Introduction: Efficient NTDs elimination strategies require effective surveillance and targeted interventions. Traditional methods are costly and time-consuming, often failing to cover entire populations in case of movement restrictions. To address these challenges, a morbidity image-based surveillance system is being developed. This innovative approach which leverages the smartphone technology aims at simultaneous surveillance of multiple NTDs, enhancing cost-efficiency, reliability, and community involvement, particularly in areas with movement constraints. Moreover, it holds promise for post-elimination surveillance. Methodology: The pilot of this method will be conducted across three states in southern Nigeria. It will target people affected by Neglected Tropical Diseases and members of their communities. The new surveillance method will be introduced to target communities in the selected states through community stakeholder's advocacy meetings and awareness campaigns. The pilot which is set to span eighteen months, entails sensitizing NTDs-affected individuals and community members using signposts, posters, and handbills, to capture photos of NTDs manifestations upon notice using smartphones. These images, along with pertinent demographic information, will be transmitted to a dedicated server through WhatsApp or Telegram accounts. The received images will be reviewed and organized at backend and then forwarded to a panel of experts for identification and annotation to specific NTDs. Data generated, along with geocoordinate information, will be used to create NTDs morbidity hotspot maps using ArcGIS. Accompanying metadata will be used to generate geographic and demographic distributions of various NTDs identified. To protect privacy, people will be encouraged to send manifestation photos of the affected body part only without any identifiable features. Evaluation protocol: NTDs prevalence data obtained using conventional surveillance methods from both the pilot and selected control states during the pilot period will be compared with data from the CIMS-NTDs method to determine its effectiveness. Expected results and conclusion: It is expected that an effective, privacy-conscious, population inclusive new method for NTDs surveillance, with the potential to yield real-time data for the identification of morbidity hotspots and distribution patterns of NTDs will be established. The results will provide insights into the effectiveness of the new surveillance method in comparison to traditional approaches, potentially advancing NTDs elimination strategies.
Neglected Tropical Diseases (NTDs) constitute a group of debilitating and often overlooked diseases that primarily affect the world's most impoverished populations [[
Some NTDs have been designated as targets for elimination by the World Health Organization (WHO) in the NTDs Road Map 2021–2030 [[
The WHO's NTDs Road Map 2021–2030 outlines a strategic framework for the control, elimination, and eradication of these diseases, with the ultimate goal of achieving a world free of NTDs-related suffering by the end of the decade [[
Addressing these challenges requires innovative solutions that can augment existing surveillance efforts, reach underserved populations, and provide timely data for decision-making. Notably, recent experiences have demonstrated that crowdsourced data-based surveillance methods offer a cost-effective, real-time, scalable, and efficient means to enhance malaria surveillance [[
First, an electronically transmitted crowdsourced photograph method to enhance NTDs surveillance will be created and validated. To achieve this, we will educate individuals with NTDs manifestations and their communities on using their smartphones to capture images of these manifestations. These images, along with essential demographic information, will be transmitted via WhatsApp and Telegram to a designated mobile telephone number. Subsequently, the collected data will be organized in an electronic database, where experts will identify and categorize the images by specific NTDs. Geolocation data will be leveraged to create morbidity hotspot/ distribution maps for these NTDs, which will aid policymakers in effective planning and targeted deployment of interventions. Importantly, this method also has the potential to support post-elimination surveillance by enabling swift reporting of potential cases by the empowered community members.
Secondly, we aim to develop a feedback mechanism and personalized care for identified NTDs subjects. Utilizing the mobile telephone numbers through which the images were submitted, personalized feedback would be provided on preliminary diagnosis, counselling on immediate morbidity management, and disability prevention to the individual subjects. This also offers non-clinical support on hygiene practices (care and management of elephantiasis, for instance), transmission avoidance behaviors, and guidance on accessing interventions. Subjects whose photographs were sent on their behalf by our CCPs will also receive their feedback through the CCPs who will be trained on basic NTDs management counselling and feedback provision.
Finally, we aim to develop and train an Artificial Intelligence (AI)/Machine Learning (ML) algorithm, along with a mobile application. This tool, utilizing categorized images and NTDs knowledge, will aid healthcare personnel in differential diagnosis and offer real-time clinical management or referral advice at health facilities. This AI/ML model aims to replace human annotators for swift and more accurate identification and matching of manifestation photographs to specific NTDs. It will eliminate time lag and potential errors associated with human annotation as well as enhance NTDs differential diagnosis, aiding front-line health workers in their duties.
The pilot of the Crowdsourced Image-Based Morbidity Hotspot Surveillance Method for Neglected Tropical Diseases (CIMS-NTDs) will be carried out in Nigeria. Nigeria has a tropical climate with variable rainy and dry seasons, depending on location. It is hot and wet most of the year in the southeast but dry in the southwest and farther inland. Nigeria is one of the most densely populated nations in Africa, the most populous country in the African continent, and the seventh-most populous nation in the world [[
The study will be conducted in six (
Fig 1 is the flowchart of the entire project process, while Fig 2 is a simple pictorial depiction of the CIMS-NTDs concept. The project process by timeline is presented as follows;
DIAGRAM: Fig 1 Flow diagram of the CIMS-NTDs process.
Graph: Fig 2 The simple pictorial depiction of the CIMS-NTDs process.
Inception meeting of project partners (Month 1). This project will commence with a hybrid meeting (virtual and in-person) of all project partners. The project partners include the Federal Ministry of Health and Social Welfare of Nigeria Programme Offices (NPO) for NTDs, and NGOs- whose role will be majorly community mobilization, sensitization and follow up. This meeting will involve further familiarization of project partners, assessment of the project design, procedures and protocols, confirmation of assigned roles as well as setting up the work flow/system for the project.
Advertisement design and project sites selection (Month 1). At the beginning of the project, the process of designing the project advertisement and selection of the project sites will be initiated. This crucial phase involves the following key steps:
1. Photo and literature search: We will conduct an extensive search for photographs depicting the manifestations of the targeted Neglected Tropical Diseases (NTDs), including Onchocerciasis, Lymphatic filariasis, Trachoma, Buruli Ulcer, Guinea worm infection, Leprosy, and Ascariasis. These photos will serve as visual references for our awareness campaign.
2. Photo validation: Selected photos will undergo validation by National Programme Office for NTDs officials, following the World Health Organization (WHO) standard operating procedures (SOP). This validation process ensures the accuracy and relevance of the selected images.
3. Advertisement content: The validated photos will be used to craft our study advertisement/notice. The content of the advertisement will include:
- Distinctive photos illustrating the manifestations of the targeted NTDs, accompanied by descriptions in both English and local languages relevant to the study locations.
- A call to action for individuals who either have NTDs manifestations or have encountered them to capture clear photographs of these manifestations using their smartphones. Consent from the subjects will be obtained, and the images will exclude the subjects' faces and other indefinable features.
- Instructions to transmit the photographs, along with demographic information about the subject (including location, age, gender, occupation, marital status, and educational level), through designated social media channels such as WhatsApp and Telegram. Alternatively, community members lacking the necessary technology can utilize a designated community contact person (CCP), whose name and telephone number will be provided on the advertisement.
- A notice indicating that the NPO will provide available intervention measures to those who comply with the request.
4. Multilingual narratives: Advertisements will feature narratives in both English and the local languages spoken in the pilot locations to ensure broad accessibility and understanding.
Advertisement materials: To disseminate this critical information effectively, we will produce the following advertisement materials:
- Signposts designated as _B__I_C2SSS_i_ (Community Crowdsourced Surveillance Sensitization Signposts): These 8ft by 4ft signposts will be strategically placed in each study community.
- Posters designated as _B__I_C2SSP_i_ (Community Crowdsourced Surveillance Sensitization Posters): Approximately 300 posters will be affixed in and around each pilot community to maximize visibility.
- Flyers designated as _B__I_C2SSF_i_ (Community Crowdsourced Surveillance Sensitization Flyers): Around 1000 flyers will be distributed throughout the pilot communities, with an additional
- s shared every three months to maintain continued awareness within the communities.
This phase sets the stage for community engagement, data collection, and the implementation of our crowd-sourced image-based morbidity surveillance method.
To ensure a robust and comprehensive study, we will follow a systematic process to select our pilot study sites;
We will begin by identifying states with high prevalence of Neglected Tropical Diseases (NTDs) based on data provided by the Federal Ministry of Health and Social Welfare (FMOH) NTDs Programme Office.
Project implementation sites: Among the identified states, three will be designated as project implementation sites, where we will actively implement and evaluate our crowdsourced image-based morbidity hotspot surveillance method.
Control Sites: The remaining three states will serve as control sites. In these states, we will obtain the usual NTDs surveillance data that will later be used as a basis for comparison with the data generated by the piloted surveillance method.
In the selected project implementation states, we will further narrow down our focus by selecting five Local Government Areas (LGAs) from each state. These LGAs will be selected based on recommendations and NTDs prevalence data from the respective state's NTDs programme office.
From each of the five selected LGAs, we will equally select three communities/wards to serve as our project pilot study sites.
This meticulous selection process allows us to gather data from both project implementation sites and control sites, ensuring a comprehensive assessment of the CIMS-NTDs' effectiveness. By comparing data from the two groups, we aim to provide valuable insights into the effectiveness and potential benefits of our innovative approach.
Advocacy visits, engagement of local stakeholders and inception workshop (Month 2). Stakeholders in the selected states, including officials from State and Local Government health authorities, religious and community leaders, as well as local and international NGOs supporting NTDs programmes in the intervention states, will be engaged to solicit their support in sensitizing and mobilizing community members, and in any other way that could help the project succeed.
Community Contact Persons (CCPs) will be selected in each pilot community by the community members, preferably from among suitable Community Directed Distributors (CDDs) of ivermectin or any suitable community member who can operate a smartphone. These individuals will be resident in the community throughout the project's duration. These CCPs will serve as the liaison between the project team and the project community. They will assist in carrying out project sensitization, distributing of the project C2SSF, and posting C2SSP materials around the community after the team has departed. An inception workshop will be held to interact with and seek the opinions of key stakeholders regarding the project's purpose and procedures, which will be vital to secure community buy-in and for its successful execution.
Intervention communities' mobilization and sensitization (Month 3&4). Following stakeholder engagement, mobilization and sensitization of communities, pilot in the intervention states will commence. This will be achieved by securing the support of the National NTDs Programme Office to collaborate with selected State NTDs Programme Officers. The project team will work with two state NTDs officers and two Local Government Area (LGA) NTDs officers, comprising the LGA's social mobilization officer and the LGA's NTDs focal person. The primary goal is to raise awareness about the project among community members, ensuring their active participation throughout its duration.
These initial engagement activities will be complemented by ongoing engagement throughout the project, promoting community ownership and allowing for adaptation to optimize project implementation. Additionally, there will be periodic advocacy visits to the project communities and continuous engagement with community stakeholders, both in-person and virtually, to ensure their involvement and commitment throughout the project, ultimately fostering community ownership.
During this community engagement and sensitization, the designed advertisements/notices will be produced after validation by the Federal Ministry of Health's national NTD programme office and deployed in intervention states as follows; C2SSS- to be deployed at strategic locations such as community centers; C2SSP- to be posted at primary, secondary and tertiary health facilities, commuter parks, religious centers, markets and schools; C2SSF- to be distributed at all public gatherings within the communities including the market squares, healthcare facilities, churches and schools. Additional adverts/notices will be placed on local Radio stations. These are aimed at adequately sensitizing the public on the procedures and their involvement in the process.
Control states will continue with the traditional surveillance systems without the intervention.
Reception, collation, processing and analysis of photo and demographic data, and other data (Month 4–15). Transmitted photos and demographic data will be received and collated in a central electronic data base and protected with an access code. Photos will be processed and sorted based on clarity, replications and complete data. Internet Protocol (IP) of the devices used in the transmission of the photos will be checked to eliminate repeated submissions. All data will be anonymized so that they will not be linked to individuals. A data protection expert will be involved to ensure compliance with relevant data protection laws. Initially, we will work with our expert consultants to identify, confirm, and match crowdsourced images to specific NTDs, while work on development, training and validation of the AI/ ML algorithm is ongoing. As soon as the AI/ ML algorithm has been trained and validated to the extent of confidence required to screen and match transmitted images, it will then be applied to replace identification/ matching of images by expert consultants. Subsequently, therefore, the AI/ML will automatically identify and match crowdsourced photos to specific NTDs. Arc Map, a digital mapping software will thereafter be used to map the respective target NTDs using the identified/ matched photos together with the location data along with the GPS location imprints of the transmitted images. Demographic and geographic data will be analysed using statistical software packages like SPSS and R to determine geographic and demographic distribution of these NTDs. Towards the end of the photo or image data collection, quantitative and qualitative techniques will be used to collect data from the subjects on their experience, acceptability, usability and feasibility of this crowdsourced image-based NTDs surveillance method. Data will also be collected from officers at local government NTDs programme offices on their experiences with the conventional NTDs surveillance method and possible perceptions about this new method.
Feedback on preliminary diagnosis and information on actions to take (Personalized/ Individual Care) (Month 4–15). Concurrently with data reception, transmission, collation and processing, there will be feedback to subjects whose data were transmitted through the telephone numbers used in transmitting such data. This will be done as the respective photos are successfully matched to specific NTDs. The feedback will be on the preliminary diagnosis of their conditions, counselling, and provision of information on appropriate actions to take as well as follow up. This will be undertaken by the project case managers and officers who are physicians with experiences regarding NTDs. They will also visit the communities periodically to provide diagnosis physically and support to identified subjects. In conjunction with the FMOH's national NTDs programme and local authorities/ health facilities as well as the community contact persons, standard operating procedure (SOPs) for investigating, triaging between the Federal, State, Local Government NTDs control/ elimination programme offices and responding to NTDs cases that are confirmed remotely will be developed to ensure confirmatory diagnosis and appropriate treatment is provided. This will involve leveraging on existing NTDs control/ elimination structures which includes frontline health facilities in every Local Government where identified cases of NTDs will be managed and counselled, and referral to tertiary health facilities where more serious cases beyond the capacity of the frontline facilities will be handled. Community contact persons together with selected community health workers at the local or community levels will additionally be trained as adherence counselors to track individuals who transmitted images and received feedback to ensure that they take recommended actions and assist in delivering specific messages against stigmatization.
Large volume collection of photographs of manifestations of NTDs and development of artificial intelligence (AI) driven matcher of images to specific NTDs (Month 4–7). This activity will be conducted simultaneously with the project implementation in intervention communities (month 3&4). In the initial stages of the project, expert consultants with extensive experience in NTDs research, along with officials from the National NTDs Programme Office under the Federal Ministry of Health and Social Welfare as well as personnel from partner NGOs, will be requested to gather, validate, and categorize a substantial volume of photographs illustrating various stages of NTD manifestations prevalent in the project locations. Digital cameras will be employed for this purpose. Additionally, we will collaborate with researchers from universities, clinicians, and recognized NTDs experts in Nigeria and other parts of the world to solicit their contributions of confirmed NTDs cases' photographs from their diverse image collections. These collected photographs will form the dataset essential for creating and training the AI and Machine Learning (ML) algorithms. This algorithm when developed will facilitate the automated identification and matching of electronically transmitted crowdsourced images with specific NTDs. Furthermore, this dataset, combined with a comprehensive knowledge database will serve as the foundation for developing a point-of-care differential diagnosis and management mobile application.
Before applying the AI/ML photo matching algorithm to crowdsourced images, we will rigorously test it on a set of test images and compare its results with the outcomes of expert matching processes to ensure its validity and diagnostic accuracy.
At the conclusion of the pilot study, our primary focus will be on evaluating the effectiveness and efficiency of the CIMS-NTDs method in comparison to the conventional surveillance approach. To assess this, we will primarily examine the quantity and quality of NTDs data collected using the CIMS-NTDs method from the pilot study site. This data will then be compared with the NTDs prevalence information gathered through the traditional surveillance method, both within the pilot study locations and in the control locations. It is important to note that this comparison will exclusively consider NTDs data collected from both methods during the study period.
The data collected for this study will primarily encompass the following:
The majority of the data generated by the study will consist of photographs depicting various manifestations submitted by participants via WhatsApp or Telegram, along with accompanying metadata. Upon receipt, this data will be processed in our database, undergoing cleaning and organization before being transmitted to our experts for precise matching to specific NTDs. Stringent security measures will be in place to safeguard this data within the database. Upon the return of annotated results, they will be integrated into another section of the database, where they will be transformed into results and presented as preliminary diagnoses.
The data analysis plan, which encompasses the utilization of received photo and accompanying metadata to develop incidence and prevalence data for NTDs in our study sites. This data will be disaggregated by age, sex, educational attainment, and occupation of the subjects, providing a comprehensive overview of the affected demographics. Additionally, we will gather information regarding the current management of NTDs among the subjects and present this information in a straightforward frequency distribution table.
To assess the efficacy of the CIMS-NTDs method compared to the traditional surveillance approach, we will collect NTDs prevalence data from control states and traditional NTDs surveillance prevalence data from intervention states. Our comparative analysis will consider various indicators, including but not limited to:
- Proportion of suspected NTD cases (per disease) reported weekly/monthly.
- Rate and timeliness of reporting of suspected cases.
- Proportion of identified cases that received a response in the intervention states versus the control states.
- Promptness of the response received.
- Demographic and geographic distributions of identified cases per specific focus NTDs.
For geographic analysis, we will employ Arc GIS to create spatial maps highlighting NTDs morbidity hotspots within the pilot study states. These maps will be generated based on the NTDs images provided by the affected individuals and their respective communities.
In addition to quantitative data, we will gather qualitative insights through key informant interviews with NTDs stakeholders in the pilot states. These interviews will focus on their experiences with the traditional NTDs surveillance method and their perceptions of the CIMS-NTDs method. Furthermore, we will assess community members' experiences and perceptions of the CIMS-NTDs method using structured, interviewer-administered questionnaires. Responses will be compiled, aggregated, and visually presented in charts for clarity. Experiences will be categorized as either "good," "poor," or "neutral," while perceptions will be reported as either "positive" or "negative."
This comprehensive data analysis plan will enable us to evaluate the effectiveness of the CIMS-NTDs method and its potential benefits over traditional surveillance approaches, ultimately contributing to the enhancement of NTDs control and management strategies.
Ethical approval (NHREC Approval Number NHREC/01/01/2007-16/01/2023) was given by the National Health Research Ethics Committee (NHREC), Federal Ministry of Health, Abuja Nigeria. Also, approval was obtained from the Institutional Review Board of the Federal University of Technology, Owerri, Nigeria. Our advertisements will bear a brief description of the project, its intentions and the role of potential participants in lay language, and request that only those who give consent to participate should transmit images of NTDs manifestations (without their faces) and accompanying demographics (without their names). To further validate informed consent, there will be an automated response from our WhatsApp and Telegram platforms prompting those who transmit images/ data to confirm their consent and permission to use their data in this research. Additionally, our community contact persons who will assist those without smart devices to take photographs of the images and transmit will collect informed written consent from such subjects. For the children and vulnerable groups, their parents and care givers will be allowed to provide the consent on their behalf with the children assenting to it. Hard copies of signed consent forms will be collected from our Community Contact Persons and stored in a secure steel cabinet while electronic consent will be stored in our password secured electronic data base. Data collection and analysis method will be in conformity with the terms and conditions for source data.
This protocol presents a comprehensive description of an ongoing pilot study introducing an innovative surveillance method for Neglected Tropical Diseases (NTDs), aligning with the WHO's NTDs elimination agenda for 2030, as outlined in the NTDs Roadmap 2021–2030 [[
A notable limitation of this project is the restricted access to smartphones and other smart devices among many residents in rural communities, which are often the areas most heavily affected by NTDs [[
Dissemination of the knowledge and information acquired from the project will occur through diverse mechanisms. First, a dissemination seminar will be conducted to communicate project outcomes and information to stakeholders. Second, policy briefs will be developed and shared with decision-makers to facilitate timely implementation and decision-making [[
It is anticipated that this project phase will yield a timely, cost-effective, population-inclusive, feasible, and efficient alternative to traditional NTDs surveillance methods. It holds promise for scalability, integration into ongoing NTDs elimination efforts and health systems, enhanced large-scale surveillance of NTDs in the country and the sub-Saharan African region, simultaneous monitoring of multiple NTDs, improved diagnosis, case management, prevention, and, ultimately, significant contributions toward NTDs elimination. Furthermore, this method will prove invaluable for post-elimination surveillance, enabling the prompt identification of residual cases or underserved areas and groups to prevent resurgence. Future endeavors will explore full automation and digitalization of the entire image-based surveillance and response process with minimal human intervention, utilizing artificial intelligence, machine learning, cloud computing tools, and further personalization for affected subjects.
In conclusion, this pilot study's innovative approach to NTDs surveillance holds promise to significantly improve the surveillance for NTDs and accelerating the WHO's attainable goals for NTDs elimination by 2030. Despite challenges related to smartphone accessibility in rural areas, the inclusion of CCPs helps bridge this gap, ensuring equitable participation in the surveillance process.
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Yaro Clement Ameh Academic Editor
10 Nov 2023
PONE-D-23-31987Crowdsourced Image-Based Morbidity Hotspot Surveillance for Neglected Tropical Diseases (CIMS-NTDs): Study ProtocolPLOS ONE
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Reviewer #1: Yes
Reviewer #2: Yes
***
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Reviewer #2: Yes
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Reviewer #2: Yes
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Reviewer #1: Check acronym: CCP vs CPP
This study if done well promises to be of great value in rural and hard to reach populations where NTDs are endemic. Here are a few questions for clarity and some suggestions that could possibly improve on this study:
This way you could eliminate any bias that could influence the outcomes in your study
7.In the intervention sites, both methods are going to continue concurrently, how are you going to manage the influence from your study on the traditional method of surveillance. For instance, an affected person can opt to report the case to both your study and to the Health Ministry at the same time. Will you take this influence into consideration when you analyse the data?
8.When the study is completed and you are publishing the results, are you going to allow other researchers and clinicians access to your database as is a requirement for PLOS data policy?
Reviewer #2: This is a very nice manuscript, that describes the study protocol of an ongoing and very important piece. I have made significant comments within the text most around grammatical flaws, restructuring of some sections, rephrasal of several sentences amongst others. Additionaly, I think too much of details have been provided in the supplementary section. Authors should only provide the ethical approval letter, and remove the others
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Reviewer #1: Yes: Dr Kuku Voyi
Reviewer #2: Yes: Mogaji Hammed
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Submitted filename: HOM_PONE-D-23-31987_reviewer.pdf
7 Dec 2023
RESPONSE TO ACADEMIC EDITOR AND THE REVIEWRS
Section Point Raised Response
Abstract; Introduction This introduction is quite lengthy. Authors should summarize in max 5 lines.
I would expect that the authors would clearly express that this study aims to develop and test a new methodology The abstract introduction has been summarized and re-presented in a more succinct manner
Abstract; Methods Authors also need to re-write/re-structure this section; with clear details about the study area, participants, study design/approach, timings, brief details of the newly developed tool, and how it would be used, details on the evaluation protocol; what the expected results would be and the likes. The methods section of the abstract has been re-presented using the prompts as suggested by the reviewer.
Abstract; Ethics and Dissemination Authors should re-write this as well, 1/2 lines for ethics
and a separate sub-section for funding.
e.g., Funding: This study received financial support from XYZ (Grant number: XYZ) This sub-section has been re-introduced as Ethical Approval with a stand-alone sub-section for funding.
Introduction; line 66 Not all of them. So kindly rephrase this Some of the NTDs are marked for elimination, some for control, some for eradication while some for elimination as a public health problem. The statement has be re-written to reflect this.
Introduction; line 71 could these come up before line 66-71 The paragraph truly sounds like it should introduce the subject matter. It has been brought up to begin the introduction.
Introduction; line 85 It is important to emphasize the challenges that necessitate the prose on traditional surveillance. The challenges are the problem with the traditional NTDs surveillance method. This has been elaborated and brought up before line 85.
Introduction; line 87 this should as well be referenced A proper citation has been attached to the statement
Introduction; line 89 this should come up around line 85, and should be referenced A proper citation has been provided and the statement has been moved to line 85.
Introduction; line 102 this can start as a new paragraph, and of course rephrased:
consider staring like; The authors agree with this argument. We have moved it to a new paragraph and we have also rephrased the statement.
Introduction; line 105 This could have been the first sub-section under the methodology section.
"Development of XYZ" This statement is introducing our study objectives as part of our introduction. We believe that that is where it should be. For clarity's sake, we have rephrased the statement.
Introduction; line 106 This could have been the first sub-section under the methodology section.
"Development of XYZ" We also believe that this is still part of our introduction which was later elaborated in the methodology. We have also rephrased the statement for better understanding.
Introduction; line 111 this entire section needs to be rephrased and reported in a more succinct style. We have rephrased and presented in a more succinct style.
Introduction; line 115 If the images were uploaded by third-parties on behalf of affected persons, since most affected persons may live in resource constrained settings, where access to smart-phones, electricity and internet may be lacking. Then one would wonder who gets the feedback proposed here
Then the line 119-121, where the authors mentioned that hygiene practices can also be provided is confusing; authors should be very specific on what would or would not be implemented Though in our methods section, this objective is elaborated, for clarity, we have added additional statement that shows that the CCPs who obtains and forward NTDs manifestation photographs on behalf of the subject will also be employed to take feedback to the subject. The CCPs will be trained in basic counselling provision for home management of common NTDs.
Regarding hygienic practices. The subject will be counselled and trained on basic home care of NTDs like elephantiasis and trachoma that requires regular cleaning with warm water and antiseptic disinfectants.
Introduction; line 122 This section is also not clear enough. What exactly would The section has been re-written. The objective is the development and AI/ML algorithm model that will help in the prompt and accurate identification and annotation of morbidity images that will be fed into it to specific NTDs, providing a sort of differential diagnosis. Thus, eliminating the need for human annotators as we currently have.
Introduction; line 128 This section should also go into the last paragraph of the discussion Even though the protocol manuscript has no discussion section. The statement truly seems like a good concluding statement, we have therefore, moved it to the very last paragraph of the manuscript, after the statement of how the research finding will be disseminated.
Materials and Methods; line 142 this entire section should serve as the justification for developing the novel methods and should fit into the introductory section (the last paragraphs that leads to the aims/objective of the study) We are not too sure that the PLOS ONE protocol manuscript for publication should contain a justification section; in the interim, we have created a justification sub-section under the introduction and we have moved the statement therein because we agree that the statement is actually justifying the need for the study.
Materials and Methods; line 176 Needs to be referenced Appropriate reference has been provided.
Materials and Methods; line 187 Please rephrase this The statement has been re-presented in a clearer form.
Materials and Methods; line 190 this is the first mention of this acronym
NGOs like WHO, UNICEF etc are common acronyms that often time do not require interpretation in reports. The acronym has however, been written in full.
Materials and Methods; line 192 The study design is still not clear. Author should used a flow chat to describe the implementation process; in the intervention and cotrol states, who would be the target audience, and how will the interventions be deployed.
Kindly refer to the "Description of Processes" section in line 198 which has now been re-named as "Study Design". Also refer to the project's comprehensive flowchart (Fig 1) in Appendix
Materials and Methods; line 198 This should be merged with the study design section which I suggested above A study design section has been created and this has been made a sub-section under the newly created study design section
Materials and Methods; line 306 Throughout this process, it is still not clear how the NTDs photographs would be sourced/obtained from the community
The process of photograph collection was described in line 208 – 245 where we described our advertisement materials. We then give the description of our study sites in line 247 – 270. We explained that advert notice will be put out in our study sites calling for NTDs subjects and their community members to send us photos of NTDs manifestations upon notice through our dedicated WhatsApp and Telegram channels. We also described the process of community entry, engagement and sensitization and the selection of CCPs within the people that will help us to get manifestation photographs of subjects who cannot send us photographs on their own.
Materials and Methods; line 308 this section should be described separately; the first section on how to manage the photographs received; and the second section on the AI development etc
This activity will commence in the 4th month of our project inception. It will continue simultaneously with other activities including morbidity images crowdsourcing from the communities. We are presenting it here because the entire process was described within their timelines of implementation.
Materials and Methods; line 327 this should be discussed simultaneously with other section, and not separately as described here. The section has been cut out and joined positioned directly under the section that describes the Intervention communities' mobilization and sensitization
Data Management Plane; line 384 This is the first time of mentioning this, I think the detailed methodology and platform should have been described earlier before getting to this stage
This is not the first time we mentioned WhatsApp and Telegram in the protocol, it was first mentioned in the Abstract, then under study aim that has been changed to Justification then it was mentioned under "description of process"
Data Management Plane; line 391 Authors could merge this section with the Outcome Measure section, and title the section as "Study Indicators". Under this section they should describe the data, and also the explanatory and outcome variable, and also the planned statistical analysis
They have been merged.
Ethical considerations and informed consent; line 432 Please delete this, there is no reason to have the protocol number in this section
Protocol number has been removed from the statement.
Discussion; line 455 this should be specified; what demographic data; sex, age, name or what The types of demographic data that will be obtained has been clearly spelt out.
Discussion; line 457 on the long run, would this be achieved? when providing care to this population, the healthcare worker would still be aware. Are there reports of stigmatization from HCW to patients or among community members and those affected Note that the care that each subject will receive based on their specific diagnosis will be personalized and likely to be delivered to in the homes of these subjects. The stigmatization here in most cases does not emanate from the HCW but from other members of the community. The CIMS-NTDs method prevent the situation where a subject is made to wait endlessly at the health center trying to access care.
Discussion; line 466 what measures of This comment is not clear. The acronym there is CCP (Community Contact Person) and not CPP.
Discussion; line 478 to Correction taken
ACADEMIC REVIEWERS COMMENT
Comment 1 Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming The manuscript has been re-designed to meet the PLOS ONE's style
Comment 2 In your Methods section, please include additional information about your dataset and ensure that you have included a statement specifying whether the collection and analysis method complied with the terms and conditions for the source of the data. The Methods section has been enhanced to include additional information about our dataset. Our data collection and analysis method will be in conformity with the terms and conditions for source data. We have included a statement indicating this under our ethical consideration and informed consent section
Comment 3 Thank you for stating the following in the Acknowledgments Section of your manuscript: "We would like to express our heartfelt gratitude to the following organizations and entities for their invaluable support and contributions to this research project;
The Bill and Melinda Gates Foundation for their generous funding, which made this study possible. The Nigeria Federal Ministry of Health NTD Programme Office for their collaboration and partnership throughout the project.
Please remove any funding-related text from the manuscript The funding-related texts has been removed from the manuscript
Comment 4 In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. This is a proposal of an ongoing project; we are yet to generate or analyse any data that may yield a valid conclusion. No result was described in the proposal manuscript.
Attachment
Submitted filename: Response to Reviewers.docx
Yaro Clement Ameh Academic Editor
27 Mar 2024
PONE-D-23-31987R1Protocol for the Crowdsourced Image-Based Morbidity Hotspot Surveillance Method for Neglected Tropical Diseases (CIMS-NTDs)PLOS ONE
Dear Dr. Chukwuocha,
Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE's publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.
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PLOS ONE
Journal Requirements:
Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article's retracted status in the References list and also include a citation and full reference for the retraction notice.
[Note: HTML markup is below. Please do not edit.]
Reviewers' comments:
Reviewer's Responses to Questions
1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?
The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.
Reviewer #1: Yes
Reviewer #2: Yes
***
2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?
The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.
Reviewer #1: Yes
Reviewer #2: Yes
***
3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?
Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.
Reviewer #1: Yes
Reviewer #2: Yes
***
4. Have the authors described where all data underlying the findings will be made available when the study is complete?
The https://journals.plos.org/plosone/s/materials-and-software-sharing requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.
Reviewer #1: No
Reviewer #2: No
***
5. Is the manuscript presented in an intelligible fashion and written in standard English?
PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.
Reviewer #1: No
Reviewer #2: Yes
***
6. Review Comments to the Author
Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.
You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.
(Please upload your review as an attachment if it exceeds 20,000 characters)
Reviewer #1: This revised version requires language editing
As the previous review comments were suggestions to improve the study, the authors have selected what feels right for them.
The writing of this protocol flows better in the arranged format.
Check these and correct:
References are not sequential in the Introduction section, in Line 62 you started with 1,3,4 and only in line 78 do you cite reference 2.
Social media handles mentioned in line 107, the rest of the protocol is mentioning WhatsApp and Telegram. Does this mean other social media will be considered in future? Mention that in line 107.
The Pilot sites are 6/36 of states in Nigeria, include this information in the demographics paragraph to give the reader a clear perspective of the size of the country. Are all 36 states NTDs endemic?
It is not clear how this data is going to be managed, there is something about IP, but I think some explanation is required to clarify this point
Reviewer #2: I believe the authors have satisfactorily responded to all the comments raised earlier on.
However, they have introduced a new section on Justification. my initial suggestion to them was to just include a few lines to justify the protocol, as part of their introduction. I guess this must have been wrongly understood. Authors should try to reconcile, and the lines in the new justification section are kindof repetitive of those earlier raised in the introduction.
***
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Reviewer #1: Yes: Kuku Voyi
Reviewer #2: Yes: HAMMED OLADEJI MOGAJI
***
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2 Apr 2024
RESPONSES TO REVIEWERS' COMMENTS
Reviewer 1
General
Comment
This revised version requires language editing
Response
The manuscript has been subjected to English language editing, it was improved for grammar, spellings, punctuations and clarity.
Comment
As the previous review comments were suggestions to improve the study, the authors have selected what feels right for them.
Response
Our review was made in the light of the recommendations from the academic editors and the two peer reviewers. We strictly followed the reviewers comments to carry out the revision of the manuscript. We have made effort to make the manuscript as smooth flowing as possible through further English language editing which was done by an English expert.
References
Comment
References are not sequential in the Introduction section, in Line 62 you started with 1,3,4 and only in line 78 do you cite reference 2.
Response
It was an oversight from the editing author, the error has been corrected. The references are now properly presented in the order of appearances.
Introduction
Comment
Social media handles mentioned in line 107, the rest of the protocol is mentioning WhatsApp and Telegram. Does this mean other social media will be considered in future? Mention that in line 107.
Response
We made use of the phrase social media handles to give a blanket name to WhatsApp and Telegram platform. These are the most common platforms that the Nigerian population are conversant with. We do not plan to include other social media handles in the future, we have therefore replaced the phrase "social media handles" with "WhatsApp and Telegram"
Materials and methods
Comment
Study setting: The Pilot sites are 6/36 of states in Nigeria, include this information in the demographics paragraph to give the reader a clear perspective of the size of the country. Are all 36 states NTDs endemic?
Response
All the 36 states in Nigeria plus the FCT have at least one NTD being endemic.
A statement mentioning the number of states in Nigeria and the number of the pilot study sites have been included in the "Study setting" sub-section.
Comment
Description of process: It is not clear how this data is going to be managed, there is something about IP, but I think some explanation is required to clarify this point
Response
Activities in the Reception, collation, processing and analysis of photo and demographic data, and other data (Month 4-15) starting from line 308 – 330 described the manners with which the received data will be managed.
The use of IP number- internet protocol number of the device that will send the data to us is just to add another layer of security to the data management activities. The IP number of the devices that sends in photo-data will be identified to allow the researchers to know where the data is coming from, this will help us checkmate the situation of multiple submission of the same data thereby maintain the integrity of the submitted data.
In addition to this, the section on "Data Management and Analysis Plans" also gave a succinct description of how data that will be received will be dealt with prior to forwarding to our experts for annotation and what will be done with the annotated image-data.
Reviewer 2
Comment
I believe the authors have satisfactorily responded to all the comments raised earlier on.
However, they have introduced a new section on Justification. my initial suggestion to them was to just include a few lines to justify the protocol, as part of their introduction. I guess this must have been wrongly understood. Authors should try to reconcile, and the lines in the new justification section are kind of repetitive of those earlier raised in the introduction.
Response
The JUSTIFICATION sub-heading has been collapsed into the INTRODUCTION section with the two merged together while avoiding duplication of points raised.
Attachment
Submitted filename: Second Responses to Reviewers.docx
Yaro Clement Ameh Academic Editor
22 Apr 2024
Protocol for the Crowdsourced Image-Based Morbidity Hotspot Surveillance Method for Neglected Tropical Diseases (CIMS-NTDs)
PONE-D-23-31987R2
Dear Dr. Chukwuocha,
We're pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.
Within one week, you'll receive an e-mail detailing the required amendments. When these have been addressed, you'll receive a formal acceptance letter and your manuscript will be scheduled for publication.
An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at https://
If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they'll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.
Kind regards,
Clement Ameh Yaro, Ph.D
Academic Editor
PLOS ONE
Additional Editor Comments (optional):
Reviewers' comments:
Reviewer's Responses to Questions
Comments to the Author
1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?
The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.
Reviewer #1: Yes
Reviewer #2: Yes
***
2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?
The manuscript should describe the methods in sufficient detail to prevent undisclosed flexibility in the experimental procedure or analysis pipeline, including sufficient outcome-neutral conditions (e.g. necessary controls, absence of floor or ceiling effects) to test the proposed hypotheses and a statistical power analysis where applicable. As there may be aspects of the methodology and analysis which can only be refined once the work is undertaken, authors should outline potential assumptions and explicitly describe what aspects of the proposed analyses, if any, are exploratory.
Reviewer #1: Yes
Reviewer #2: Yes
***
3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?
Descriptions of methods and materials in the protocol should be reported in sufficient detail for another researcher to reproduce all experiments and analyses. The protocol should describe the appropriate controls, sample size calculations, and replication needed to ensure that the data are robust and reproducible.
Reviewer #1: Yes
Reviewer #2: Yes
***
4. Have the authors described where all data underlying the findings will be made available when the study is complete?
The https://journals.plos.org/plosone/s/materials-and-software-sharing requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception, at the time of publication. The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.
Reviewer #1: Yes
Reviewer #2: Yes
***
5. Is the manuscript presented in an intelligible fashion and written in standard English?
PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.
Reviewer #1: Yes
Reviewer #2: Yes
***
6. Review Comments to the Author
Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.
You may also provide optional suggestions and comments to authors that they might find helpful in planning their study.
(Please upload your review as an attachment if it exceeds 20,000 characters)
Reviewer #1: In this revised manuscript,
1. The language has been edited and it reads well.
2. All requested changes have been done.
I have no further comments to the authors, well done
Reviewer #2: All comments have been sufficiently addressed
All comments have been sufficiently addressed"=
All comments have been sufficiently addressed
***
7. PLOS authors have the option to publish the peer review history of their article (https://journals.plos.org/plosone/s/editorial-and-peer-review-process#loc-peer-review-history). If published, this will include your full peer review and any attached files.
If you choose "no", your identity will remain anonymous but your review may still be made public.
Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our https://
Reviewer #1: Yes: Kuku Voyi
Reviewer #2: Yes: MOGAJI HAMMED OLADEJI
***
Yaro Clement Ameh Academic Editor
29 Apr 2024
PONE-D-23-31987R2
PLOS ONE
Dear Dr. Chukwuocha,
I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team.
At this stage, our production department will prepare your paper for publication. This includes ensuring the following:
* All references, tables, and figures are properly cited
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on behalf of
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Academic Editor
PLOS ONE
We thank the Nigeria Federal Ministry of Health and Social Welfare NTDs Programme Office for their collaboration and support.
By Uchechukwu Madukaku Chukwuocha; Christopher Sule Oyamienlen; Ayoola Oluwaseun Bosede and Ikechukwu Nosike Dozie
Reported by Author; Author; Author; Author
