In this study, we designed smart deworming devices that use RMS for surveillance of echinococcosis. The steps for control by smart deworming devices are as follows: (1) Attach the smart collar on the neck of the target dog or fix the smart feeder near the target dog, (2) match ID of the smart devices with ID of the target dog, owner, the village, and village administrator, and (3) set deworming frequency, the dosing time, and the deworming dosage, then the smart devices will deliver the PZQ baits according to the set procedure. The RMS provides a variety of deworming frequency options, such as once a month, once every two months, once a quarter, and once every six months, which can be selected depending on the local Echinococcus prevalence and actual requirements. The dosing date can be set (we set the time as the 30th of each month) and the deworming dosage for each dog can also be set individually (we can set one bait or two baits to be administered to the dog at a time according to the weight of the target dog) on the RMS. Table 4 shows that the positive rate of dog faeces in the manual deworming group is significantly higher than that of the smart deworming group. The smart devices controlled by RMS can greatly reduce the worm biomass in dogs. The “attaching once, lasting a year, deworming 12 times” of the smart deworming devices greatly improves the efficiency and effectiveness of deworming, and saves time, labour, and capital costs, especially in the Tibetan agricultural and pastoral areas with harsh climates. The RMS is a potential replacement of the existing manual deworming and can ensure precise prevention and control of echinococcosis.
The completeness, accuracy, and timeliness of surveillance data are the basic requirements for precise control of echinococcosis. Monitoring includes active mass screening for human echinococcosis, surveillance for canine echinococcosis, and surveillance for echinococcosis in livestock.27 The main monitoring indicators of the echinococcosis include the positive rates of canine faeces and the prevalence of the disease in the general human population, children, and livestock. The national survey data of echinococcosis from 2012–2016 were incorporated to RMS for real-time dynamic comprehensive analysis on the epidemic status of echinococcosis. Annual surveillance data of echinococcosis in target areas can be added after RMS has been adopted. The comparative analysis of the effectiveness before and after smart deworming can be performed, and the parallel comparative evaluation of the effectiveness of the smart deworming versus manual deworming can also be conducted. Dynamic surveillance can guide decision-making for echinococcosis control and inform the public and the policymakers about the progress and effectiveness of control initiatives. In addition, all the data and results on the RMS can be printed online or exported for further statistical analysis. The RMS can promote the scientific and electronic management, storage, mining, and utilisation of surveillance data, reduce the labour costs and errors, and improve the completeness, accuracy, and effectiveness of the data. The latest version of the RMS has updated the monitoring indicators to be compatible with the upgraded National Hydatid Disease Surveillance Program (Chinese Center for Disease Control and Prevention, Notice of the National Hydatid Surveillance Program, 2020 version).
As a telemanagement platform, friendly and easy to operate interface can greatly improve user experience. The preliminary interviews with administrators at the five levels show that the RMS is both friendly and easy to conduct, and the satisfaction rate reached 93.8%. The content displayed on the interface of the RMS mainly includes overview of the jurisdiction, information entry, information list, smart control and prevention, data analysis, and personnel management. The “overview of the jurisdiction” displays the basic information of echinococcosis prevention and control in a particular jurisdiction including the endemic map embedded in the centre of interface, basic information such as the number of administrators in this jurisdiction and the lower levels, and the number of endemic provinces, cities, counties, townships, and villages. The human population prevalence, the total number of dogs and infection rates, the number of dogs deworming by smart devices, and the infection rates are displayed on the right interface. These data are automatically generated and summarised from the lower-level data. The entire interface is intuitive and visual, and the data is relayed in real time (Fig. 5). Information entry mainly includes the input of basic information, baseline data, and test results (Fig. 3). Information lists enable the administrators to browse and query related information in real time. Smart control and prevention enable the administrators to browse and query the operating status of smart deworming devices as well as fault repair and teleguidance. The interface of data analysis has focused not only on smart control data and monitoring data but also on the movement trajectory of each dog over a particular period. The smart collars or feeders help the RMS to trace the dogs to a village, a township, or even a county. Therefore, it is possible to understand the precise movement scope of the infection source of echinococcosis and implement targeted preventive control measures. In addition, the interface of voltage and temperature can help the administrators know the actual status of the smart devices in real time and determine whether batteries of the given collar need to be replaced or recharged.
During the development process of the RMS from 2016 to 2019, a worrisome fundamental concern was the availability of wireless network coverage in the echinococcosis-endemic area of alpine Tibetan. Without reliable wireless network coverage, the RMS would not achieve the goal of remote control and surveillance for echinococcosis. It is gratifying that China’s rapid economic development over the past few decades, especially driven by China's Western Development Policy and the rapid improvement of mobile communication technology, has provided a strong network foundation and feasibility for the RMS. In 2019, in the Tibet Autonomous Region, the penetration rate of fixed broadband reached 98.7 per 100 households, the broadband coverage of the administrative villages reached 100.0%, the coverage rate of the 3G network reached 100%, the administrative village realised full coverage of mobile signals.28 In Gansu, the mobile phone penetration rate is 104.3 units/100 people, and the penetration rate of mobile broadband access users is 90.8 per 100 people.29 Therefore, the internet or wireless network and telecommunication coverage do not seem to be a serious problem in the echinococcosis-endemic area of Qinghai-Tibet Plateau. In this study, 94.8% of smart collars could successfully connect to the local wireless network and upload the related information to RMS. But even so, to ensure that the coverage and the frequency of deworming for dogs are not affected by the wireless network, a self-control loop and data storage unit were embedded in the smart devices. They guarantee that, even if there is no wireless network, the smart deworming devices can automatically deliver PZQ baits regularly and, quantitatively and record the information about delivery reminders, fault alarms, location, working temperature, and battery voltage and save them in the CPU. Once the wireless network is restored, the smart devices can connect to the RMS and upload the stored information automatically.
Although the RMS has a reasonable architecture, stable performance, strong operability, and friendly interface, there is a need to improve several limitations as follows. (1) The interfaces and their related content should be further optimised. For example, the upgraded “overview of Jurisdiction” should increase to display the dynamic change graphs, including the population prevalence, the infection rate of dogs, the prevalence of children, and the prevalence of livestock in a particular jurisdiction; (2) The statistical analysis should be enriched by adding a variety of statistical analysis methods, even drawing and generating two-dimensional or three-dimensional charts, and linking it to relevant statistical analysis software to establish an early warning module for the echinococcosis epidemic; (3) Accordingly, there is a need to adjust and optimise the database tables, contents, and evaluation indicators to give the RMS a more highlighted focus, smoother running, and more reasonable layout; (4) Some new functional modules such as data backup module, system optimisation, and update module should also be established;(5) The Huawei cloud server will be used to ensure that the application environment is reliable, flexible, efficient, and safe for the RMS. Now, the RMS has been upgraded and iterated three times up to Version 3.0.1 (Record No: SHR19022138) and has been tested and evaluated in Hezuo since 2019 with no serious adverse events such as crash, data disorder, and information divulgence has been recorded. Moreover, it has passed the stress and load tests and obtained the network licence issued by the industry competent department.