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Using community knowledge and citizen science to help tackle climate-sensitive, water-associated infectious disease

6 February 2023

New project aims to map cholera in India by collecting sanitation and disease data through a publicly accessible smartphone app.
We are pleased to announce the successful funding award for a new project that aims to help dramatically reduce the spread and overall burden of climate-sensitive infectious diseases, such as cholera.
The project ‘Water-Associated infectious Diseases in India: digital Management tools (WADIM)’, funded by the Wellcome Trust, will develop a multi-layered digital tool to map sanitation conditions and disease occurrences. This will deliver essential disease data that are needed to improve climate-sensitive infectious disease modelling and to build resilience in afflicted communities through improved knowledge transfer.
The management tool, initially designed for use in 2 case study sites India, will be rapidly updatable with data on cholera outbreaks and sanitation issues by a wide range of users. This will be especially important in the event of natural disasters, such as floods, or changes in environmental conditions, notably monsoon rainfall.
Cholera is a waterborne infectious disease that can cause severe diarrhoea and even death. It continues to be a major public health threat in 175 countries across the world, with up to 4 million people contracting the disease and 21,000-143,000 deaths occurring each year.
The disease is considered to be climate-driven with the pathogenic bacteria responsible for the cholera illness, Vibrio cholerae, being linked to specific seasons and regions. Major environmental factors associated with outbreaks of cholera include water temperature, sea-level, precipitation and flooding, which are all affected by climate variability and change. The majority of cholera outbreaks start in coastal regions but can rapidly spread inland through waterways and other aquatic infrastructure.
In many countries with potentially high rates of cholera, there is an acutely-felt information gap relating to disease outbreaks and their pathways through populations. In fact only 1-16% of cholera cases are reported to the World Health Organisation (WHO), resulting in the global burden of cholera being largely unknown. The underreporting of cases as well as an overall lack of cholera testing in many regions and data compatibility and validation issues all contribute to this paucity of accessible information.
The WADIM project, a partnership between PML, Nansen Environmental Research Centre (India), CSIR-National Institute of Oceanography (India), Centre for Environment, Fisheries and Aquaculture Science (UK), Peninsula Medical School of the University of Plymouth (UK), Postgraduate Institute of Medical Education and Research, Chandigarh (India) and the Wellcome Sanger Institute (UK), aims to bridge this information gap in data by delivering:
  • Sanitation and disease smartphone app that will allow citizen scientists and front-line healthcare professionals to enter information on sanitary conditions as well as occurrence and symptoms of waterborne diseases. The collected data will be used to provide dynamic, up-to-date and georeferenced sanitation and diseases maps, directly accessible to stakeholders and end-users.
  • Regularly updated satellite-based maps of flooding, water quality and environmental Vibrio cholerae risk through Multi-Spectral Imager (MSI) and Synthetic Aperture Radiation (SAR) remote sensing observations, used to provide maps of flooding, water quality indicators, and environmental Vibrio cholerae risk to stakeholders and end-users through the sanitation and disease app.
  • Acute diarrheal disease (ADD) risk maps from a satellite-based empirical model based on optical water classes obtained from MSI and ocean-colour (OC) remote sensing observations, used to forecast the risk of ADD, provided monthly to stakeholders and end-users via the smartphone app.
  • In situ database of pathogens, environment and sanitation as a result of local fieldwork to collect samples of environmental and pathogenic bacteria, such as Vibrio cholerae and Escherichia coli, and associated environmental variables and reservoirs, to validate and improve the satellite-based (risk) maps and to study the role of the aquatic ecosystem in spreading waterborne diseases. Sanitation surveys will also be carried out to validate the citizen-science-based risk maps.
  • Training and stakeholder engagement programme around the use of the sanitation and disease app. The importance of the aquatic environment in the spreading of waterborne diseases and the use of digital tools to reduce disease risk will be addressed. The stakeholder engagement programme is focused on promoting and embedding the app in existing public health structures, with involvement of stakeholders to meet the needs for improving public health practices.
The 2 case study sites are the Vembanad-Kol-Wetland System along the southwest coast of India, a coastal site where waterborne diseases are endemic, and the region around Chandigarh city in the north of India, an inland area where waterborne diseases are more epidemic. These sites have been carefully selected by the team based on population size, vulnerability to environmental changes, smartphone access and existing collaborations with stakeholders.
Previous projects led by PML scientists have studied the Vembanad area extensively and built strong relationships over many years with networks of stakeholders, who are keen to feed into this work to help develop suitable solutions to the issue of water-borne and climate-sensitive infectious diseases. They have not previously worked in Chandigarh, where the factors driving transmission of waterborne diseases are different to those in Vembanad, and are looking forward to collaborating with a new partner at the Postgraduate Institute of Medical Education and Research, Chandigarh.
It is hoped that the tools developed in WADIM will be transferable to other regions around the world and will incorporate additional diseases in the future.
Dr Shubha Sathyendranath, Merit Remote Sensing Scientist at PML and lead scientist of WADIM, comments:

“We are delighted to be able to advance our work on water-borne, climate-sensitive infectious diseases with this funding from the Wellcome Trust.”
“The primary targets of the work are cholera and other Acute Diarrheal Diseases, but the digital tool will be developed in such a way as to be readily transferrable to other threats that are emerging under climate change, such as Leptospirosis or food-poisoning and wound infections caused by Vibrio bacteria”.
Dr Gemma Kulk, Senior Phytoplankton Physiologist at PML and Co-Principal Investigator, added:
“In the past two years, smartphone applications have emerged as an invaluable tool in collecting information related to public health. In countries worldwide, including India, apps have been successfully used to monitor and contain the outbreak of COVID-19 disease.”
“While the use of smartphone applications in public health is not new, the scale at which they were used by citizens and public health authorities during the COVID-19 pandemic shows the potential for this technology to collect information on infectious diseases in a timely fashion, and without straining the limited resources for health care.”

Dr. Anas Abdulaziz, Principal Scientist at CSIR-National Institute of Oceanography and project partner, commented:
“Smartphone applications are proving to be effective in gathering large-scale data by citizens on the quality of water they interact with. Analyses of the data generated through such applications can help in identifying contaminated water bodies and avoiding human interactions with such areas so as to prevent outbreaks of water-associated diseases like acute diarrheal diseases, cholera, and leptospirosis”.


Related information

Wellcome Trust Funding Announcement