data later in the day. This resulted in all centres being able to upload on schedule for central monitoring to take place.
More importantly, initial results from evaluation of the impact of PsA-TT in Burkina Faso are encouraging with marked drops in the incidence of serogroup A meningitis and carriage following introduction of the vaccine.
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