Telephone hotlines for infectious disease outbreaks in Africa

Telephone hotlines are used in Africa for infectious disease outbreaks. This thesis explores the role and effectiveness of telephone hotlines in outbreak settings in Africa, the barriers and opportunities for sustainability, considerations for using mobile applications and a simplified framework for sustainability. A systematic review with meta-analysis was conducted using the Cochrane handbook and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A scoping review and qualitative study were conducted. For the systematic review and meta-analysis, the search yielded 1251 unique citations that were assessed. Forty-one full texts were selected, and 21 studies were included in the narrative synthesis, while 12 were included in the meta-analysis. A total of 332,323 alerts were generated, and 67,658 met the case definition, corresponding to an overall pooled proportion of alerts generated(sensitivity) of 38% (95%CI: 24-52%). The sensitivity was 41% (95% CI: 24-59%) for local hotlines and 26%(95%CI:5-47%) for national hotlines. The most frequently described barriers to implementation and sustainability of telephone hotlines were due to calls and data management, finances, human resource, technology/infrastructure and socio-cultural factors. The government was the main source of funding in four countries for infectious diseases telephone hotlines. Transitioning to either complete or shared government ownership with diversification and integration of the hotline into routine use was the main facilitator for sustainability. Telephone hotlines may play a crucial role in infectious diseases outbreaks in Africa. There is need for capacity building on telephone hotlines across Africa; a mobile application that can be used alongside telephone hotlines; better studies on hotlines designs and a pilot of the simplified framework of sustainability of telephone hotlines.