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Mwase C, Nkhoma K, Allsop MJ. The role of digital health in palliative care for people living with HIV in sub-Saharan Africa: A systematic review. Digit Health 2022; 8:20552076221133707. [DOI: 10.1177/20552076221133707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/30/2022] [Indexed: 11/24/2022] Open
Abstract
Background In 2018, 26.6 million people were living with HIV in sub-Saharan Africa. Palliative care services are recommended for people living with HIV at all stages from diagnosis through to end-of-life. However, the provision of palliative care in sub-Saharan Africa is limited, leading to little or no access for the majority of patients. Digital technologies in sub-Saharan Africa present an opportunity to improve access to palliative care for people living with HIV in the region. This review synthesised literature on digital health interventions for palliative care for people living with HIV in sub-Saharan Africa and assessed their effects on patient outcomes. Methods Literature searches were conducted in MEDLINE, Embase, PsycINFO and Global Health. Inclusion and exclusion criteria were applied. Two independent reviewers conducted study screening, data extraction and quality appraisal. A narrative synthesis was performed to draw together and report findings across heterogeneous studies. Reporting of this review follows the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist. Results Out of 4117 records, 25 studies were included, covering 3592 people living with HIV, across 21 countries. Studies included three randomised controlled trials, three qualitative, three pre- and post-test, two observational, two case series, six cross-sectional and six mixed methods studies. Telemedicine was the most reported digital health intervention, with 12 studies demonstrating the effectiveness of digital health interventions. Conclusion Emerging evidence suggests digital health interventions can be effective in facilitating patient-provider communication and health professional decision-making as a part of palliative care for people living with HIV. There is a need for further development and evaluation of digital health interventions alongside determining optimal approaches to their implementation as a part of palliative care provision in sub-Saharan Africa.
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Affiliation(s)
- Christopher Mwase
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK
| | | | - Mathew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK
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Kabukye JK, Kakungulu E, Keizer ND, Cornet R. Digital health in oncology in Africa: A scoping review and cross-sectional survey. Int J Med Inform 2021; 158:104659. [PMID: 34929545 DOI: 10.1016/j.ijmedinf.2021.104659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/09/2021] [Accepted: 12/05/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Low- and middle-income countries, especially in Africa, face a growing cancer burden. Adoption of digital health solutions has the potential to improve cancer care delivery and research in these countries. However, the extent of implementation and the impact of digital health interventions across the cancer continuum in Africa have not been studied. AIMS To describe the current landscape of digital health interventions in oncology in Africa. METHODS We conducted a scoping literature review and supplemented this with a survey. Following the PRISMA for Scoping Reviews guidelines, we searched literature in PubMed and Embase for keywords and synonyms for cancer, digital health, and African countries, and abstracted data using a structured form. For the survey, participants were delegates of the 2019 conference of the African Organization for Research and Training in Cancer. RESULTS The literature review identified 57 articles describing 40 digital health interventions or solutions from 17 African countries, while the survey included 111 respondents from 18 African countries, and these reported 25 different digital health systems. Six articles (10.5%) reported randomized controlled trials. The other 51 articles (89.5%) were descriptive or quasi-experimental studies. The interventions mostly targeted cancer prevention (28 articles, 49.1%) or diagnosis and treatment (23 articles, 40.4%). Four articles (7.0%) targeted survivorship and end of life, and the rest were cross-cutting. Cervical cancer was the most targeted cancer (25 articles, 43.9%). Regarding WHO classification of digital interventions, most were for providers (35 articles, 61.4%) or clients (13, 22.8%), while the others were for data services or cut across these categories. The interventions were mostly isolated pilots using basic technologies such as SMS and telephone calls for notifying patients of their appointments or results, or for cancer awareness; image capture apps for cervical cancer screening, and tele-conferencing for tele-pathology and mentorship. Generally positive results were reported, but evaluation focused on structure and process measures such as ease of use, infrastructure requirements, and acceptability of intervention; or general benefits e.g. supporting training and mentorship of providers, communication among providers and clients, and improving data collection and management. No studies evaluated individualized clinical outcomes, and there were no interventions in literature for health system managers although the systems identified in the survey had such functionality, e.g. inventory management. The survey also indicated that none of the digital health systems had all the functionalities for a comprehensive EHR, and major barriers for digital health were initial and ongoing costs, resistance from clinical staff, and lack of fit between the EHR and the clinical workflows. CONCLUSION Digital health interventions in oncology in Africa are at early maturity stages but promising. Barriers such as funding, fit between digital health tools and clinical workflows, and inertia towards technology, shall need to be addressed to allow for advancement of digital health solutions to support all parts of the cancer continuum. Future research should investigate the impact of digital health solutions on long-term cancer outcomes such as cancer mortality, morbidity and quality of life.
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Affiliation(s)
- Johnblack K Kabukye
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands; Uganda Cancer Institute, Upper Mulago Hill Road, P.O. Box 3935, Kampala, Uganda.
| | - Edward Kakungulu
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
| | - Nicolette de Keizer
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
| | - Ronald Cornet
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, Location AMC, Meibergdreef 15, Amsterdam, the Netherlands
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3
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Joseph Wu TS, Kagoli M, Kaasbøll JJ, Bjune GA. Integrated Disease Surveillance and Response (IDSR) in Malawi: Implementation gaps and challenges for timely alert. PLoS One 2018; 13:e0200858. [PMID: 30496177 PMCID: PMC6264833 DOI: 10.1371/journal.pone.0200858] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022] Open
Abstract
Objective The recent 2014 Ebola Virus Disease (EVD) outbreaks rang the bell to call upon global efforts to assist resource-constrained countries to strengthen public health surveillance system for early response. Malawi adopted the Integrated Disease Surveillance and Response (IDSR) strategy to develop its national surveillance system since 2002 and revised its guideline to fulfill the International Health Regulation (IHR) requirements in 2014. This study aimed to understand the state of IDSR implementation and differences between guideline and practice for future disease surveillance system strengthening. Methods This was a mixed-method research study. Quantitative data were to analyze completeness and timeliness of surveillance system performance from national District Health Information System 2 (DHIS2) during October 2014 to September 2016. Qualitative data were collected through interviews with 29 frontline health service providers from the selected district and 7 key informants of the IDSR system implementation and administration at district and national levels. Findings The current IDSR system showed relatively good completeness (73.1%) but poor timeliness (40.2%) of total expected monthly reports nationwide and zero weekly reports during the study period. Major implementation gaps were lack of weekly report and trainings. The challenges of IDSR implementation revealed through qualitative data included case identification, compiling reports for timely submission and inadequate resources. Conclusions The differences between IDSR technical guideline and actual practice were huge. The developing information technology infrastructure in Malawi and emerging mobile health (mHealth) technology can be opportunities for the country to overcome these challenges and improve surveillance system to have better timeliness for the outbreaks and unusual events detection.
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Affiliation(s)
- Tsung-Shu Joseph Wu
- Department of Informatics, University of Oslo, Oslo City, Norway
- Research Department, Luke International, Mzuzu City, Malawi
- Overseas Mission Department, Pingtung Christian Hospital, Pingtung County, Taiwan
- Department of Public Health, National Taiwan University, Taipei City, Taiwan
- * E-mail: ,
| | - Matthew Kagoli
- Department of Epidemiology, Ministry of Health, Lilongwe City, Malawi
- Public Health Institute of Malawi, Lilongwe, Malawi
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Bush RA, Pérez A, Baum T, Etland C, Connelly CD. A systematic review of the use of the electronic health record for patient identification, communication, and clinical support in palliative care. JAMIA Open 2018; 1:294-303. [PMID: 30842998 PMCID: PMC6398614 DOI: 10.1093/jamiaopen/ooy028] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objectives Globally, healthcare systems are using the electronic health record (EHR) and elements of clinical decision support (CDS) to facilitate palliative care (PC). Examination of published results is needed to determine if the EHR is successfully supporting the multidisciplinary nature and complexity of PC by identifying applications, methodology, outcomes, and barriers of active incorporation of the EHR in PC clinical workflow. Methods A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The data sources PubMed, CINAL, EBSCOhost, and Academic Search Premier were used to identify literature published 1999–2017 of human subject peer-reviewed articles in English containing original research about the EHR and PC. Results The search returned 433 articles, 30 of which met inclusion criteria. Most studies were feasibility studies or retrospective cohort analyses; one study incorporated prospective longitudinal mixed methods. Twenty-three of 30 (77%) were published after 2014. The review identified five major areas in which the EHR is used to support PC. Studies focused on CDS to: identify individuals who could benefit from PC; electronic advanced care planning (ACP) documentation; patient-reported outcome measures (PROMs) such as rapid, real-time pain feedback; to augment EHR PC data capture capabilities; and to enhance interdisciplinary communication and care. Discussion Beginning in 2015, there was a proliferation of articles about PC and EHRs, suggesting increasing incorporation of and research about the EHR with PC. This review indicates the EHR is underutilized for PC CDS, facilitating PROMs, and capturing ACPs.
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Affiliation(s)
- Ruth A Bush
- Beyster Institute of Nursing Research, Hahn School of Nursing and Health Science, University of San Diego, San Diego, California, USA
| | - Alexa Pérez
- Beyster Institute of Nursing Research, Hahn School of Nursing and Health Science, University of San Diego, San Diego, California, USA
| | - Tanja Baum
- Beyster Institute of Nursing Research, Hahn School of Nursing and Health Science, University of San Diego, San Diego, California, USA
| | - Caroline Etland
- Beyster Institute of Nursing Research, Hahn School of Nursing and Health Science, University of San Diego, San Diego, California, USA.,Education, Department of Research and Professional Practice, Sharp Chula Vista Medical Center, Sharp Healthcare System San Diego, San Diego, California, USA
| | - Cynthia D Connelly
- Beyster Institute of Nursing Research, Hahn School of Nursing and Health Science, University of San Diego, San Diego, California, USA
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Ploss B, Douglas TS, Glucksberg M, Kaufmann EE, Malkin RA, McGrath J, Mkandawire T, Oden M, Osuntoki A, Rollins A, Sienko K, Ssekitoleko RT, Reichert W. Part II: U.S.—Sub-Saharan Africa Educational Partnerships for Medical Device Design. Ann Biomed Eng 2017; 45:2489-2493. [DOI: 10.1007/s10439-017-1898-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ellsworth MA, Dziadzko M, O'Horo JC, Farrell AM, Zhang J, Herasevich V. An appraisal of published usability evaluations of electronic health records via systematic review. J Am Med Inform Assoc 2017; 24:218-226. [PMID: 27107451 PMCID: PMC7654077 DOI: 10.1093/jamia/ocw046] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 02/25/2016] [Accepted: 03/01/2016] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE In this systematic review, we aimed to evaluate methodological and reporting trends present in the current literature by investigating published usability studies of electronic health records (EHRs). METHODS A literature search was conducted for articles published through January 2015 using MEDLINE (Ovid), EMBASE, Scopus, and Web of Science, supplemented by citation and reference list reviews. Studies were included if they tested the usability of hospital and clinic EHR systems in the inpatient, outpatient, emergency department, or operating room setting. RESULTS A total of 4848 references were identified for title and abstract screening. Full text screening was performed for 197 articles, with 120 meeting the criteria for study inclusion. CONCLUSION A review of the literature demonstrates a paucity of quality published studies describing scientifically valid and reproducible usability evaluations at various stages of EHR system development. A lack of formal and standardized reporting of EHR usability evaluation results is a major contributor to this knowledge gap, and efforts to improve this deficiency will be one step of moving the field of usability engineering forward.
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Affiliation(s)
- Marc A Ellsworth
- Division of Neonatal Medicine, Mayo Clinic, Rochester, MN, USA
- Multidisciplinary Epidemiology and Translational Research in Critical Care, Emergency and Perioperative Medicine (METRIC-PM) Group, Mayo Clinic, Rochester, MN, USA
| | - Mikhail Dziadzko
- Multidisciplinary Epidemiology and Translational Research in Critical Care, Emergency and Perioperative Medicine (METRIC-PM) Group, Mayo Clinic, Rochester, MN, USA
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
| | - John C O'Horo
- Multidisciplinary Epidemiology and Translational Research in Critical Care, Emergency and Perioperative Medicine (METRIC-PM) Group, Mayo Clinic, Rochester, MN, USA
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Ann M Farrell
- Mayo Clinic Libraries, Mayo Clinic, Rochester, MN, USA
| | - Jiajie Zhang
- School of Health Information Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Vitaly Herasevich
- Multidisciplinary Epidemiology and Translational Research in Critical Care, Emergency and Perioperative Medicine (METRIC-PM) Group, Mayo Clinic, Rochester, MN, USA
- Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA
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7
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Jafry MA, Jenny AM, Lubinga SJ, Larsen-Cooper E, Crawford J, Matemba C, Babigumira JB. Examination of patient flow in a rural health center in Malawi. BMC Res Notes 2016; 9:363. [PMID: 27456090 PMCID: PMC4960743 DOI: 10.1186/s13104-016-2144-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 06/30/2016] [Indexed: 11/26/2022] Open
Abstract
Background Malawi, like many low-income countries, is facing a severe health worker shortage. A potential stop-gap solution to this crisis is improving the efficiency of health center operations. Given the lack of research on center efficiency in rural health centers in Malawi, we conducted a study to identify deficiencies in center organization and barriers to patient flow. Methods We performed a time-motion survey at a rural health center in Ntaja, Malawi over a period of 1 week. We used a standardized questionnaire to collect information on the amount of time a patient spent with each health worker, the number of center staff that attended to each patient, and the total time spent at the center. Additionally, at the end of the visit, we conducted an exit survey to collect demographic information and data on perception of quality of care with the center visit for all patients. Results A total of 1018 patients were seen over the five-day study. The average total time spent at the center by the patients was 123 min (2–366 min). Adults had an average total time spent at the center of 111 min (2–366 min) and children 134 min (7–365 min). Patient waiting time (PWT) was higher in the early morning hours ranging from 157 min (between 06:00 and 08:00) to 53 min (between 14:00 and 16:00). Health worker contact time (HCT) was higher for adults (2.3 min) than children (1.7 min). Shorter wait times were associated with higher perceptions of quality of service. Conclusion Despite shortages in health workers and funds, opportunities are available to increase efficiency in rural health centers. By removing bottlenecks to increase the productivity of health workers, centers in low-income countries can treat more patients and improve service quality. Electronic supplementary material The online version of this article (doi:10.1186/s13104-016-2144-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M A Jafry
- University of Washington, Seattle, WA, USA.
| | - A M Jenny
- Global Medicines Program, University of Washington, Seattle, WA, USA
| | - S J Lubinga
- Global Medicines Program, University of Washington, Seattle, WA, USA.,Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, USA
| | | | | | | | - J B Babigumira
- Global Medicines Program, University of Washington, Seattle, WA, USA.,Pharmaceutical Outcomes Research and Policy Program, University of Washington, Seattle, WA, USA
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8
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Rouhollahi MR, Saghafinia M, Zandehdel K, Motlagh AG, Kazemian A, Mohagheghi MA, Tahmasebi M. Assessment of a Hospital Palliative Care Unit (HPCU) for Cancer Patients; A Conceptual Framework. Indian J Palliat Care 2015; 21:317-27. [PMID: 26600701 PMCID: PMC4617040 DOI: 10.4103/0973-1075.164901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction: The first hospital palliative care unit (HPCU) in Iran (FARS-HPCU) has been established in 2008 in the Cancer Institute, which is the largest referral cancer center in the country. We attempted to assess the performance of the HPCU based on a comprehensive conceptual framework. The main aim of this study was to develop a conceptual framework for assessment of the HPCU performances through designing a value chain in line with the goals and the main processes (core and support). Materials and Methods: We collected data from a variety of sources, including international guidelines, international best practices, and expert opinions in the country and compared them with national policies and priorities. We also took into consideration the trend of the HPCU development in the Cancer Institute of Iran. Through benchmarking the gap area with the performance standards, some recommendations for better outcome are proposed. Results: The framework for performance assessment consisted of 154 process indicators (PIs), based on which the main stakeholders of the HPCU (including staff, patients, and families) offered their scoring. The outcome revealed the state of the processes as well as the gaps Conclusion: Despite a significant improvement in many processes and indicators, more development in the comprehensive and integrative aspects of FARS-HPCU performance is required. Consideration of all supportive and palliative requirements of the patients through interdisciplinary and collaborative approaches is recommended.
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Affiliation(s)
- Mohammad Reza Rouhollahi
- Cancer Research Center (Secretariat of National Cancer Research Network), Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Saghafinia
- Cancer Research Center (Secretariat of National Cancer Research Network), Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran ; Department of Anesthesiology, Faculty of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Kazem Zandehdel
- Cancer Research Center (Secretariat of National Cancer Research Network), Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Ghanbari Motlagh
- Department of Radiotherapy, Shahid Baheshti University of Medical Sciences, Tehran, Iran
| | - Ali Kazemian
- Cancer Research Center (Secretariat of National Cancer Research Network), Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mohagheghi
- Cancer Research Center (Secretariat of National Cancer Research Network), Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
| | - Mamak Tahmasebi
- Cancer Research Center (Secretariat of National Cancer Research Network), Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran
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Shah K, Skerrett E, Nojoomi M, Walker T, Maynard K, Pan M, Flynn B, Yuan M, Horton P, Vaughn T, Miros R, Molyneux E, Saterbak A, Oden ZM, Richards-Kortum R. Maji: a new tool to prevent overhydration of children receiving intravenous fluid therapy in low-resource settings. Am J Trop Med Hyg 2015; 92:1053-8. [PMID: 25732685 DOI: 10.4269/ajtmh.14-0495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 01/30/2015] [Indexed: 11/07/2022] Open
Abstract
We designed and evaluated the accuracy and usability of a device to regulate the volume of fluid dispensed during intravenous drip therapy. The mechanical system was developed in response to a pressing need articulated by clinicians in pediatric wards throughout sub-Saharan Africa, who require a tool to prevent overhydration in children receiving intravenous fluid in settings that lack burettes or electronic infusion pumps. The device is compatible with most intravenous bags and limits the volume dispensed to a preset amount that can be adjusted in 50 mL increments. Laboratory accuracy over a range of clinically-relevant flow rates, initial bag volumes, and target volumes was within 12.0 mL of the target volume. The ease of use is "excellent," with a mean system usability score of 84.4 out of 100. Use of the device limits the volume of fluid dispensed during intravenous therapy and could potentially reduce the morbidity and mortality associated with overhydration in children receiving intravenous therapy.
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Affiliation(s)
- Kamal Shah
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Erica Skerrett
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Matthew Nojoomi
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Thor Walker
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Kelley Maynard
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Michael Pan
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Bailey Flynn
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Melissa Yuan
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Paige Horton
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Taylor Vaughn
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Robert Miros
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Elizabeth Molyneux
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Ann Saterbak
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Z Maria Oden
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Rebecca Richards-Kortum
- Department of Bioengineering, Rice University, Houston, Texas; Rice 360°, Institute for Global Health Technologies, Rice University, Houston, Texas; 3rd Stone Design, San Rafael, California; Department of Paediatrics, Queen Elizabeth Central Hospital, Blantyre, Malawi
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