e-RAZR (Electronic-Real-time Assessment of Zoonotic Risks)

We live in an environment not just owned by us, but also by a myriad of other species of plants and animals. This is precisely why, in addition to the rich resources that we share with them, we also share a set of diseases and this class of diseases and infections that are naturally transmitted between people and vertebrate animals is zoonoses. Global estimates suggest that over a billion cases of illness and millions of deaths are reported every year from zoonoses which might still be an under reporting of the actual picture. Further, among the reported emerging infectious diseases globally, 60% are zoonoses and also 75% of the newly detected human pathogens are of animal origin substantiating the burden of zoonoses on human health. According to a study by the International Livestock Research Institute study, 2.4 billion cases of human disease and 2.2 million deaths per year are being attributed to 13 zoonotic diseases alone. In India, the major public health zoonotic diseases are rabies, brucellosis, toxoplasmosis, cysticercosis, echinococcosis, Japanese Encephalitis (JE), plague, leptospirosis, Scrub typhus, nipah, trypanosomiasis, Kyasanur forest disease (KFD), and Crimean-Congo hemorrhagic fever.

     Project e-RAZR is intended towards the rural and semi urban population of the state that comprises around 71% of the state population as per the demographics report 2021. Similarly, 62% of the state`s population are dependent on agriculture and allied sectors. Thus, this sector is under a very high risk of contracting a myriad of zoonotic diseases and this project has been aimed exactly to combat this silent risk. Further, the health schemes and services in the state have been implemented with minimal consideration to the zoonotic aspect of disease occurrence in rural populations.
In contrast to the magnitude of the impact of zoonoses, awareness among the people regarding the zoonotic implications is very low and null at several instances. Further, the health schemes and services implemented by the government are often intended towards regular diseases and the zoonotic diseases are often neglected. Further, the disease data and outbreak data is being collected by the health care workers based on the hospital records alone and thus the health care services that are being provided at the PHC level needs to be tailor made to suit the needs of the population in that specified region.
             Henceforth, the problem that we are solving through this application is
“The lack of real-time risk assessment of population with respect to the zoonotic diseases and lack of people-specific primary health care services instead of a one for all approach”.

           Our solution is to develop an android application with an easy User Interface (UI) that would allow a regular user oriented syndromic data collection with respect to the exposure factors and clinical symptoms that would aid the medical authorities in designing specific health care activities.

          Instead of collecting the disease data from hospitals, a regular update from the people itself regarding their weekly exposure to several risk factors and their health status would be a more reliable and definite source of health profile of a population. As several sets of exposure factors are being verified in correlation to the symptomatology, the often neglected zoonotic diseases would be identified based on the correlation. Further, rather than identifying the disease trends at post-symptomatic stage, as most of the people reach out to a hospital only at the later stages of the disease, a regular update on the symptom profile of a population would ensure preparedness among the primary health care workers in managing a disease better.
              In addition to syndromic data, the application would also integrate event based surveillance into the analysis, taking the weekly pharmaceutical sale records, student absenteeism records, mass gathering events, immigrant personnel records, milk production records and laboratory reports into consideration for a more holistic approach. In most of the cases, the disease surveillance is carried out with little consideration to these related events which would greatly aid a medical personnel in
analyzing the disease status and efficiency of the health care services that are being provided in addition to any required amendments.
As of now, the prototype application has been developed that would collect the data from the target groups regarding the zoonotic risk factors, health status and related events and send them to the concerned medical officer for analysis. The UI involves simple dichotomous queries without any open ended questions that would ensure a better response.
              However, we would like to update the application a simple UI that would take in complete data only through colour perception by the people. Bearing in mind, the wide variation in educational standards of the target populations, this colour perception module would be employed in the application where the user needs to answer the query through selecting a coloured block that would represent a Yes/No or a High/Low response. Further, the queries would be also read out loud in the vernacular language along with the on-screen text to assist the rural people who might find it difficult in responding to a textual query.
             The application would provide different domains of logging into it to the medical officer, general people, pharmacists, school faculty, milk collection personnel, village head, laboratory technician and health care workers to enter their information for that week. Further, the overall command at the PHC level lies in the hands of the concerned medical officer who can analyze the data under different heads as follows:

- Proportion of people under that specific PHC jurisdiction with the application installed in their mobiles.
- Proportion of people response in that week
- The most prominent exposure factor that might be a virtual causal factor in the future days.
- Suspected zoonotic chains of diseases in that week
- The symptomatology of the population in that week
- Medicines that had a sudden rise or fall in sales in that week.
- Any changes in the absenteeism trends of school children in that week.
- Any immigrants from other states/countries into that population in that week
- Occurrence of events that had mass gatherings like marriages/rallies in that week.
- Milk quantity and quality levels in that week
- Medical laboratory reports of that week

           As the information is a primary data, there would be a very thin chance of inappropriate or fabricated data with respect to the exposure factors or symptoms. As of now, the application involves the transmission of the weekly data recorded from a PHC region respondents to the medical officer through email. The data would then be analyzed to identify the possible zoonotic risk level of that population. Further, the updated application would be preloaded with pre-defined definitions to suspect a zoonotic disease based on the combination of responses along with an AI-algorithm that would allow the medical officer to quickly compile and analyze the weekly responses from all the domains and generate “trend maps” regarding exposure factors, symptoms, medicines, absenteeism and milk quantity to identify and predict any disease in the coming weeks. Based on these trend maps, the medical officer can analyze the effectiveness of the health care services and make amendments to suit the generated health status and disease trends of that population.

Example:
A population has reported high rodent population, recent floods in that area due to heavy rainfall and also reported fever, head ache and vomiting in their symptomatology. Health care workers reported a rise in jaundice cases in that region from the past 2 weeks.
         When such data is collected in the application,
Based on the unique combination of responses, the medical officer could identify that there is a surge in Leptospirosis cases by checking the unique combination of responses with an already provided list of possible combinations that would indicate a specific zoonotic disease.
When a medical officer has such a picture of the population, he/she can implement the health care facilities that would prevent the spread of leptospirosis and also can confirm the suspected cases by laboratory confirmation.
             Further, based on the data reported on the later weeks, he/she can analyze the effectiveness of the provided health care services and could amend them as required. As most of the diseases are noticed at a late stage by the authorities making them tough to manage, such a disease management based on the regular symptoms and risk factors of a population would greatly enhance the disease management and provision of health care services.

Existing methods of disease surveillance in our region and why is this approach a better one comparatively.

        In our state, several health schemes and disease surveillance programs are at use aiming for a healthy population but a specific surveillance system dedicated to assess the zoonotic risks of a population through participatory surveillance is lacking and our proposed application would exactly suffice this shortcoming.
          Further, existing surveillance programs are relying on the secondary data from health care workers and hospital reports which might not indicate the exact needs of the people. Similarly, primary health care services though are being implemented in the target populations, a regular monitoring of their efficacy has been lacking. “Involving the population directly into the surveillance program not only produces a reliable primary data with respect to zoonotic risk factors and health status, but also creates awareness among the population regarding the various ways of zoonotic transmission and the prevention strategies against them.”
         Similarly, unlike the earlier sophisticated applications which were technically more demanding, this proposed e-RAZR application involves simple dichotomous responses; thus making it a more user friendly technique of understanding the population health status and needs.
Also, the medical officer at the PHC level can integrate with the other PHC officers for a broader picture of the diseases and could suggest the Community Health Center (CHC) personnel regarding the amendments with respect to the provision of health care facilities.

Assessing the risk factors – Quantification
In order to asses the zoonotic risk of the population, various risk factors are assessed with respect to the important zoonotic diseases. The strength of the association of these risk factors with the manifestation of various clinical symptoms is analyzed statistically through multivariate analysis and the most significant risk factors predisposing the population to these zoonotic diseases
are considered. This would ensure the control and prevention measures are designed by the authorities at their level in bringing down these significant risk factors. Such risk factor assessment would be done regularly to achieve an early surveillance system with respect to zoonotic diseases and proper provision of health care services to the public.
Push-prompts
The application would involve sending a push notification to all the installed mobiles to fill out the questionnaire every week to ensure the people are reminded. Until the respondents have responded to the queries, the notifications would be sent regularly to ensure a higher response rate
from the public.
Scope for extension of this project
The risk factor data and syndromic trends that would be collected regularly generate huge data-sets that could be used in myriad of statistical disease models that would further strengthen the risk assessment with an evidence-based approach. Further, these data sets could also be integrated to mapping where the risk factors would be correlated with the spatial database to
analyze the risk factors through a more holistic approach.
Proper splitting up of our target population:
The project would be aimed at three levels:
1. General population – Public who would voluntarily provide weekly syndromic data
2. Sentinel population – Pharmacists, School teachers, Village heads, Milk collection center personnel - People who provide disease related event data
3. Special population-Laboratory technicians, Health related workers – People who provide secondary disease data through testing.
Concept of data authority:
As data would be collected at different levels of hierarchy, every authority will have a specified amount of control and ownership on the collected data to a specific level. This is to ensure that, the concerned authority would be in a position to initiate appropriate action based on their data.

This solution is intended to serve the rural and semi urban populations in our state (Andhra Pradesh, India) who are at a constant risk of contracting zoonotic diseases as most of them are involved in agriculture and animal husbandry activities. Awareness among the public regarding the zoonotic disease transmission is just around 1 % as per the reports and thus are often affected by these diseases.

 The target population has been deemed underserved regarding the zoonotic disease surveillance and health care services based on the following inclusion criteria:

- There is no awareness among the people regarding zoonotic diseases
- Health care services are being provided to them without considering their actual health needs.
- A regular symptom profile and risk assessment of the population regarding zoonotic diseases has been lacking in the state.
- Proper primary data collection aids regarding population health status are not yet fully explored.
- Techniques for analyzing the efficiency of provided primary health care services at the rural level are lacking in this region.
- An easy-to-use application to respond on their symptoms and events has not been developed.

    Henceforth, this solution would allow the people to gain awareness about zoonotic diseases, report their symptoms and risk status regularly to health authorities easily and would also assist a medical officer to provide better health care facilities based on the reported information.

         We would like to back ourselves competent enough to design and deliver this proposed solution to the target population as we work under the Department of Veterinary Public Health and Epidemiology (VPHE), College of Veterinary Science, Sri Venkateswara Veterinary University, Tirupati, Andhra Pradesh. Our department of VPHE has been constantly taking up researches towards enhancing the public health status of the state and bringing awareness among the public regarding the zoonotic diseases. Several researches and epidemiological investigations have been carried out by our department with special emphasis on organisms of public health significance and zoonotic implication like S. aureus, E. coli, K. pneumonia, P. mirabilis, Y. enterocolitica, E. granulosus, T. canis,S. typhimurium, A. hydrophilaand L. monocytogenes. Similarly, several public health surveys have been conducted across the state among several risk group individuals and normal populations regarding their awareness levels on Zoonoses. Further, the research studies that are carried out in our department involve regular visits to the rural and semi urban areas for the collection of samples, conducting surveys and analyzing their awareness levels. Most of the studies are concerned with the prevalence of these zoonotic organisms in our everyday samples like milk, meat, eggs, drinking water and soil samples. Henceforth, the risk of contracting these infections in that specific populations could be analyzed to some extent. 

       Thus, our department has been working hand in glove with the rural people across the state as the research works span across different parts of the state and across different livestock species. As a part of these investigations, a clear understanding of the rural populations, their vulnerability to zoonotic diseases and the health care facilities status across the state has been recorded from the past few years that would greatly aid in delivering the solution in an efficient way. The most important aspect of this solution is

        “The rural population of the state who are at the receiving end of this solution are the same individuals who are the substratum for this solution”.

 The whole solution design has been developed bearing in the mind, the active engagement of the people. As their engagement results in a proportionate enhancement of their own health care services, we expect them to turn out in better numbers towards the solution. Further, the solution is a completely people centric approach where their reports, preferences and habits define their own betterment in terms of the health care services they would be provided.

       This project e-RAZR is set on course to develop a state wide network that would involve community participation and event based surveillance in regular assessment of the zoonotic risks and the efficiency of provided health care services in a population. Zoonotic diseases are often neglected in disease surveillance programs that are implemented largely due to lack of awareness and neglecting the one health approach towards a better health status.
       Our department of Veterinary Public Health and Epidemiology has been deploying several research works and surveys across the state to bring awareness among the zoonotic diseases and the need for a one health approach. In this regard, our department has come up with the project e-RAZR, which is a people centered approach that would involve the rural population in self-reporting their symptoms, related events and the health care services regularly to evaluate and act accordingly for their own betterment.
        In this regard, the MIT solve challenge is a once in a lifetime opportunity out of the blue, that would power this vision to action. This solution has a set of hurdles of its own and is discussed below.
Technical:
The prototype as of now has been developed that would collect the data from rural population with a hypothesis that one in every family would be competent enough of responding to a textual query. Further, the smart phone availability in rural population as per the 2021 statistics is hitting around the 70% mark which is a major factor in turning towards this solution. Moreover, our state has implemented several schemes for the people that involves basic android operation that would act as a cushion for this solution.
        However, to achieve a greater coverage of this objective, the application has been under development towards a vocal and color based tool. This would ensure the query is understood by any individual as it would be read aloud in the local language and as the response too includes a color selection, more population could be covered under the project. Moreover, another technical inclusion under way is a real time analysis of the responses by the medical officer coupled with an AI-algorithm for risk assessment and analyzing the health care services. We sincerely hope, these inclusions take shape in the near future that would serve a greater population.
Financial:
       In the state of Andhra Pradesh, majority of the population depend on agriculture and animal husbandry activities and thus are in constant contact with a myriad of risk factors associated with zoonotic diseases. This project e-RAZR, is ought to bring awareness regarding zoonotic diseases, asses the zoonotic risks and analyze the efficiency of health care services in this population. In order to carry out these activities, though our department has a constant relation with these populations, an effective collaboration with the animal husbandry department would ensure a deeper penetration of this solution.
        Our state has 11 districts that harbors 7507 Sub centers, 1147 Primary health centers, 191 Community health centers, 34 area hospitals, 8 district hospitals and 11 teaching hospitals confining to the three tier health structure. Veterinary dispensaries are located across every mandal and thus are an effective focal points for implementing this project. However, the implementation might incur expenses with respect to the preliminary awareness campaigns, training the medical health workers and veterinary assistants in reporting the data regularly, integrating with the animal husbandry and state health department, shaping the tool with the fore mentioned technical amendments and sustaining the initial period of project stabilization across the state.
Legal:
         The project involves hardly any legal repercussions as it would be implemented across the state under the aegis of animal husbandry and state health department.
Cultural:
         Our state boasts several indigenous cultures across its width and yet these stand on similar terms with respect to health and its related aspects. Project e-RAZR has been developed considering the wide cultural differences across the state including the zoonotic risks that are quite endemic to one part of the state. However, the application might stand strong if it has a backing up to undergo periodic amendments at the early stages to come out as a more generalized tool suiting everyone`s needs across the state.
Market:
        Project e-RAZR is not out on a money minting purpose, instead is a solution with a long term objective of a healthy state. Further, consideration of competitive solutions in the state might be a wafer thin line of thought as regular zoonotic risk assessment through community participation, syndromic and event based surveillance is a lacking discipline in terms of health scheme implementation. However, proper implementation of this project would involve market barriers like capital costs, advertising expenditure, government regulations, patent costs and licensing requirements. As this project is a service oriented solution, majority of market barriers that would be attributed to a normal proposal could be omitted.

Health schemes are a part and parcel of any government implementation in a state and several schemes are running successfully in the state as of now. In addition, health care services are provided to the people across the state by the government through a 3-tier structure involving SC, PHC, CHC, AH, DH and TH. However, amidst all these programs and schemes for the public, a proper surveillance program that emphasizing the REGULAR ZOONOTIC DISEASE RISK ASSESMENT is lacking.

The major factors that would make this project stand apart are

- Community participation
- Regular surveillance
- Syndromic data collection to evaluate disease status rather than conventional outbreak reports and case reports
- Regular Zoonotic risk assessment of the population
- Consideration of major zoonotic diseases (Tuberculosis, Leptospirosis, Listeriosis, Brucellosis, Malaria, Typhoid, Chikungunya, Echinococcosis, Cysticercosis, Scrub typhus, Dengue, Japanese Encephalitis)
- Bringing awareness among the rural population
- Easy-to-use dichotomous data reporting application rather than open ended cumbersome questionnaire
- This allows an easy way of evaluating the efficiency of provided health care services
- Can assist the medical officer to amend the health care services based on the recent reported syndromic data and risk levels of that population
- Health related events are also being considered for risk assessment rather than conventional diagnostic aids.
- There is a rich scope for further integration with prevailing programs and remaining regions.

          Henceforth, this project would bring out remarkable growth and development in the health status of the state population through rigorous risk assessment and proper provision of health care services catering the needs of the people.

Impact goals for the next year:
- Training all the medical and veterinary assistants across the state regarding the project e-RAZR and the zoonotic disease risks.
- Refining the application technically to the soundest design possible
- Carrying out awareness campaigns among the public through the above mentioned trained personnel and making the e-RAZR application installed in at least 50% of the population
- Assessing the zoonotic risks across the state and re defining the health care services provision.
- Integrating medical and veterinary professionals across the state for a holistic health services designing based on one health approach

Impact goals for the next five years:
- Achieving a near 100% penetration of e-RAZR across the target population (i.e. installation of the application among at least 1 person / family).
- Development of a huge zoonotic disease risk database for the state population across seasons.
- Development of an AI based algorithm to predict the zoonotic risks based on the past 5-year risk assessment data
- Development of an algorithm to evaluate the health status of the population in a specific season with age, gender, region and geographical specifications based on the past 5-year syndromic data.
- Integration of this zoonotic disease risk assessment and syndromic data module with meteorological data to predict season and climate specific risk factors.
- Zoonotic outbreak prediction algorithm across the state that would alert the veterinarians, medical officers, health department and public health officials for designing specific health care services.
- Incorporating other disease related events and strengthening event based surveillance module
- Involving the urban population also into the syndromic surveillance considering the urban disease risks across the state.

Plans to achieve these impact goals:

         As our VPHE department is based on the core pillars of public health and zoonoses, every research work borne out of the department has its essence. In our state, several schemes related to the veterinary and medical sciences are being implemented regularly across the rural sector. As our project e-RAZR shares the same target population at the initial level, an integration with these schemes would greatly benefit the project. The medical and animal husbandry assistants are the ones who are a virtual part of every rural household and thus are the most effective means of disseminating this project at a wide scale. As our department has the benefit of guiding the veterinarians across the state, this project could be made a part of their routine rural campaigns and drive this solution deeper.
          Further, as this solution involves the communities directly, the design of the application should be made as accessible as possible by almost every individual irrespective of their technical skillsets. Henceforth, by the end of the first year, considering the penetration efficiency of this project into the population, the required changes to the app UI, any amendments in the risk factors and recommended technical make over would be made that would generate a better datasets, integration and analytical algorithm. Efforts would be put in to generate an updated application with a design that would be made considering the year long data and preferences with a near zero probability of leaving out any risk factor or community.
               Rural communities are in an already filled up pool of mobile applications and adding another drop to it is indeed a tricky task unless performed carefully. Henceforth, the people are to be made aware of concepts of zoonotic diseases, their magnitude and also associated risk factors. Most importantly, they must be made understood the positive implications of the project at immediate future and at the longer run with respect to enhancement of their own health status. Health care services are something that defines a societal growth in almost every dimension and thus people are entitled to the best services possible. However, instead of a conventional one for all approach, this project e-RAZR would ensure tailor made health care services at the community level by the medical officer and this aspect must be drilled fine into the minds of the people.
             Data generated is by far the most precious resource in any community driven solution and in specific, primary data is a level apart. As this project generates voluminous primary health data, a string of AI based prediction algorithms could be developed with these datasets. Based on the syndromic data across regions, sex, gender and seasons, a state wide prediction module could be developed that would indicate the medical officers a predicted surge in specific symptoms and zoonotic cases at a given point of time. Similarly, several events go unnoticed, though are of immense significance in defining an outbreak. Thus, a regular event based surveillance when implemented across the state, any sort of event that has a connection with disease emergence in the population would be covered and thus a holistic surveillance would be achieved with respect to health status of the population.

The project e-RAZR is aimed at a few important impact goals that have the ability to transform the societal health status remarkably and thus has a set of vital indicators to ensure that the project is running forward towards the final aim of a healthier population. The indicators are as follows:
- Regular data analysis on the number of app installations across the state.
- Regular evaluation of public awareness levels on zoonotic risks through bi-monthly e-surveys.
- A monthly evaluation of veterinarians and medical officers regarding the rise and fall in number of respondents and possible recommendations based on the reported trend.
- Evaluating the population coverage by the project tri-annually through the geo-location of all the application installations across the state.
- Correlating the reported syndromic data and event based disease reports with conventional hospital case reports bi-annually to analyze the efficiency of this approach.
- Analyzing the AI-algorithm generated risk predictions efficiency with the actual disease reports bi-annually to further strengthen the AI-algorithm.
- Post 6 months after project implementation , the following indices would be evaluated bi-monthly to make sure the project has been working the right way as intended:
o Level of reported cases across the state
o Level of school absenteeism among the school children
o Vector population status of the state
o Level of awareness among public on zoonotic diseases
o Level of suspected cases reported from laboratories.

          The core technology on which the project e-RAZR is built is an easy-to-use android application. The technology involves simple responses to a string of dichotomous queries and the medical officer would analyze the responses for analyzing the zoonotic disease risk assessment of the population. Further, the awareness activities makes use of already being circulated health scheme applications in the state along with the local campaigns held by the veterinary doctors and medical officers regularly across the rural populations. In addition, several mass gatherings are often carried out across the state as a part of several women empowerment schemes, NGO program, health camps and many of these events could be made use for bringing awareness among the public about the project e-RAZR.
           Training of the veterinary and medical assistants in carrying out the project and teaching the rural people on involving in the surveillance program using their android mobiles would be done through a 3-day e-program. This would give a complete picture about the project, the application utilization, the protocol for collection, the types of communities involved and personnel to be educated for these assistants. Further, a tutorial video would also be circulated across the state through all sorts of communication portals that would educate the public on the need for involving in this people-centric surveillance project. Amendments for the application UI would be made on the technical dimension to further improve its accessibility for individuals of all strata and this involves audio-visual tool inclusion which is a very powerful means of gaining respondents from rural populations. Further, AI-algorithms that would be developed at the later stages of the project involves artificial machine learning technology that would analyze the reported risk factor and health status data and gives out suspected zoonotic disease burden and required health care services that are to be provided.
           Henceforth, this project e-RAZR would be an effective solution to combat the silent zoonotic disease burden across the state through community participation and regular risk assessment. Further, primary health care services efficiency would also be evaluated regularly based on the respondent information which would greatly benefit the population itself to access a greater level of health care services and lead a healthy life.

Primary health care data in this project is given directly by the people themselves through an android application ranging rom their exposed risk factors to their symptoms. However, the health care workers need to bring awareness among the people with respect to such community participation through android tools. Further, the medical officer concerned to that area analyzes the data and amends the health care services

Our team has a leader with immense experience in handling epidemiological researches on zoonotic organisms for the past 10 years, ranging from prevalence studies to dry lab data analytics. 6 women faculty members are also in our team who have vast experience in these zoonotic disease research and are an integral part of almost every activity of our organization. Similarly, researchers include students of masters and doctoral programs who are in continuous contact with the rural and urban populations as apart of their routine study activities for sample collection and epidemiological surveys. Thus our team is a combination of eminent and experienced lead, enthusiastic and energetic researchers and ever supporting working staff to run this organization with minimal turbulence. 

     Further, several researches from other departments and organizations often collaborate with us for the works of larger magnitude and requires higher cadre of efficiency. Researchers from other states like Kerala, Tamil Nadu, Karnataka and many other universities are always in good harmony for collaborative projects and valuable insights in heavier projects. Thus our organization has its wings spread across a wider reach and thus would definitely stand tall in cracking out the solution. 

Key resources:

                        In order to effectively run the project, several resources are required. As the project is aimed at improving the health care services across the state of Andhra Pradesh, a collaborative effort with respect to man power and resources would be demanded. Health care workers play a pivotal role in initial dissemination of the project into the public and spreading awareness on its application. Further, financial cushion is indeed required to initially bring awareness in the public on how and why to involve directly in this project and the aid would also be required to amend the e-tool regularly to suit the public needs. In addition, as the project involves collaboration with the prevailing surveillance programs in its later stages, access to the governmental organizations and NGOs would also be expected.

Partners + Key stake holders:

            In the project e-RAZR, several personnel have indeed a pivotal part of holding it up across the state.

• Researchers and public health professionals across the state
• Medical officers
• Health care workers
• Policy makers
• NGOs
• Android app developers
• Epidemiologists
• Sentinel classes of people – Village heads, Pharmacists, School teachers, Lab technicians, Health workers
• Public themselves
• Medical and Veterinary University officials to provide technical and financial aid towards this proposal.

Key activities

            Basic activities that are being carried out by the project are 

• Regular research on the prevalence and epidemiology of zoonotic diseases across the state with respect to humans and livestock.
• Developing several technical collaborations with the medical fraternity in due course of work and research
• Bringing public awareness among people about zoonotic diseases.
• Regular KAP analysis of people across state to understand the complete scenario regarding these diseases.
• Training the health care workers on how to use the e-RAZR tool
• Regular involvement of general public in disease surveillance
• Analyzing the syndrome data and event data related to these diseases regularly
• Making regular updates to the android tool to allow more and more people to effectively involve in this participatory surveillance.
• Developing syndromic and event database pertaining to zoonotic diseases across the state

Type of intervention:

            This project is actually an e-tool, a product not in the physical sense but is of a physical value that has been developed towards service to the general public. This intervention is a service to the betterment of primary health care services in the state through an early warning system that relies not on the reports and cases recorded at the hospital, instead on the regular symptom profile of the population and their associated risk factors.

Channels:

            As a part of research programs, several of the people across the state are often interacted with, in due course of sample collection or KAP analysis surveys. Further, through the Veterinary Assistant Surgeons and Veterinary Assistants along with Medical officer and Health care workers, almost every part of the population across the state could be easily approached as these earlier mentioned segments provide the basic framework of health to the people across state.

Segments – Beneficiaries:

            Our intervention benefits the following segments

• General public – Better health care services would be provided; Awareness could be brought among people about the zoonotic diseases transmission
• Medical officers – An early disease status could be attained for better disease management.
• Policy makers -Can design policies and programs considering the region specific risk factors and symptom profiles as observed.
• Health care workers- Being the segment that has the direct contact with the general public with respect to health management, could be greatly benefitted in understanding what services are to be provided by them in their concerned region.
• Epidemiologists – As these persons rely greatly on recorded cases and hospital reports, such a primary data from the people itself that too regularly largely aids them in analyzing the disease more effectively.

Cost structure:    

         Major costs incur in initial awareness campaigning and programs across the state on how to involve people into this program. Also, the medical officers, health care workers and people are to be trained sufficiently to disseminate the project that would incur additional costs. Similarly, e-RAZR beingan android tool involves regular updates and thus carry a set of costs to it. To further design the application to a better form requires app development personnel and incur costs. 

Disease surveillance is not something that is new with respect to the health schemes and programs being employed in the state.

Why our tool not others?

Zoonotic diseases are something that were always lurking in the shadows and have never been brought out. Thus, our tool is an exclusive approach in mitigation of these zoonotic diseases across the state. Further, unlike other programs, our tool involves the people directly in surveillance of these diseases considering their exposure to risk factors and developed symptoms. Thus, this data being primary, is of high value and can be employed to effectively design health care services. Also, as several related events information is also recorded, a holistic approach would be generated.

Specific benefits

• Better Primary health care services
• Awareness on Zoonotic diseases
• Early identification of disease and better management opportunity
• An easy to use UI that would also benefit people with minimal skills

Revenue

            As this tool is not a money oriented one, instead a service oriented one, revenue generation is not something of the highest relevance, however in order to sustain the project on the longer run, a definite source of income is required.

            As this tool is an android application, on integration, several of the governmental and other programs could be advertised as a part of the app that would reach larger populations. In addition, as more and more downloads are done, a part of revenue could be expected to sustain the application charges. Further, an effective collaboration with the prevalent surveillance programs would allow us to also share their infrastructure, personnel and capital to proceed with the program which would largely aid the project financially. As the revenue generated depends on the number of downloads, number of active users and number of advertisements that had been gone through, having a healthy collaboration with other health programs, policies, animal husbandry products and others, a healthy revenue would be generated.

Surplus

            The profits that are generated would be again invested in the project towards its betterment in enhancing the project to other parts of the state and include several other disease of significance. As the tool might undergo several enhancements over time, the surplus would be invested into these activities and also in disseminating the program to deeper parts of the population. 

Our organization has been handling projects on zoonotic pathogens and their epidemiology ranging from state wide projects to international collaborations. DST(Department of Science and Technology), Govt. of India has funded an international project with Ministry of Higher Education, TUNISIA - 

"Comparative study of Shiga Toxin producing Escherichia coli biodiversity in India and Tunisia: An integrated surveillance and molecular characterization of Shiga Toxin producing Escherichia coli (STEC) and its antimicrobial resistance and zoonotic significance"

Similarly, We are also handling an  ICMR (Indian Council of Medical Research) funded project on 

"A comparative genome analysis of anti-microbial resistant S. aureus and      E. coli isolates recovered from livestock, environment and livestock attendants by genome sequencing and molecular genotyping techniques across three districts of Rayalaseema region, Andhra Pradesh."

    Similarly, several projects have been handled for the last 10 years by our organization with regard to the zoonotic disease epidemiology and thus we back ourselves proficient enough to handle this problem of zoonotic disease risk assessment involving community directly along with event based surveillance for having region specific primary health care services rather than a one for all approach.