To our knowledge, this article is the first to review mHealth applications for managing FBD outbreaks. We described characteristics of studies identified and assessed the features, capabilities and key functionalities of mobile applications currently available for FBD outbreak management. Only one study by Hamzah et al. met the inclusion criteria and reported on one specific mHealth application named MyMAFI that was developed to collect data during field investigation of FBD outbreaks in Malaysia [22]. The study [22] assessed the effectiveness of the mobile application in collecting data and MyMAFI was found to have improved timeliness of reporting as compared to the paper-based format. Findings by Hamzah et al. are similar to what has been reported in other studies reporting on the use of mobile applications for disease surveillance and outbreak response activities [23, 24].
MyMAFI operate on an Android platform and is available in one language Malay. Availability of the mobile application in one platform may lead to limited use of the application as public health officials utilising smartphones with iPhone operating system (iOs) will not be in a position to collect data during field investigation. As such, there is a need to encompass other operating systems and platforms such as iOs and web-based applications. Inclusion of other platforms would result in more coverage and lead to increased reporting and notifications as more people would have access to the application. There was absence of information on system type and server characteristics of MyMAFI. However, based on minimal information available, MyMAFI may have been developed on a closed source platform and function as a client-based network. mHealth interventions that are already in use for other disease outbreak management were developed on an open source platform [25,26,27]. Open source networks encourage collaboration as others can learn from and improve features and functionalities of respective applications that have been developed making them more sustainable.
There was limited information describing detailed qualities and key functionalities of MyMAFI. As a result, it was not possible to assess all attributes that MyMAFI offers. However, based on available information, basic elements constituting the standard investigation form for FBD with additional features were used to develop an application for field investigation. The basic elements in the investigation form usually include personal and clinical details, food history/risk factor information and in some specimen details for laboratory investigations. Features that were also added included automatic generation of line lists, epidemiological curve and descriptive analysis. Outbreak verification and epidemiological investigation were the key functionalities that were specified. There was no mention of other crucial components such as environmental and laboratory investigations. It is not clear whether these elements are available or not. Lack of these components would hamper identification of implicated food and pathogens that might be responsible for an outbreak.
An effective FBD outbreak system should incorporate key attributes on outbreak verification, epidemiological, environmental and laboratory investigations. These attributes are crucial in verifying existence, determining the possible source and cause of an outbreak, so that corrective measures can be implemented and prevent further spread. In addition, laboratory-based alerts are of importance as they facilitate immediate relaying of results so that appropriate case management and intervention measures can be initiated timeously to prevent further spread. Furthermore, provision of decision support framework will guide outbreak response teams in gathering information needed for public health action. Although laboratory data management and decision support framework may not be key attributes of a FBD outbreak response system, they are important key functionalities for disease outbreak management as they provide much needed info relating to pathogen/s causing disease and guidance to public health official in real time.
Even though only one mobile application for FBD outbreak investigation was identified, there have been advancements in recognising that mobile applications can be useful tools in collecting data related to foodborne diseases. In 2019, Seitzinger et al. published an article on a mobile application named Ethica that was assessed for data collection on food consumed and foodborne diseases but focus was not on FBD outbreak management [28]. The Ethica application was described to have improved data quality and displayed basic features such as reliability, flexibility, security features, feedback loops, generate reports and automatic updates. Additional features include ability to capture detailed food history in real time, store data for weeks when access to data is not available and availability of user and time-triggered interfaces to report illness. The Ethica application can operate on Android, iPhone and web-based platforms. Basic features of the Ethica application are in par with other outbreak management systems in use [27, 29]. The Ethica application has the potential to be used for FBD outbreak investigation if key attributes for FBD outbreak management can be incorporated on the application.
Furthermore, though limited, there are web-based platforms that have been in use for years for FBD surveillance and outbreak reporting in the United States [30, 31]. These platforms i.e. the National Outbreak Reporting System (NORS) and Foodborne Disease Outbreak Surveillance System (FDOSS) by the Centers for Disease Control and Prevention have proved to collect data needed for public health action. However, there is still limited use of web-based systems for FBD outbreak management in many parts of the world including South Africa. Platforms such as NORS/FDOSS can guide further development of other web-based systems or mobile applications in terms of features and components required to generate meaningful data during FBD outbreak investigations. Mobile applications are also of importance as they can be used to collect data in real time when officials are in the field. As FBD outbreaks are notifiable and common, it is important to have systems that will encompass both FBD surveillance and outbreak investigation as surveillance will lead to early detection and timely response to outbreaks.
Our study has several limitations. Firstly, our search was limited to scientific literature databases and did not include Google Scholar. As such, publications on this platform may have been missed. Secondly, inclusion criteria was limited to mobile phone-based applications for FBD outbreak, therefore it is not representative of all systems in use for collection of FBD data including surveillance. Web-based systems were excluded and this may have resulted in this review missing other features that may be useful for FBD outbreak investigation. Thirdly, only studies published in English were included and did not account for articles published in other languages. Fourthly, only one mobile-based application was identified and there was lack of published information regarding its detailed features and functionalities. As such, it was not possible to compare its characteristics with other applications making it difficult to determine if the application is in par with other mHealth application in use for disease outbreak management. Lastly, attempts were made through email and by telephone, multiple times, to contact the corresponding author of the MyMAFI paper to obtain more information; however response was not forthcoming. We also searched online and through app stores for the application to be able to reach out to the developers, but the application was not available through these searches.