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Semango GP, Buza J. Review of the Current Status on Ruminant Abortigenic Pathogen Surveillance in Africa and Asia. Vet Sci 2024; 11:425. [PMID: 39330804 PMCID: PMC11435614 DOI: 10.3390/vetsci11090425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/14/2024] [Accepted: 05/17/2024] [Indexed: 09/28/2024] Open
Abstract
Ruminant abortion events cause economic losses. Despite the importance of livestock production for food security and the livelihoods of millions of people in the world's poorest communities, very little is known about the scale, magnitude, or causes of these abortions in Africa and Asia. The aim of this review was to determine the current status of surveillance measures adopted for ruminant abortigenic pathogens in Africa and Asia and to explore feasible surveillance technologies. A systematic literature search was conducted using PRISMA guidelines for studies published between 1 January 1990 and 1 May 2024 that reported epidemiological surveys of abortigenic pathogens Africa and Asia. A meta-analysis was used to estimate the species-specific sero-prevalence of the abortigenic agents and the regions where they were detected. In the systematic literature search, 39 full-text manuscripts were included. The most prevalent abortigenic pathogens with sero-prevalence greater than 10% were BHV-1, Brucella, Chlamydia abortus, Neospora caninum, RVFV, and Waddlia chondrophila in cattle, BVDV in sheep, and RVFV and Toxoplasma gondii in goats in Africa. In Asia, Anaplasma, BHV-1, Bluetongue virus, Brucella, and BVDV were prevalent in cattle, whereas Mycoplasma was important in goats and sheep.
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Affiliation(s)
- George Peter Semango
- School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha P.O. Box 447, Tanzania
| | - Joram Buza
- School of Life Sciences and Bioengineering, Nelson Mandela African Institution of Science and Technology, Arusha P.O. Box 447, Tanzania
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Mabetha K, Soepnel LM, Mabena G, Motlhatlhedi M, Nyati L, Norris SA, Draper CE. Mobile Technology Use in Clinical Research Examining Challenges and Implications for Health Promotion in South Africa: Mixed Methods Study. JMIR Form Res 2024; 8:e48144. [PMID: 38588527 PMCID: PMC11036187 DOI: 10.2196/48144] [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: 04/13/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND The use of mobile technologies in fostering health promotion and healthy behaviors is becoming an increasingly common phenomenon in global health programs. Although mobile technologies have been effective in health promotion initiatives and follow-up research in higher-income countries and concerns have been raised within clinical practice and research in low- and middle-income settings, there is a lack of literature that has qualitatively explored the challenges that participants experience in terms of being contactable through mobile technologies. OBJECTIVE This study aims to explore the challenges that participants experience in terms of being contactable through mobile technologies in a trial conducted in Soweto, South Africa. METHODS A convergent parallel mixed methods research design was used. In the quantitative phase, 363 young women in the age cohorts 18 to 28 years were contacted telephonically between August 2019 and January 2022 to have a session delivered to them or to be booked for a session. Call attempts initiated by the study team were restricted to only 1 call attempt, and participants who were reached at the first call attempt were classified as contactable (189/363, 52.1%), whereas those whom the study team failed to contact were classified as hard to reach (174/363, 47.9%). Two outcomes of interest in the quantitative phase were "contactability of the participants" and "participants' mobile number changes," and these outcomes were analyzed at a univariate and bivariate level using descriptive statistics and a 2-way contingency table. In the qualitative phase, a subsample of young women (20 who were part of the trial for ≥12 months) participated in in-depth interviews and were recruited using a convenience sampling method. A reflexive thematic analysis approach was used to analyze the data using MAXQDA software (version 20; VERBI GmbH). RESULTS Of the 363 trial participants, 174 (47.9%) were hard to reach telephonically, whereas approximately 189 (52.1%) were easy to reach telephonically. Most participants (133/243, 54.7%) who were contactable did not change their mobile number. The highest percentage of mobile number changes was observed among participants who were hard to reach, with three-quarters of the participants (12/16, 75%) being reported to have changed their mobile number ≥2 times. Eight themes were generated following the analysis of the transcripts, which provided an in-depth account of the reasons why some participants were hard to reach. These included mobile technical issues, coverage issues, lack of ownership of personal cell phones, and unregistered number. CONCLUSIONS Remote data collection remains an important tool in public health research. It could, thus, serve as a hugely beneficial mechanism in connecting with participants while actively leveraging the established relationships with participants or community-based organizations to deliver health promotion and practice.
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Affiliation(s)
- Khuthala Mabetha
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Larske M Soepnel
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Gugulethu Mabena
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Molebogeng Motlhatlhedi
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Lukhanyo Nyati
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, United Kingdom
| | - Catherine E Draper
- South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Alhassan Y, Otiso L, Okoth L, Murray L, Hemingway C, Lewis JM, Oguche M, Doyle V, Muturi N, Ogwang E, Barsosio HC, Taegtmeyer M. Four antenatal care visits by four months of pregnancy and four vital tests for pregnant mothers: impact of a community-facility health systems strengthening intervention in Migori County, Kenya. BMC Pregnancy Childbirth 2024; 24:224. [PMID: 38539129 PMCID: PMC10967157 DOI: 10.1186/s12884-024-06386-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/01/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Early attendance at antenatal care (ANC), coupled with good-quality care, is essential for improving maternal and child health outcomes. However, achieving these outcomes in sub-Saharan Africa remains a challenge. This study examines the effects of a community-facility health system strengthening model (known as 4byFour) on early ANC attendance, testing for four conditions by four months of pregnancy, and four ANC clinic visits in Migori county, western Kenya. METHODS We conducted a mixed methods quasi-experimental study with a before-after interventional design to assess the impact of the 4byFour model on ANC attendance. Data were collected between August 2019 and December 2020 from two ANC hospitals. Using quantitative data obtained from facility ANC registers, we analysed 707 baseline and 894 endline unique ANC numbers (attendances) based on negative binomial regression. Logistic regression models were used to determine the impact of patient factors on outcomes with Akaike Information Criterion (AIC) and likelihood ratio testing used to compare models. Regular facility stock checks were undertaken at the study sites to assess the availability of ANC profile tests. Analysis of the quantitative data was conducted in R v4.1.1 software. Additionally, qualitative in-depth interviews were conducted with 37 purposively sampled participants, including pregnant mothers, community health volunteers, facility staff, and senior county health officials to explore outcomes of the intervention. The interview data were audio-recorded, transcribed, and coded; and thematic analysis was conducted in NVivo. RESULTS There was a significant 26% increase in overall ANC uptake in both facilities following the intervention. Early ANC attendance improved for all age groups, including adolescents, from 22% (baseline) to 33% (endline, p = 0.002). Logistic regression models predicting early booking were a better fit to data when patient factors were included (age, parity, and distance to clinic, p = 0.004 on likelihood ratio testing), suggesting that patient factors were associated with early booking.The proportion of women receiving all four tests by four months increased to 3% (27/894), with haemoglobin and malaria testing rates rising to 8% and 4%, respectively. Despite statistical significance (p < 0.001), the rates of testing remained low. Testing uptake in ANC was hampered by frequent shortage of profile commodities not covered by buffer stock and low ANC attendance during the first trimester. Qualitative data highlighted how community health volunteer-enhanced health education improved understanding and motivated early ANC-seeking. Community pregnancy testing facilitated early detection and referral, particularly for adolescent mothers. Challenges to optimal ANC attendance included insufficient knowledge about the ideal timing for ANC initiation, financial constraints, and long distances to facilities. CONCLUSION The 4byFour model of community-facility health system strengthening has the potential to improve early uptake of ANC and testing in pregnancy. Sustained improvement in ANC attendance requires concerted efforts to improve care quality, consistent availability of ANC commodities, understand motivating factors, and addressing barriers to ANC. Research involving randomised control trials is needed to strengthen the evidence on the model's effectiveness and inform potential scale up.
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Affiliation(s)
- Yussif Alhassan
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Lilian Otiso
- LVCT Health, Sonning Suites, Suna Road off Ngong Rd, Adams Arcade, P.O. Box 19835, Nairobi, Kenya
| | - Linet Okoth
- LVCT Health, Sonning Suites, Suna Road off Ngong Rd, Adams Arcade, P.O. Box 19835, Nairobi, Kenya
| | - Lois Murray
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Charlotte Hemingway
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Joseph M Lewis
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Mandela Oguche
- LVCT Health, Sonning Suites, Suna Road off Ngong Rd, Adams Arcade, P.O. Box 19835, Nairobi, Kenya
| | - Vicki Doyle
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nelly Muturi
- Airbel Impact Lab- International Rescue Committee, Nairobi, Kenya
| | - Emily Ogwang
- LVCT Health, The Key Place, Along Homa Bay-Rongo Road, P.O Box 352-40300, Homabay, Kenya
| | | | - Miriam Taegtmeyer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Tropical Infectious Diseases Unit, Liverpool University Hospitals Foundation Trust, Liverpool, UK
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Grewal G, Fuller SS, Rababeh A, Maina M, English M, Paton C, Papoutsi C. Scoping review of interventions to improve continuity of postdischarge care for newborns in LMICs. BMJ Glob Health 2024; 9:e012894. [PMID: 38199778 PMCID: PMC10806884 DOI: 10.1136/bmjgh-2023-012894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 11/12/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Neonatal mortality remains significant in low-income and middle-income countries (LMICs) with in-hospital mortality rates similar to those following discharge from healthcare facilities. Care continuity interventions have been suggested as a way of reducing postdischarge mortality by better linking care between facilities and communities. This scoping review aims to map and describe interventions used in LMICs to improve care continuity for newborns after discharge and examine assumptions underpinning the design and delivery of continuity. METHODS We searched seven databases (MEDLINE, CINAHL, Scopus, Web of Science, EMBASE, Cochrane library and (Ovid) Global health). Publications with primary data on interventions focused on continuity of care for newborns in LMICs were included. Extracted data included year of publication, study location, study design and type of intervention. Drawing on relevant theoretical frameworks and classifications, we assessed the extent to which interventions adopted participatory methods and how they attempted to establish continuity. RESULTS A total of 65 papers were included in this review; 28 core articles with rich descriptions were prioritised for more in-depth analysis. Most articles adopted quantitative designs. Interventions focused on improving continuity and flow of information via education sessions led by community health workers during home visits. Extending previous frameworks, our findings highlight the importance of interpersonal continuity in LMICs where communication and relationships between family members, healthcare workers and members of the wider community play a vital role in creating support systems for postdischarge care. Only a small proportion of studies focused on high-risk babies. Some studies used participatory methods, although often without meaningful engagement in problem definition and intervention implementation. CONCLUSION Efforts to reduce neonatal mortality and morbidity should draw across multiple continuity logics (informational, relational, interpersonal and managerial) to strengthen care after hospital discharge in LMIC settings and further focus on high-risk neonates, as they often have the worst outcomes.
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Affiliation(s)
- Gulraj Grewal
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Sebastian S Fuller
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Asma Rababeh
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Michuki Maina
- Health Services Unit, KEMRI - Wellcome Trust Research Institute, Nairobi, Kenya
| | - Mike English
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Health Services Unit, KEMRI - Wellcome Trust Research Institute, Nairobi, Kenya
| | - Chris Paton
- Nuffield Department of Medicine, Center for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
- Department of Information Science, University of Otago, Dunedin, New Zealand
| | - Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK
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Ngũnjiri A, Memiah P, Kimathi R, Wagner FA, Ikahu A, Omanga E, Kweyu E, Ngunu C, Otiso L. Utilizing User Preferences in Designing the AGILE (Accelerating Access to Gender-Based Violence Information and Services Leveraging on Technology Enhanced) Chatbot. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7018. [PMID: 37947574 PMCID: PMC10647327 DOI: 10.3390/ijerph20217018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Technology advancements have enhanced artificial intelligence, leading to a user shift towards virtual assistants, but a human-centered approach is needed to assess for acceptability and effectiveness. The AGILE chatbot is designed in Kenya with features to redefine the response towards gender-based violence (GBV) among vulnerable populations, including adolescents, young women and men, and sexual and gender minorities, to offer accurate and reliable information among users. METHODS We conducted an exploratory qualitative study through focus group discussions (FGDs) targeting 150 participants sampled from vulnerable categories; adolescent girls and boys, young women, young men, and sexual and gender minorities. The FGDs included multiple inquiries to assess knowledge and prior interaction with intelligent conversational assistants to inform the user-centric development of a decision-supportive chatbot and a pilot of the chatbot prototype. Each focus group comprised 9-10 members, and the discussions lasted about two hours to gain qualitative user insights and experiences. We used thematic analysis and drew on grounded theory to analyze the data. RESULTS The analysis resulted in 14 salient themes composed of sexual violence, physical violence, emotional violence, intimate partner violence, female genital mutilation, sexual reproductive health, mental health, help-seeking behaviors/where to seek support, who to talk to, and what information they would like, features of the chatbot, access of chatbot, abuse and HIV, family and community conflicts, and information for self-care. CONCLUSION Adopting a human-centered approach in designing an effective chatbot with as many human features as possible is crucial in increasing utilization, addressing the gaps presented by marginalized/vulnerable populations, and reducing the current GBV epidemic by moving prevention and response services closer to people in need.
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Affiliation(s)
- Anne Ngũnjiri
- LVCT Health Kenya, Nairobi P.O. Box 19835-00202, Kenya; (A.N.); (R.K.); (A.I.); (E.O.); (L.O.)
| | - Peter Memiah
- Graduate School, University of Maryland, 620 W. Lexington Street, Baltimore, MD 21201, USA
| | - Robert Kimathi
- LVCT Health Kenya, Nairobi P.O. Box 19835-00202, Kenya; (A.N.); (R.K.); (A.I.); (E.O.); (L.O.)
| | - Fernando A. Wagner
- School of Social Work, University of Maryland, 525 W. Redwood Street, Baltimore, MD 21201, USA;
| | - Annrita Ikahu
- LVCT Health Kenya, Nairobi P.O. Box 19835-00202, Kenya; (A.N.); (R.K.); (A.I.); (E.O.); (L.O.)
| | - Eunice Omanga
- LVCT Health Kenya, Nairobi P.O. Box 19835-00202, Kenya; (A.N.); (R.K.); (A.I.); (E.O.); (L.O.)
| | - Emmanuel Kweyu
- Faculty of Information Technology, Strathmore University, Nairobi P.O. Box 59857-00200, Kenya;
| | - Carol Ngunu
- Department of Health, Nairobi City County, Nairobi P.O. Box 30075-00100, Kenya;
| | - Lilian Otiso
- LVCT Health Kenya, Nairobi P.O. Box 19835-00202, Kenya; (A.N.); (R.K.); (A.I.); (E.O.); (L.O.)
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Otieno P, Agyemang C, Wainaina C, Igonya EK, Ouedraogo R, Wambiya EOA, Osindo J, Asiki G. Perceived health system facilitators and barriers to integrated management of hypertension and type 2 diabetes in Kenya: a qualitative study. BMJ Open 2023; 13:e074274. [PMID: 37567749 PMCID: PMC10423776 DOI: 10.1136/bmjopen-2023-074274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
OBJECTIVE Understanding the facilitators and barriers to managing hypertension and type 2 diabetes (T2D) will inform the design of a contextually appropriate integrated chronic care model in Kenya. We explored the perceived facilitators and barriers to the integrated management of hypertension and T2D in Kenya using the Rainbow Model of Integrated Care. DESIGN This was a qualitative study using data from a larger mixed-methods study on the health system response to chronic disease management in Kenya, conducted between July 2019 and February 2020. Data were collected through 44 key informant interviews (KIIs) and eight focus group discussions (FGDs). SETTING Multistage sampling procedures were used to select a random sample of 12 study counties in Kenya. PARTICIPANTS The participants for the KIIs comprised purposively selected healthcare providers, county health managers, policy experts and representatives from non-state organisations. The participants for the FGDs included patients with hypertension and T2D. OUTCOME MEASURES Patients' and providers' perspectives of the health system facilitators and barriers to the integrated management of hypertension and T2D in Kenya. RESULTS The clinical integration facilitators included patient peer support groups for hypertension and T2D. The major professional integration facilitators included task shifting, continuous medical education and integration of community resource persons. The national referral system, hospital insurance fund and health management information system emerged as the major facilitators for organisational and functional integration. The system integration facilitators included decentralisation of services and multisectoral partnerships. The major barriers comprised vertical healthcare services characterised by service unavailability, unresponsiveness and unaffordability. Others included a shortage of skilled personnel, a lack of interoperable e-health platforms and care integration policy implementation gaps. CONCLUSIONS Our study identified barriers and facilitators that may be harnessed to improve the integrated management of hypertension and T2D. The facilitators should be strengthened, and barriers to care integration redressed.
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Affiliation(s)
- Peter Otieno
- Chronic Disease Management Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development (AIGHD), AHTC, Amsterdam, The Netherlands
| | - Charles Agyemang
- Department of Public & Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Caroline Wainaina
- Department of Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Emmy Kageha Igonya
- Department of Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Ramatou Ouedraogo
- Department of Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | | | - Jane Osindo
- Department of Emerging and Re-emerging Infectious Diseases, African Population and Health Research Center (APHRC), Nairobi, Kenya
| | - Gershim Asiki
- Chronic Disease Management Unit, African Population and Health Research Center (APHRC), Nairobi, Kenya
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Holst C, Tschirhart N, Ngowi B, Noll J, Winkler AS. Utilizing community InfoSpots for health education: perspectives and experiences in Migoli and Izazi, Tanzania. Health Promot Int 2023; 38:daab187. [PMID: 34897433 PMCID: PMC10439510 DOI: 10.1093/heapro/daab187] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Limited access to health education can be a barrier for reaching the Sustainable Development Goals, especially in rural communities in sub-Saharan Africa. We addressed this gap by installing community information spots (InfoSpots) with access to the internet and a locally stored digital health education platform (the platform) in Migoli and Izazi, Tanzania. The objective of this case study was to explore the perspectives and experiences of InfoSpot users and non-users in these communities. We conducted 35 semi-structured interviews with participants living, working or studying in Migoli or Izazi in February 2020 and subsequently analysed the data using content analysis. The 25 InfoSpot users reported variations in use patterns. Users with more education utilized the platform for their own health education and that of others, in addition to internet surfing. High school students also used the platform for practicing English, in addition to health education. Most InfoSpot users found the platform easy to use; however, those with less education received guidance from other users. Non-users reported that they would have used the InfoSpot with the platform if they had been aware of its existence. All participants reported a positive view of the digital health messages, especially animations as a health knowledge transfer tool. In conclusion, different and unintended use of the platform shows that the communities are creative in ways of utilizing the InfoSpots and gaining knowledge. The platform could have been used by more people if it had been promoted better in the communities.
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Affiliation(s)
- Christine Holst
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O box 1130, Blindern, 0318 Oslo, Norway
| | - Naomi Tschirhart
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O box 1130, Blindern, 0318 Oslo, Norway
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Thompson Hall - THN 136, 25 University Private, Ottawa, ON K1N 7K4, Canada
- Oslo Group on Global Health Policy, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O. box 1130, Blindern, 0318 Oslo, Norway
- Department of Family Medicine, Chiang Mai University, 239 Huay Kaew Road, Muang District, 50200 Chiang Mai Thailand, Thailand
| | - Bernard Ngowi
- Muhimbili Medical Research Centre, National Institute for Medical Research (NIMR), 3 Barack Obama Drive, P.O. box 9653, 11101 Dar es Salaam, Tanzania
- University of Dar es Salaam, Mbeya College of Health and Allied Sciences, P.O. box 608, Mbeya, Tanzania
| | - Josef Noll
- Basic Internet Foundation, Gunnar Randers vei 19, 2007 Kjeller, Norway
- Department of Technology Systems, University of Oslo, P.O box 70, 2027 Kjeller, Norway
| | - Andrea Sylvia Winkler
- Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, P.O box 1130, Blindern, 0318 Oslo, Norway
- Center for Global Health, Department of Neurology, Technical University of Munich, Ismaninger Straße 22, 81675 München, Germany
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Broomhead SC, Mars M, Scott RE. A New eHealth Investment Appraisal Framework for Africa: Validation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6426. [PMID: 37510658 PMCID: PMC10378755 DOI: 10.3390/ijerph20146426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023]
Abstract
(1) Background: Decisions to use eHealth are complex and involve addressing a large opportunity cost. Sound choices are essential. Weighing up investment options is challenging in resource-constrained settings where there are frequently insufficient economics data and expertise to conduct adequate appraisals. To address this, a new eHealth Investment Appraisal Framework (eHIAF) for Africa has been designed and developed. The aim of this paper was to validate the new framework to consider whether it is fit for purpose and to refine it as needed. (2) Methods: An online survey of purposively selected eHealth experts was used to conduct a desktop validation of the proposed eHIAF for Africa. The survey covered the framework development process, structure, content, completeness, and utility. Expert opinions were charted, and a reflective and iterative process used to assess the tool and extract recommendations for refinement. (3) Results: Eleven eHealth experts who completed the survey had experience in African countries and elsewhere. The majority agreed with the eHIAF for Africa development approach and output. They provided valuable suggestions for minor refinements and felt that with these amendments, the eHIAF for Africa would be 'fit for purpose'. (4) Conclusions: The eHIAF for Africa is considered appropriate for use by policy- and decision-makers working in resource-constrained settings who face the task of selecting optimal eHealth investments. It has the potential for applicability beyond Africa and the framework should now be tested in African countries.
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Affiliation(s)
- Sean C Broomhead
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- Health Information Systems Program South Africa, Pretoria 0181, South Africa
- African Centre for eHealth Excellence, Cape Town 7130, South Africa
| | - Maurice Mars
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Richard E Scott
- Department of TeleHealth, School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, AB T2N 1N4, Canada
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Wang L, Yan XY, Mei L, Jia ZW, Hao RG, Xu JH, Zhang B. Effect of e-health interventions on HIV prevention: a protocol of systematic review and meta-analysis. Syst Rev 2023; 12:106. [PMID: 37391806 PMCID: PMC10311723 DOI: 10.1186/s13643-023-02274-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 06/18/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Global epidemiological data indicates that despite implementation of multiple interventions and significant financial investment, the HIV/AIDS epidemic remained inadequately controlled as of 2020. E-health presents a novel approach in delivering health information and health care and has gained popularity in HIV prevention worldwide. However, evidence on the effectiveness of e-health interventions on HIV prevention among diverse populations remains inadequate. Our study aims to systematically evaluate the effectiveness of varying e-health interventions on HIV prevention, with the objective of providing data support and guidance for the development of future e-health HIV intervention strategies. METHODS A systematic search of electronic English databases, including MEDLINE through PubMed, Embase, Scopus, and Web of Science, along with three Chinese databases, including National Knowledge Infrastructure (CNKI), Chinese Wanfang Digital Periodicals (WANFANG), and Chinese Science and Technology Periodicals (VIP) database, will be conducted for the period of 1 January 1980 to 31 December 2022. Additionally, gray literature and unpublished trials in trial registers will be searched. Studies aimed at HIV prevention through e-health interventions, with full-text publications available in either English or Chinese, will be included. Study types will be limited to RCT, cluster RCT, and quasi-experiment study. The risk of bias in individual studies will be assessed following the guideline highlighted by the Cochrane Handbook for Systematic Reviews of Interventions. The outcomes will cover cognitive, behavioral, psychological, management, and biological measures of individuals involved in e-health interventions. The quality of evidence will be assessed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Ultimately, a systematic review with meta-analysis will be conducted to compare the effectiveness of e-health interventions among diverse populations. DISCUSSION This systematic review seeks to establish novel insights into the effectiveness of e-health interventions in diverse populations worldwide. It will inform the design and use of e-health interventions to optimize HIV-related strategies. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022295909.
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Affiliation(s)
- Lei Wang
- Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
- School of Public Health, Peking University, Beijing, China
| | - Xiang-Yu Yan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
| | - Lin Mei
- Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Zhong-Wei Jia
- School of Public Health, Peking University, Beijing, China
- Center for Intelligent Public Health, Institute for Artificial Intelligence, Peking University, Beijing, China
- Center for Drug Abuse Control and Prevention, National Institute of Health Data Science, Peking University, Beijing, China
| | - Rui-Gang Hao
- Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Ji-Hong Xu
- Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Bo Zhang
- School of Life Sciences, Hainan University, Haikou, 570228, China.
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10
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Bashingwa JJH, Mohan D, Chamberlain S, Scott K, Ummer O, Godfrey A, Mulder N, Moodley D, LeFevre AE. Can we design the next generation of digital health communication programs by leveraging the power of artificial intelligence to segment target audiences, bolster impact and deliver differentiated services? A machine learning analysis of survey data from rural India. BMJ Open 2023; 13:e063354. [PMID: 36931682 PMCID: PMC10030469 DOI: 10.1136/bmjopen-2022-063354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
OBJECTIVES Direct to beneficiary (D2B) mobile health communication programmes have been used to provide reproductive, maternal, neonatal and child health information to women and their families in a number of countries globally. Programmes to date have provided the same content, at the same frequency, using the same channel to large beneficiary populations. This manuscript presents a proof of concept approach that uses machine learning to segment populations of women with access to phones and their husbands into distinct clusters to support differential digital programme design and delivery. SETTING Data used in this study were drawn from cross-sectional survey conducted in four districts of Madhya Pradesh, India. PARTICIPANTS Study participant included pregnant women with access to a phone (n=5095) and their husbands (n=3842) RESULTS: We used an iterative process involving K-Means clustering and Lasso regression to segment couples into three distinct clusters. Cluster 1 (n=1408) tended to be poorer, less educated men and women, with low levels of digital access and skills. Cluster 2 (n=666) had a mid-level of digital access and skills among men but not women. Cluster 3 (n=1410) had high digital access and skill among men and moderate access and skills among women. Exposure to the D2B programme 'Kilkari' showed the greatest difference in Cluster 2, including an 8% difference in use of reversible modern contraceptives, 7% in child immunisation at 10 weeks, 3% in child immunisation at 9 months and 4% in the timeliness of immunisation at 10 weeks and 9 months. CONCLUSIONS Findings suggest that segmenting populations into distinct clusters for differentiated programme design and delivery may serve to improve reach and impact. TRIAL REGISTRATION NUMBER NCT03576157.
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Affiliation(s)
| | - Diwakar Mohan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Kerry Scott
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Nicola Mulder
- Computational Biology Division, Department of Integrative Biomedical Sciences, IDM, University of Cape Town Faculty of Heath Sciences, Cape Town, South Africa
| | - Deshendran Moodley
- Department of Computer Science, University of Cape Town, Cape Town, South Africa
- Centre for Artificial Intelligence Research, University of Cape Town, Cape Town, South Africa
| | - Amnesty Elizabeth LeFevre
- Division of Public Health Medicine, University of Cape Town, School of Public Health, Cape Town, South Africa
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11
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Xiong S, Lu H, Peoples N, Duman EK, Najarro A, Ni Z, Gong E, Yin R, Ostbye T, Palileo-Villanueva LM, Doma R, Kafle S, Tian M, Yan LL. Digital health interventions for non-communicable disease management in primary health care in low-and middle-income countries. NPJ Digit Med 2023; 6:12. [PMID: 36725977 PMCID: PMC9889958 DOI: 10.1038/s41746-023-00764-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/21/2023] [Indexed: 02/03/2023] Open
Abstract
Current evidence on digital health interventions is disproportionately concerned with high-income countries and hospital settings. This scoping review evaluates the extent of use and effectiveness of digital health interventions for non-communicable disease (NCD) management in primary healthcare settings of low- and middle-income countries (LMICs) and identifies factors influencing digital health interventions' uptake. We use PubMed, Embase, and Web of Science search results from January 2010 to 2021. Of 8866 results, 52 met eligibility criteria (31 reviews, 21 trials). Benchmarked against World Health Organization's digital health classifications, only 14 out of 28 digital health intervention categories are found, suggesting critical under-use and lagging innovation. Digital health interventions' effectiveness vary across outcomes: clinical (mixed), behavioral (positively inclined), and service implementation outcomes (clear effectiveness). We further identify multiple factors influencing digital health intervention uptake, including political commitment, interactivity, user-centered design, and integration with existing systems, which points to future research and practices to invigorate digital health interventions for NCD management in primary health care of LMICs.
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Affiliation(s)
- Shangzhi Xiong
- The George Institute for Global Health, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia.
- Global Health Research Centre, Duke Kunshan University, Kunshan, China.
| | - Hongsheng Lu
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Ege K Duman
- Global Health Research Centre, Duke Kunshan University, Kunshan, China
- School of Anthropology and Museum Ethnography, Oxford University, Oxford, UK
| | - Alberto Najarro
- Global Health Research Centre, Duke Kunshan University, Kunshan, China
- The Yenching Academy of Peking University, Beijing, China
| | - Zhao Ni
- School of Nursing, Yale University, New Haven, CT, USA
| | - Enying Gong
- School of Population Medicine and Public Health, China Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ruoyu Yin
- Department of Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Truls Ostbye
- Global Health Research Centre, Duke Kunshan University, Kunshan, China
| | | | - Rinchen Doma
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Sweta Kafle
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Maoyi Tian
- The George Institute for Global Health, Faulty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Lijing L Yan
- Global Health Research Centre, Duke Kunshan University, Kunshan, China.
- Duke Global Health Institute, Duke University, Durham, NC, USA.
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- The George Institute for Global Health, Beijing, China.
- School of Health Sciences, Wuhan University, Wuhan, China.
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12
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Schuetze L, Srivastava S, Missenye AM, Rwezaula EJ, Stoermer M, De Allegri M. Factors Affecting the Successful Implementation of a Digital Intervention for Health Financing in a Low-Resource Setting at Scale: Semistructured Interview Study With Health Care Workers and Management Staff. J Med Internet Res 2023; 25:e38818. [PMID: 36607708 PMCID: PMC9862332 DOI: 10.2196/38818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 10/01/2022] [Accepted: 10/31/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Digital interventions for health financing, if implemented at scale, have the potential to improve health system performance by reducing transaction costs and improving data-driven decision-making. However, many interventions never reach sustainability, and evidence on success factors for scale is scarce. The Insurance Management Information System (IMIS) is a digital intervention for health financing, designed to manage an insurance scheme and already implemented on a national scale in Tanzania. A previous study found that the IMIS claim function was poorly adopted by health care workers (HCWs), questioning its potential to enable strategic purchasing and succeed at scale. OBJECTIVE This study aimed to understand why the adoption of the IMIS claim function by HCWs remained low in Tanzania and to assess implications for use at scale. METHODS We conducted 21 semistructured interviews with HCWs and management staff in 4 districts where IMIS was first implemented. We sampled respondents by using a maximum variation strategy. We used the framework method for data analysis, applying a combination of inductive and deductive coding to organize codes in a socioecological model. Finally, we related emerging themes to a framework for digital health interventions for scale. RESULTS Respondents appreciated IMIS's intrinsic software characteristics and technical factors and acknowledged IMIS as a valuable tool to simplify claim management. Human factors, extrinsic ecosystem, and health care ecosystem were considered as barriers to widespread adoption. CONCLUSIONS Digital interventions for health financing, such as IMIS, may have the potential for scale if careful consideration is given to the environment in which they are placed. Without a sustainable health financing environment, sufficient infrastructure, and human capacity, they cannot unfold their full potential to improve health financing functions and ultimately contribute to universal health coverage.
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Affiliation(s)
- Leon Schuetze
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
| | - Siddharth Srivastava
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | | | - Manfred Stoermer
- Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
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13
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Paul AM, Lee C, Fesshaye B, Gur-Arie R, Zavala E, Singh P, Karron RA, Limaye RJ. Conceptualizing the COVID-19 Pandemic: Perspectives of Pregnant and Lactating Women, Male Community Members, and Health Workers in Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10784. [PMID: 36078503 PMCID: PMC9518350 DOI: 10.3390/ijerph191710784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 06/15/2023]
Abstract
Pregnant women are at greater risk of adverse outcomes from SARS-CoV-2 infection. There are several factors which can influence the ways in which pregnant women perceive COVID-19 disease and behaviorally respond to the pandemic. This study seeks to understand how three key audiences-pregnant and lactating women (PLW), male community members, and health workers-in Kenya conceptualize COVID-19 to better understand determinants of COVID-19 related behaviors. This study used qualitative methods to conduct 84 in-depth interviews in three counties in Kenya. Data were analyzed using a grounded theory approach. Emerging themes were organized based on common behavioral constructs thought to influence COVID-19 related behaviors and included myths, risk perception, economic implications, stigma, and self-efficacy. Results suggest that risk perception and behavioral attitudes substantially influence the experiences of PLW, male community members, and health workers in Kenya during the COVID-19 pandemic. Public health prevention and communication responses targeting these groups should address potential barriers to preventive health behaviors, such as the spread of misinformation, financial constraints, and fear of social ostracization.
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Affiliation(s)
- Alicia M. Paul
- International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Clarice Lee
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Berhaun Fesshaye
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Rachel Gur-Arie
- Berman Institute of Bioethics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Eleonor Zavala
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Prachi Singh
- International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Ruth A. Karron
- Center for Immunization Research, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Rupali J. Limaye
- International Vaccine Access Center, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Health, Behavior, and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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14
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Mohan D, Bashingwa JJH, Scott K, Arora S, Rahul S, Mulder N, Chamberlain S, LeFevre AE. Optimising the reach of mobile health messaging programmes: an analysis of system generated data for the Kilkari programme across 13 states in India. BMJ Glob Health 2022; 6:bmjgh-2022-009395. [PMID: 35940611 PMCID: PMC9366343 DOI: 10.1136/bmjgh-2022-009395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/12/2022] [Indexed: 11/26/2022] Open
Abstract
Kilkari is an outbound service that makes weekly, stage-based, prerecorded calls about reproductive, maternal, neonatal and child health directly to families’ mobile phones, starting from the second trimester of pregnancy and until the child is 1 year old. Since its initiation in 2012–2013, Kilkari has scaled to 13 states across India. In this analysis article, we explored the subscriber’s journey from entry to programme to engagement with calls. Data sources included call data records and household survey data from the 2015 National Family Health Survey. In 2018, of the 13.6 million records received by MOTECH, the technology platform that powers Kilkari, 9.5 million (~70%) were rejected and 4.1 million new subscribers were created. Overall, 21% of pregnant women across 13 states were covered by the programme in 2018, with West Bengal and Himachal Pradesh reaching a coverage of over 50%. Among new subscriptions in 2018, 63% were subscribed during pregnancy and 37% after childbirth. Of these, over 80% were ever reached by Kilkari calls and 39% retained in the programme. The main causes for deactivation of subscribers from the system were low listenership and calls going unanswered for six continuous weeks. Globally, Kilkari is the largest maternal mobile messaging programme of its kind in terms of number of subscribers but the coverage among pregnant women remains low. While call reach appears to be on the higher side, subscriber retention is low; this highlights broader challenges with providing mobile health services at scale across India.
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Affiliation(s)
- Diwakar Mohan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jean Juste Harrisson Bashingwa
- Medical Research Council/ Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St Andrews Road, Parktown, Johannesburg, 2193, South Africa, Johannesburg, South Africa.,National Institute for Theoretical and Computational Sciences (NITheCS), South Africa, Johannesburg, South Africa.,Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Kerry Scott
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | - Sai Rahul
- Beehyv Software Solutions Limited, Hyderabad, Telangana, India
| | - Nicola Mulder
- Computational Biology Division, Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, South Africa
| | - Sara Chamberlain
- BBC Media Action, Delhi, Delhi NCR, India.,Asia, BBC Media Action, London, UK
| | - Amnesty Elizabeth LeFevre
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.,School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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15
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Stocks J, Ibrahim S, Park L, Huchko M. Mobile Phone Ownership and Use Among Women Screening for Cervical Cancer in a Community-Based Setting in Western Kenya: Observational Study. JMIR Public Health Surveill 2022; 8:e28885. [PMID: 35671089 PMCID: PMC9214615 DOI: 10.2196/28885] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 02/28/2022] [Accepted: 04/01/2022] [Indexed: 12/24/2022] Open
Abstract
Background Mobile phone ownership among women of reproductive age in western Kenya is not well described, and our understanding of its link with care-seeking behaviors is nascent. Understanding access to and use of mobile phones among this population as well as willingness to participate in mobile health interventions are important in improving and more effectively implementing mobile health strategies. Objective This study aims to describe patterns of mobile phone ownership and use among women attending cervical cancer screening and to identify key considerations for the use of SMS text message–guided linkage to treatment strategies and other programmatic implications for cervical cancer screening in Kenya. Methods This analysis was nested within a cluster randomized trial evaluating various strategies for human papillomavirus (HPV)–based cervical cancer screening and prevention in a rural area in western Kenya between February and November 2018. A total of 3299 women were surveyed at the time of screening and treatment. Questionnaires included items detailing demographics, health history, prior care-seeking behaviors, and patterns of mobile phone ownership and use. We used bivariate and multivariable log-binomial regression to analyze associations between independent variables and treatment uptake among women testing positive for high-risk HPV. Results Rates of mobile phone ownership (2351/3299, 71.26%) and reported daily use (2441/3299, 73.99%) were high among women. Most women (1953/3277, 59.59%) were comfortable receiving their screening results via SMS text messages, although the most commonly preferred method of notification was via phone calls. Higher levels of education (risk ratio 1.23, 95% CI 1.02-1.50), missing work to attend screening (risk ratio 1.29, 95% CI 1.10-1.52), and previous cervical cancer screening (risk ratio 1.27, 95% CI 1.05-1.55) were significantly associated with a higher risk of attending treatment after testing high-risk HPV–positive, although the rates of overall treatment uptake remained low (278/551, 50.5%) among this population. Those who shared a mobile phone with their partner or spouse were less likely to attend treatment than those who owned a phone (adjusted risk ratio 0.69, 95% CI 0.46-1.05). Treatment uptake did not vary significantly according to the type of notification method, which were SMS text message, phone call, or home visit. Conclusions Although the rates of mobile phone ownership and use among women in western Kenya are high, we found that individual preferences for communication of messages about HPV results and treatment varied and that treatment rates were low across the entire cohort, with no difference by modality (SMS text message, phone call, or home visit). Therefore, although text-based results performed as well as phone calls and home visits, our findings highlight the need for more work to tailor communication about HPV results and support women as they navigate the follow-up process.
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Affiliation(s)
- Jacob Stocks
- Center for Global Reproductive Health, Duke Global Health Institute, Durham, NC, United States
| | | | - Lawrence Park
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, United States.,Research Design and Analysis Core, Duke Global Health Institute, Durham, NC, United States
| | - Megan Huchko
- Center for Global Reproductive Health, Duke Global Health Institute, Durham, NC, United States.,Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, United States
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16
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Scherrer R, Tschumi N, Lejone TI, Kopo M, Motaboli L, Mothobi B, Amstutz A, Deml MJ, Lerotholi M, Labhardt ND. eHealth supported multi-months dispensing of antiretroviral therapy: a mixed-methods preference assessment in rural Lesotho. Pilot Feasibility Stud 2022; 8:61. [PMID: 35277206 PMCID: PMC8913859 DOI: 10.1186/s40814-022-01019-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/02/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multi-month dispensing (MMD) of antiretroviral therapy (ART) represents one approach of differentiated service delivery (DSD) aiming to improve quality and cost-effectiveness for HIV services in resource-limited settings. However, reduction in clinic visits for people living with HIV (PLWH) should go along with out-of-clinic care tailored to PLWH`s preferences and comorbidities to maintain quality of care. eHealth supported MMD offers a potential solution. METHODS Between October 2019 and January 2020 we assessed preferences on an eHealth supported MMD package among adult PLWH attending routine ART care at a rural clinic in Lesotho using a mixed-methods approach. Participants reported their preferences among different refill and eHealth options. They were invited to test automated text messages (SMS) informing about their viral load results, an automated tuberculosis symptoms screening call and telemedical support by an expert nurse. Telemedical service comprised a call-back option if participants required any additional support and adherence counselling for closer follow-up of participants with unsuppressed viral loads. After 6 weeks, participants were followed-up to assess perception of the chosen eHealth support using a qualitative approach. RESULTS Among 112 participants (median age = 43 years; 74% female), 83/112 (75%) preferred MMD for 6-12 months (median = 9 months, IQR = [5, 12]). Neither sex, age, employment, costs and time for travel to clinic, nor the duration of taking ART correlated with the MMD preference. All 17 participants attending routine viral load measurement wished to receive the result via SMS. Fifteen (19.2%) participants requested a telemedical nurse call-back during the study period. All participants with recent unsuppressed viral load (N = 13) requested telemedical adherence counselling for closer follow-up. Among 78 participants followed-up, 76 (97%) would appreciate having the call-back option in future. Seventy-five participants (67%) received and evaluated the automated symptomatic tuberculosis screening call, overall 71 (95%) appreciated it. CONCLUSIONS The great majority of PLWH in this study preferred 6-12 months MMD and appreciated the additional eHealth support, including viral load results via SMS, telemedical nurse consultations and automated tuberculosis symptom screening calls. eHealth supported MMD packages appear to be a promising approach for DSD models and should be assessed for clinical endpoints and cost-effectiveness in larger studies.
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Affiliation(s)
- Ramona Scherrer
- Clinical Research Unit, Department Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Nadine Tschumi
- Clinical Research Unit, Department Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Mathebe Kopo
- SolidarMed, Swiss Organization for Health in Africa, Butha-Buthe, Lesotho
| | - Lipontso Motaboli
- SolidarMed, Swiss Organization for Health in Africa, Butha-Buthe, Lesotho
| | - Buoang Mothobi
- SolidarMed, Swiss Organization for Health in Africa, Butha-Buthe, Lesotho
| | - Alain Amstutz
- Clinical Research Unit, Department Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Michael J. Deml
- Institute of Sociological Research, Department of Sociology, University of Geneva, Geneva, Switzerland
- Division of Social and Behavioural Sciences, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | | | - Niklaus Daniel Labhardt
- Clinical Research Unit, Department Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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17
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Sowon K, Maliwichi P, Chigona W. The Influence of Design and Implementation Characteristics on the Use of Maternal Mobile Health Interventions in Kenya: Systematic Literature Review. JMIR Mhealth Uhealth 2022; 10:e22093. [PMID: 35084356 PMCID: PMC8832263 DOI: 10.2196/22093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/16/2021] [Accepted: 11/27/2021] [Indexed: 12/03/2022] Open
Abstract
Background The growth of mobile technology in developing countries, coupled with pressing maternal health care challenges, has led to a widespread implementation of maternal mobile health (mHealth) innovations. However, reviews generating insights on how the characteristics of the interventions influence use are scarce. Objective This study aims to review maternal mHealth interventions in Kenya to explore the influence of intervention design and implementation characteristics on use by maternal health clients. We also provide a starting inventory for maternal mHealth interventions in the country. Methods Using a systematic approach, we retrieved a total of 1100 citations from both peer-reviewed and gray sources. Articles were screened on the basis of an inclusion and exclusion criterion, and the results synthesized by categorizing and characterizing the interventions presented in the articles. The first phase of the literature search was conducted between January and April 2019, and the second phase was conducted between April and June 2021. Results A total of 16 articles were retrieved, comprising 13 maternal mHealth interventions. The study highlighted various mHealth design and implementation characteristics that may influence the use of these interventions. Conclusions In addition to elaborating on insights that would be useful in the design and implementation of future interventions, this study contributes to a local inventory of maternal mHealth interventions that may be useful to researchers and implementers in mHealth. This study highlights the need for explanatory studies to elucidate maternal mHealth use, while complementing existing evidence on mHealth effectiveness.
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Affiliation(s)
- Karen Sowon
- University of Cape Town, Department of Information Systems, Cape Town, South Africa
| | - Priscilla Maliwichi
- University of Cape Town, Department of Information Systems, Cape Town, South Africa
- Department of Computer Science and Information Technology, Malawi University of Science and Technology, Limbe, Malawi
| | - Wallace Chigona
- University of Cape Town, Department of Information Systems, Cape Town, South Africa
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18
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Onukwugha FI, Smith L, Kaseje D, Wafula C, Kaseje M, Orton B, Hayter M, Magadi M. The effectiveness and characteristics of mHealth interventions to increase adolescent's use of Sexual and Reproductive Health services in Sub-Saharan Africa: A systematic review. PLoS One 2022; 17:e0261973. [PMID: 35061757 PMCID: PMC8782484 DOI: 10.1371/journal.pone.0261973] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/14/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND mHealth innovations have been proposed as an effective solution to improving adolescent access to and use of Sexual and Reproductive Health (SRH) services; particularly in regions with deeply entrenched traditional social norms. However, research demonstrating the effectiveness and theoretical basis of the interventions is lacking. AIM Our aim was to describe mHealth intervention components, assesses their effectiveness, acceptability, and cost in improving adolescent's uptake of SRH services in Sub-Saharan Africa (SSA). METHODS This paper is based on a systematic review. Twenty bibliographic databases and repositories including MEDLINE, EMBASE, and CINAHL, were searched using pre-defined search terms. Of the 10, 990 records screened, only 10 studies met the inclusion criteria. The mERA checklist was used to critically assess the transparency and completeness in reporting of mHealth intervention studies. The behaviour change components of mHealth interventions were coded using the taxonomy of Behaviour Change Techniques (BCTs). The protocol was registered in the 'International Prospective Register for Systematic Reviews' (PROSPERO-CRD42020179051). RESULTS The results showed that mHealth interventions were effective and improved adolescent's uptake of SRH services across a wide range of services. The evidence was strongest for contraceptive use. Interventions with two-way interactive functions and more behaviour change techniques embedded in the interventions improved adolescent uptake of SRH services to greater extent. Findings suggest that mHealth interventions promoting prevention or treatment adherence for HIV for individuals at risk of or living with HIV are acceptable to adolescents, and are feasible to deliver in SSA. Limited data from two studies reported interventions were inexpensive, however, none of the studies evaluated cost-effectiveness. CONCLUSION There is a need to develop mHealth interventions tailored for adolescents which are theoretically informed and incorporate effective behaviour change techniques. Such interventions, if low cost, have the potential to be a cost-effective means to improve the sexual and reproductive health outcomes in SSA.
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Affiliation(s)
- Franklin I. Onukwugha
- Institute for Clinical and Applied Health Research (ICAHR), Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Lesley Smith
- Institute for Clinical and Applied Health Research (ICAHR), Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Dan Kaseje
- Tropical Institute of Community Health and Development (TICH), Kisumu, Kenya
| | - Charles Wafula
- Tropical Institute of Community Health and Development (TICH), Kisumu, Kenya
| | - Margaret Kaseje
- Tropical Institute of Community Health and Development (TICH), Kisumu, Kenya
| | - Bev Orton
- Faculty of Arts, Culture and Education, University of Hull, Hull, United Kingdom
| | - Mark Hayter
- Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Monica Magadi
- Faculty of Arts, Culture and Education, University of Hull, Hull, United Kingdom
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Kumar M, Macharia P, Nyongesa V, Kathono J, Yator O, Mwaniga S, McKay M, Huang KY, Shidhaye R, Njuguna S, Saxena S. Human-centered design exploration with Kenyan health workers on proposed digital mental health screening and intervention training development: Thematic analysis of user preferences and needs. Digit Health 2022; 8:20552076221090035. [PMID: 35444811 PMCID: PMC9014722 DOI: 10.1177/20552076221090035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 03/09/2022] [Indexed: 12/05/2022] Open
Abstract
Background Health providers' perceived sense of knowledge, competency, and self-efficacy to support the needs of their patients contributes to optimal patient health outcomes. With regards to mental health service delivery in Kenya, this area needs further exploration. Guided by the e-health technology acceptance mode, the needs and preferences of health care providers around mental health training for clinical management and their ability to intervene in peripartum adolescent mental health care are explored. We probed how well-equipped service providers are, their engagement with technology to learn and offer services. The health care provider's technology use preferences were also explored. Method Guided by a human-centered design-focused qualitative inquiry we interviewed 20 specialists around their needs, perspectives, and preferences for digitized mental health screening and intervention. Mean age was 44.2 years, (range of 32–58 years), 25% (5) males and 75% (15) females. After a written consenting process, the online interviews (30−45 min) were conducted in April 2021, once personal information was de-identified interviews were transcribed and coded. Thematic analysis was used and we combined rapid appraisal of Google Jamboard online storyboards to do individual human-centered design personas alongside. Results Our participants were well-exposed to digital technologies. Prohibitive costs of data bundles, lack of funds for consistent online engagement, high workload, and instability of access to appropriate gadgets were found to be barriers to e-health training. Emerging opportunities were well-identified adolescent mental health service and intervention needs, willingness to take online courses offered on learning platforms, and wish for these to be disseminated through diverse social media. Other recommendations were the need to have a user-friendly interface such as data-light engaging and practical materials including animations, short, group-based learning. Conclusion Understanding contextual factors that influence perceived usefulness and ease of use of the remote/digital components would be critical for e-training development and its uptake.
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Affiliation(s)
- Manasi Kumar
- Brain and Mind Institute, Aga Khan University, Kenya
- Department of Psychiatry, University of Nairobi, Kenya
| | | | | | | | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Kenya
| | | | - Mary McKay
- Washington University at St Louis, St Louis, MO, USA
| | - Keng Yen Huang
- NYU Grossman School of Medicine, New York University, NY, USA
| | - Rahul Shidhaye
- Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | - Simon Njuguna
- Ministry of Health, Government of Kenya, Nairobi, Kenya
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Duong H, Dao S, Dang H, Nguyen L, Ngo T, Nguyen T, Tran LA, Nguyen D, Rivera M, Nguyen N. The Transition to an Entirely Digital Immunization Registry in Ha Noi Province and Son La Province, Vietnam: Readiness Assessment Study. JMIR Form Res 2021; 5:e28096. [PMID: 34694232 PMCID: PMC8576599 DOI: 10.2196/28096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 07/01/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022] Open
Abstract
Background Vietnam is one of the first low- to middle-income countries to develop and implement a national-scale electronic immunization registry. This system was finalized into the National Immunization Information System (NIIS) and scaled up to a national-level system in 2017. As a result, immunization coverage and the timeliness of vaccinations have drastically improved. The time spent on planning and reporting vaccinations has drastically reduced; as a result, vaccination planning and reporting has become more accurate and effective. However, to date, end users have been tasked with managing both the NIIS and paper-based systems in parallel until a formal assessment of the readiness to fully transition to the NIIS is conducted. Objective This study aims to evaluate the readiness to move to an entirely digital NIIS in 2 provinces of Vietnam—Ha Noi and Son La. Methods All health facilities were surveyed to assess their infrastructure, capacity, and need for human resources. NIIS end users were observed and interviewed to evaluate their NIIS knowledge and skill sets. Data from immunization cards and facility paper-based logbooks were compared with data from the NIIS, and vaccine stocks at selected facilities were tallied and compared with data from the NIIS. Results Of the 990 health facilities evaluated, most used the NIIS to enter and track immunizations (987/990, 99.7%) and vaccine stocks (889/990, 90.8%). Most had stable electricity (971/990, 98.1%), at least 1 computer (986/990, 99.6%), and ≥2 trained NIIS end users (825/990, 83.3%). End users reported that the NIIS supported them in managing and reporting immunization data and saving them time (725/767, 94.5%). Although many end users were able to perform basic skills, almost half struggled with performing more complex tasks. Immunization data were compiled from the NIIS and immunization cards (338/378, 89.4%) and paper-based logbooks (254/269, 94.4%). However, only 54.5% (206/378) of immunization IDs matched, 57% (13/23) of Bacillus Calmette-Guérin vaccination records were accurate, and 70% (21/30) of the facilities had consistent physical vaccine stock balances. The feedback received from NIIS end users suggests that more supportive supervision, frequent refresher training for strengthening their skill sets, and detailed standardized guides for improving data quality are needed. Conclusions The readiness to transition to a digital system is promising; however, additional resources are required to address the timeliness, completeness, and accuracy of the data.
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Affiliation(s)
- Hong Duong
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | - Huyen Dang
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | | | | | - Trung Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Lan Anh Tran
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
| | - Doan Nguyen
- National Institute of Hygiene and Epidemiology, Hanoi, Vietnam
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21
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Atujuna M, Simpson N, Ngobeni M, Monese T, Giovenco D, Pike C, Figerova Z, Visser M, Biriotti M, Kydd A, Bekker LG. Khuluma: Using Participatory, Peer-Led and Digital Methods to Deliver Psychosocial Support to Young People Living With HIV in South Africa. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:687677. [PMID: 36304024 PMCID: PMC9580650 DOI: 10.3389/frph.2021.687677] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/11/2021] [Indexed: 11/13/2022] Open
Abstract
Khuluma is a psychosocial and peer-to-peer mHealth intervention that uses text messaging to facilitate support groups for adolescents living with HIV (ALWH) with the aim of contributing toward positive health outcomes. Although use of mobile technology in the form of mHealth interventions has proliferated recently in the field of health, published literature describing methods and processes of its application are limited. We present a set of methods and processes utilised to develop and pilot the Khuluma mHealth intervention amongst young people (15–20 years) in South Africa. We recruited and enrolled 52 adolescents (15–20-year olds) from four clinics in Pretoria and Cape Town to participate in a 6-month pilot of Khuluma. Participants were ALWH, aware of their status, on antiretroviral therapy for more than 12 months, and not suffering from severe depression. We conducted four pre and post intervention focus group discussions (FGDs) with a proportion of ALWH (n = 36) enrolled in the pilot study using participatory methods. Several processes were utilised to then implement this pilot study. These included engaging ALWH for minor study implementation modifications; forming virtual groups; activating the mHealth platform; facilitating and delivering the Khuluma intervention. The acceptability of the intervention was informed by follow-up focus group discussions and text message data. The initial participatory processes helped to tailor the intervention design to participants' needs. The peer-led facilitation of the groups allowed for the provision of sensitive psychosocial support that allowed young people to express themselves freely, develop a sense of self-worth, and interact more. The nature of the mobile technology also allowed participants to build friendships beyond their geographic area and interact with their peers in real time. Within the evolving context of COVID-19, establishing evidence-based processes and methods for intervention design and curation in virtual spaces is critical.
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Affiliation(s)
- Millicent Atujuna
- Desmond Tutu HIV Centre, Cape Town, South Africa
- *Correspondence: Millicent Atujuna
| | - Nikita Simpson
- SHM Foundation, London, United Kingdom
- Department of Anthropology, London School of Economics and Political Science, London, United Kingdom
| | | | | | - Danielle Giovenco
- Desmond Tutu HIV Centre, Cape Town, South Africa
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carey Pike
- Desmond Tutu HIV Centre, Cape Town, South Africa
| | | | - Maretha Visser
- Department of Psychology, University of Pretoria, Pretoria, South Africa
| | | | - Anna Kydd
- SHM Foundation, London, United Kingdom
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22
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Nyangena J, Rajgopal R, Ombech EA, Oloo E, Luchetu H, Wambugu S, Kamau O, Nzioka C, Gwer S, Ndiritu Ndirangu M. Maturity assessment of Kenya's health information system interoperability readiness. BMJ Health Care Inform 2021; 28:bmjhci-2020-100241. [PMID: 34210718 PMCID: PMC8252685 DOI: 10.1136/bmjhci-2020-100241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 02/02/2021] [Accepted: 02/06/2021] [Indexed: 11/07/2022] Open
Abstract
Background The use of digital technology in healthcare promises to improve quality of care and reduce costs over time. This promise will be difficult to attain without interoperability: facilitating seamless health information exchange between the deployed digital health information systems (HIS). Objective To determine the maturity readiness of the interoperability capacity of Kenya’s HIS. Methods We used the HIS Interoperability Maturity Toolkit, developed by MEASURE Evaluation and the Health Data Collaborative’s Digital Health and Interoperability Working Group. The assessment was undertaken by eHealth stakeholder representatives primarily from the Ministry of Health’s Digital Health Technical Working Group. The toolkit focused on three major domains: leadership and governance, human resources and technology. Results Most domains are at the lowest two levels of maturity: nascent or emerging. At the nascent level, HIS activities happen by chance or represent isolated, ad hoc efforts. An emerging maturity level characterises a system with defined HIS processes and structures. However, such processes are not systematically documented and lack ongoing monitoring mechanisms. Conclusion None of the domains had a maturity level greater than level 2 (emerging). The subdomains of governance structures for HIS, defined national enterprise architecture for HIS, defined technical standards for data exchange, nationwide communication network infrastructure, and capacity for operations and maintenance of hardware attained higher maturity levels. These findings are similar to those from interoperability maturity assessments done in Ghana and Uganda.
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Affiliation(s)
- Job Nyangena
- Research and Evidence Department, Afya Research Africa, Nairobi, Kenya.,Institute of Biomedical Informatics, Moi University, Eldoret, Kenya
| | - Rohini Rajgopal
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Enock Oloo
- Research and Evidence Department, Afya Research Africa, Nairobi, Kenya
| | - Humphrey Luchetu
- Research and Evidence Department, Afya Research Africa, Nairobi, Kenya
| | | | | | | | - Samson Gwer
- Research and Evidence Department, Afya Research Africa, Nairobi, Kenya.,School of Medicine, Kenyatta University, Nairobi, Kenya
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23
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Mohan D, Scott K, Shah N, Bashingwa JJH, Chakraborty A, Ummer O, Godfrey A, Dutt P, Chamberlain S, LeFevre AE. Can health information through mobile phones close the divide in health behaviours among the marginalised? An equity analysis of Kilkari in Madhya Pradesh, India. BMJ Glob Health 2021; 6:e005512. [PMID: 34312154 PMCID: PMC8327823 DOI: 10.1136/bmjgh-2021-005512] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/17/2021] [Accepted: 04/19/2021] [Indexed: 12/31/2022] Open
Abstract
Kilkari is one of the largest maternal mobile messaging programmes in the world. It makes weekly prerecorded calls to new and expectant mothers and their families from the fourth month of pregnancy until 1-year post partum. The programme delivers reproductive, maternal, neonatal and child health information directly to subscribers' phones. However, little is known about the reach of Kilkari among different subgroups in the population, or the differentiated benefits of the programme among these subgroups. In this analysis, we assess differentials in eligibility, enrolment, reach, exposure and impact across well-known proxies of socioeconomic position-that is, education, caste and wealth. Data are drawn from a randomised controlled trial (RCT) in Madhya Pradesh, India, including call data records from Kilkari subscribers in the RCT intervention arm, and the National Family Health Survey-4, 2015. The analysis identifies that disparities in household phone ownership and women's access to phones create inequities in the population eligible to receive Kilkari, and that among enrolled Kilkari subscribers, marginalised caste groups and those without education are under-represented. An analysis of who is left behind by such interventions and how to reach those groups through alternative communication channels and platforms should be undertaken at the intervention design phase to set reasonable expectations of impact. Results suggest that exposure to Kilkari has improved levels of some health behaviours across marginalised groups but has not completely closed pre-existing gaps in indicators such as wealth and education.
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Affiliation(s)
- Diwakar Mohan
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kerry Scott
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neha Shah
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jean Juste Harrisson Bashingwa
- Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine (IDM), Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | | | - Osama Ummer
- Oxford Policy Management, New Delhi, Delhi, India
| | - Anna Godfrey
- Research and Policy, BBC Action Media, London, UK
| | | | | | - Amnesty Elizabeth LeFevre
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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24
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Manglani M, Gabhale Y, Lala MM, Balakrishnan S, Bhuyan K, Rewari BB, Setia MS. Assessing the Effectiveness of a Telemedicine Initiative in Clinical Management of Children Living with HIV/AIDS in Maharashtra, India. Curr HIV Res 2021; 19:201-215. [PMID: 33397239 DOI: 10.2174/1573399817666210104102825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/26/2020] [Accepted: 11/26/2020] [Indexed: 11/22/2022]
Abstract
AIMS To evaluate the effectiveness of telemedicine in the clinical management of children living with HIV/AIDS in resource-limited settings ; Background: Telemedicine is an important mechanism for service delivery in health care settings, both in resource-rich and resource-poor settings. Such service delivery mechanisms have shown to be associated with virologic suppression and higher CD4 counts. These services are also associated with improved access, shorter visiting times, and higher patient satisfaction. ; Objective: We designed the present two-group comparison study to compare the clinical evaluation and management of children in the anti-retroviral therapy (ART) centres linked to telemedicine facility with those who are not linked to this facility in Maharashtra, India. ; Methods: We analysed clinical records from six ART centres in Maharashtra; of these, 250 children were in the linked ART centres and 301 were in the non-linked ART centres. The outcomes were classified according to investigations, management, and monitoring. For management, we evaluated: 1) Initiation of cotrimoxazole prophylaxis; 2) Children not initiated on ART when required; 3) ART regime after appropriate investigations; and 4) Change of regime (if immunologically indicated). For monitoring, we assessed the haematological monitoring of children on ART. ; Results: The mean (SD) ages of children in linked and non-linked ART centres were 10.8 (4.6) and 10.9 (4.6) years, respectively (p=0.80). After adjusting for individual and structural level variables, physical examination (OR: 2.0, 95% CI; 1.2, 3.2), screening for tuberculosis (OR: 12.9, 95% CI: 2.0, 82.9) and cotrimoxazole prophylaxis were significantly more likely in the linked centres compared with non-linked centres (OR: 1.8, 95% CI: 1.4, 2.2). A higher proportion of children eligible for ART were not initiated on treatment in the non-linked centres compared with linked centres (26% vs. 8%, p=0.06). Children were less likely to be initiated on zidovudine-based regimens without baseline haemoglobin or with baseline haemoglobin of less than 9 gm% in linked centres (OR: 0.7, 95% CI: 0.6, 0.8). Similarly, children in the linked centres were less likely to have been started on nevirapine-based regimens without baseline liver enzymes (OR: 0.8, 95% CI: 0.7, 0.9). ; Conclusion: Thus, the overall clinical management of Children Living with HIV/ AIDS (CLHA) was better in ART centres linked with the telemedicine initiative compared with those who were not linked. Children in the linked ART centres were more likely to have a complete baseline assessment (physical, hematological, radiological, and screening for TB); the presence of a pediatrician in the centres was helpful.
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Affiliation(s)
- Mamta Manglani
- Pediatric Centre of Excellence for HIV, Department of Pediatrics, LTM Medical College and General Hospital, Mumbai, India
| | - Yashwant Gabhale
- Pediatric Centre of Excellence for HIV, Department of Pediatrics, LTM Medical College and General Hospital, Mumbai, India
| | - Mamatha Murad Lala
- Pediatric Centre of Excellence for HIV, Department of Pediatrics, LTM Medical College and General Hospital, Mumbai, India
| | | | - Khanindra Bhuyan
- UNICEF, Near 73, Lodhi Gardens, Lodhi Estate, New Delhi, 110003, India
| | - Bharat Bhushan Rewari
- WHO Regional Office of South East Asea, World Health House, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India
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Freytsis M, Barclay I, Radha SK, Czajka A, Siwo GH, Taylor I, Bucher S. Development of a Mobile, Self-Sovereign Identity Approach for Facility Birth Registration in Kenya. FRONTIERS IN BLOCKCHAIN 2021. [DOI: 10.3389/fbloc.2021.631341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Birth registration is a critical element of newborn care. Increasing the coverage of birth registration is an essential part of the strategy to improve newborn survival globally, and is central to achieving greater health, social, and economic equity as defined under the United Nations Sustainable Development Goals. Parts of Eastern and Southern Africa have some of the lowest birth registration rates in the world. Mobile technologies have been used successfully with mothers and health workers in Africa to increase coverage of essential newborn care, including birth registration. However, mounting concerns about data ownership and data protection in the digital age are driving the search for scalable, user-centered, privacy protecting identity solutions. There is increasing interest in understanding if a self-sovereign identity (SSI) approach can help lower the barriers to birth registration by empowering families with a smartphone based process while providing high levels of data privacy and security in populations where birth registration rates are low. The process of birth registration and the barriers experienced by stakeholders are highly contextual. There is currently a gap in the literature with regard to modeling birth registration using SSI technology. This paper describes the development of a smartphone-based prototype system that allows interaction between families and health workers to carry out the initial steps of birth registration and linkage of mothers-baby pairs in an urban Kenyan setting using verifiable credentials, decentralized identifiers, and the emerging standards for their implementation in identity systems. The goal of the project was to develop a high fidelity prototype that could be used to obtain end-user feedback related to the feasibility and acceptability of an SSI approach in a particular Kenyan healthcare context. This paper will focus on how this technology was adapted for the specific context and implications for future research.
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Mwaisaka J, Gonsalves L, Thiongo M, Waithaka M, Sidha H, Alfred O, Mukiira C, Gichangi P. Young People's Experiences Using an On-Demand Mobile Health Sexual and Reproductive Health Text Message Intervention in Kenya: Qualitative Study. JMIR Mhealth Uhealth 2021; 9:e19109. [PMID: 33448930 PMCID: PMC7846443 DOI: 10.2196/19109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 08/20/2020] [Accepted: 09/14/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Digital health usability assessments can help explain how well mobile health (mHealth) apps targeting young people with sexual and reproductive health (SRH) information performed and whether the intended purpose was achieved. However, few digital health assessments have been conducted to evaluate young people's perceptions regarding mHealth system interactions and content relevance on a wide range of SRH topics. In addition, the majority of randomized controlled trials (RCTs) have focused on push messaging platforms; therefore, the mHealth field lacks sufficient RCTs investigating on-demand mHealth SRH platforms. OBJECTIVE The objective of this study was to explore young people's experiences using an on-demand SRH mHealth platform in Kenya. METHODS We used qualitative data related to the usability of an mHealth platform, Adolescent/Youth Reproductive Mobile Access and Delivery Initiatives for Love and Life Outcome (ARMADILLO), collected at the end of the intervention period. A total of 30 in-depth interviews (IDIs) were held with the intervention participants (15 women and 15 men) to elicit their experiences, opinions, and perspectives on the design and content of the ARMADILLO platform. The study participants were randomly selected from a list of intervention arm participants to participate in the IDIs. The interviews were later transcribed verbatim, translated into English, and coded and analyzed thematically using NVivo version 12 software (QSR International). RESULTS Respondents reported varied user experiences and levels of satisfaction, ranging from ease of use by the majority of the respondents to systematic frustrations that prevented some participants from progressing to other stages. Interesting features of the mHealth platform included the immediate response participants received when requesting messages, weekly remunerated quizzes, and perceived ability of educative and informative content and messages to change behaviors. Proposed enhancements to the platform included revising some concepts and words for easy understanding and increasing the interactivity of the platform, whereby young people could seek clarity when they came across difficult terms or had additional questions about the information they received. CONCLUSIONS The importance of understanding the range of health literacy and technological variations when dealing with young people cannot be overemphasized. Young people, as mHealth end users, must be considered throughout intervention development to achieve optimum functionality. In addition, young people targeted with mHealth SRH interventions must be sensitized to the interactions on mHealth platforms or any other digital health apps if implemented in a nonresearch setting for optimal use by the targeted audience.
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Affiliation(s)
- Jefferson Mwaisaka
- International Centre for Reproductive Health, Kenya, Mombasa, Kenya.,Department of Population Family and Reproductive Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Lianne Gonsalves
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Mary Thiongo
- International Centre for Reproductive Health, Kenya, Mombasa, Kenya
| | - Michael Waithaka
- International Centre for Reproductive Health, Kenya, Mombasa, Kenya
| | - Hellen Sidha
- National Council for Populations and Development, Kenya, Nairobi, Kenya
| | - Otieno Alfred
- Population Studies and Research Institute, University of Nairobi, Nairobi, Kenya
| | - Carol Mukiira
- African Institute for Development Policy, Nairobi, Kenya
| | - Peter Gichangi
- International Centre for Reproductive Health, Kenya, Mombasa, Kenya.,Ghent University, Ghent, Belgium.,Technical University of Mombasa, Mombasa, Kenya
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Broomhead SC, Mars M, Scott RE, Jones T. EHealth Investment Appraisal in Africa: A Scoping Review. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211059999. [PMID: 34905975 PMCID: PMC8679012 DOI: 10.1177/00469580211059999] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
eHealth is an opportunity cost, competing for limited available funds with other
health priorities such as clinics, vaccinations, medicines and even salaries. As
such, it should be appraised for probable impact prior to allocation of funds.
This is especially pertinent as recognition grows for the role of eHealth in
attaining Universal Health Coverage. Despite optimism about eHealth’s potential
role, in Africa there remain insufficient data and skills for adequate economic
appraisals to select optimal investments from numerous competing initiatives.
The aim of this review is to identify eHealth investment appraisal approaches
and tools that have been used in African countries, describe their
characteristics and make recommendations regarding African eHealth investment
appraisal in the face of limited data and expertise. Methods: Literature on
eHealth investment appraisals conducted in African countries and published
between January 1, 2010 and June 30, 2020 was reviewed. Selected papers’
investment appraisal characteristics were assessed using the Joanna Briggs
Institute checklist for economic evaluations and a newly developed Five-Case
Model for Digital Health (FCM-DH) checklist for investment appraisal. 5 papers
met inclusion criteria. Their assessments revealed important appraisal gaps. In
particular, none of the papers addressed risk exposure, affordability,
adjustment for optimism bias, clear delivery milestones, practical plans for
implementation, change management or procurement, and only 1 paper described
plans for building partnerships. Discussion: Using this insight, an extended
5-Case Model is proposed as the foundation of an African eHealth investment
appraisal framework. This, combined with building local eHealth appraisal
capabilities, may promote optimal eHealth investment decisions, strengthen
implementations and improve the number and quality of related publications.
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Affiliation(s)
- Sean C Broomhead
- Department of TeleHealth, College of Health Sciences, 72753University of KwaZulu-Natal, Durban, South Africa.,72753Health Information Systems Program South Africa, Pretoria, South Africa.,72753African Centre for EHealth Excellence, Cape Town, South Africa
| | - Maurice Mars
- Department of TeleHealth, College of Health Sciences, 72753University of KwaZulu-Natal, Durban, South Africa.,College of Nursing and Health Sciences, 72753Flinders University, Adelaide, South Australia
| | - Richard E Scott
- Department of TeleHealth, College of Health Sciences, 72753University of KwaZulu-Natal, Durban, South Africa.,Department of Community Health Sciences, Cumming School of Medicine, 72753University of Calgary, Calgary, Canada
| | - Tom Jones
- 72753African Centre for EHealth Excellence, Cape Town, South Africa
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Bruce C, Harrison P, Giammattei C, Desai SN, Sol JR, Jones S, Schwartz R. Evaluating Patient-Centered Mobile Health Technologies: Definitions, Methodologies, and Outcomes. JMIR Mhealth Uhealth 2020; 8:e17577. [PMID: 33174846 PMCID: PMC7688390 DOI: 10.2196/17577] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/11/2020] [Accepted: 10/23/2020] [Indexed: 01/20/2023] Open
Abstract
Several recently published studies and consensus statements have demonstrated that there is only modest (and in many cases, low-quality) evidence that mobile health (mHealth) can improve patient clinical outcomes such as the length of stay or reduction of readmissions. There is also uncertainty as to whether mHealth can improve patient-centered outcomes such as patient engagement or patient satisfaction. One principal challenge behind the “effectiveness” research in this field is a lack of common understanding about what it means to be effective in the digital space (ie, what should constitute a relevant outcome and how best to measure it). In this viewpoint, we call for interdisciplinary, conceptual clarity on the definitions, methodologies, and patient-centered outcomes frequently used in mHealth research. To formulate our recommendations, we used a snowballing approach to identify relevant definitions, outcomes, and methodologies related to mHealth. To begin, we drew heavily upon previously published detailed frameworks that enumerate definitions and measurements of engagement. We built upon these frameworks by extracting other relevant measures of patient-centered care, such as patient satisfaction, patient experience, and patient activation. We describe several definitional inconsistencies for key constructs in the mHealth literature. In an effort to achieve clarity, we tease apart several patient-centered care outcomes, and outline methodologies appropriate to measure each of these patient-care outcomes. By creating a common pathway linking definitions with outcomes and methodologies, we provide a possible interdisciplinary approach to evaluating mHealth technologies. With the broader goal of creating an interdisciplinary approach, we also provide several recommendations that we believe can advance mHealth research and implementation.
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Affiliation(s)
- Courtenay Bruce
- System Quality & Patient Safety, Houston Methodist System, Houston, TX, United States
| | - Patricia Harrison
- System Quality & Patient Safety, Houston Methodist System, Houston, TX, United States
| | | | - Shetal-Nicholas Desai
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States.,Information Technology Division, Houston Methodist Hospital, Houston, TX, United States
| | - Joshua R Sol
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States.,Information Technology Division, Houston Methodist Hospital, Houston, TX, United States
| | - Stephen Jones
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, TX, United States.,Department of Surgery, Houston Methodist Hospital, Houston, TX, United States
| | - Roberta Schwartz
- Center for Innovation, Houston Methodist Hospital, Houston, TX, United States
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Chirambo GB, Muula AS, Thompson M, Hardy VE, Heavin C, Connor YO, Mastellos N, Andersson B, Donoghue JO. End-user perspectives of two mHealth decision support tools: Electronic Community Case Management in Northern Malawi. Int J Med Inform 2020; 145:104323. [PMID: 33232917 DOI: 10.1016/j.ijmedinf.2020.104323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/17/2020] [Accepted: 10/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The introduction of a paper-based Community Case Management (CCM) in Malawi has contributed to a reduction of child morbidity and mortality rates. In addition, the introduction of electronic Community Case Management (eCCM) (smartphones with built in CCM apps) may help to reduce the under-five mortality rates even further. PURPOSE It is not uncommon for Apps with a similar area of interest to develop different features to assist the end users. Such differences between Apps may have a significant role to play in its overall adoption and integration. The purpose of this research was to explore end users perspectives of two eCCM decision support tools developed and implemented by the Supporting LIFE project (SL eCCM App) and D-Tree International's (Mangologic eCCM App)in Northern Malawi. METHODS A mixed methods approach was applied, involving a survey of 109 users (106 Health Surveillance Assistants (HSAs), and 3 Integrated Management of Childhood Il6lnesses (IMCI) coordinators). This was followed up with semi-structured interviews with 34 respondents (31 HSAs, and 3 IMCI coordinators). Quantitative data was analyzed using SPSS version 20 where descriptive statistics and Chi-Squared tests were generated. Qualitative data were analyzed based on thematic analysis. RESULTS Participants reported that both Apps could assist the HSAs in the management of childhood illnesses. However, usability differed between the two apps where the Supporting LIFE eCCM App was found to be easier to use (61%) compared to the Mangologic eCCM App (4%). Both Apps were perceived to provide credible and accurate information. CONCLUSION It is essential that the quality of the data within Mobile Health (mHealth) Apps is high, however even Apps with excellent levels of data quality may not succeed if the overall usability of the App is low. Therefore it is essential that the Apps has high levels of data quality, usability and credibility. The results of this study will help inform mobile Health (mHealth) App designers in developing future eCCM Apps as well as researchers and policy makers when considering the adoption of mHealth solutions in the future in Malawi and other LMICs.
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Affiliation(s)
- Griphin Baxter Chirambo
- Faculty of Health Sciences, Mzuzu University, Private Bag 201, Luwinga, Mzuzu, Malawi; School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi.
| | - Adamson S Muula
- School of Public Health and Family Medicine, University of Malawi, College of Medicine, Blantyre, Malawi; Africa Centre of Excellence in Public Health and Herbal Medicine, University of Malawi, College of Medicine, Malawi
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Victoria E Hardy
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Ciara Heavin
- Health Information Systems Research Centre, University College Cork, Cork, Ireland
| | - Yvonne O' Connor
- Health Information Systems Research Centre, University College Cork, Cork, Ireland
| | - Nikolaos Mastellos
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Bo Andersson
- Department of Informatics, Lund University, Lund, Sweden
| | - John O' Donoghue
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK; Assert Research Centre, University College Cork, Ireland; Malawi eHealth Research Centre, University College Cork, Ireland
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Bhaskar S, Bradley S, Chattu VK, Adisesh A, Nurtazina A, Kyrykbayeva S, Sakhamuri S, Yaya S, Sunil T, Thomas P, Mucci V, Moguilner S, Israel-Korn S, Alacapa J, Mishra A, Pandya S, Schroeder S, Atreja A, Banach M, Ray D. Telemedicine Across the Globe-Position Paper From the COVID-19 Pandemic Health System Resilience PROGRAM (REPROGRAM) International Consortium (Part 1). Front Public Health 2020; 8:556720. [PMID: 33178656 PMCID: PMC7596287 DOI: 10.3389/fpubh.2020.556720] [Citation(s) in RCA: 125] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/21/2020] [Indexed: 01/03/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has accelerated the adoption of telemedicine globally. The current consortium critically examines the telemedicine frameworks, identifies gaps in its implementation and investigates the changes in telemedicine framework/s during COVID-19 across the globe. Streamlining of global public health preparedness framework that is interoperable and allow for collaboration and sharing of resources, in which telemedicine is an integral part of the public health response during outbreaks such as COVID-19, should be pursued. With adequate reinforcement, telemedicine has the potential to act as the "safety-net" of our public health response to an outbreak. Our focus on telemedicine must shift to the developing and under-developing nations, which carry a disproportionate burden of vulnerable communities who are at risk due to COVID-19.
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Affiliation(s)
- Sonu Bhaskar
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Department of Neurology, Liverpool Hospital and South Western Sydney Local Health District, Sydney, NSW, Australia
- Neurovascular Imaging Laboratory & NSW Brain Clot Bank, Ingham Institute for Applied Medical Research, The University of New South Wales, UNSW Medicine, Sydney, NSW, Australia
| | - Sian Bradley
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- The University of New South Wales (UNSW) Medicine Sydney, South West Sydney Clinical School, Sydney, NSW, Australia
| | - Vijay Kumar Chattu
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Anil Adisesh
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Department of Medicine, University of Toronto, St. Michael's Hospital, Toronto, ON, Canada
| | - Alma Nurtazina
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Saltanat Kyrykbayeva
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Department of Epidemiology and Biostatistics, Semey Medical University, Semey, Kazakhstan
| | - Sateesh Sakhamuri
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sanni Yaya
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- School of International Development and Global Studies, University of Ottawa, Ottawa, ON, Canada
| | - Thankam Sunil
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Department of Public Health, University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Pravin Thomas
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Viviana Mucci
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- School of Science, Western Sydney University, Sydney, NSW, Australia
| | - Sebastian Moguilner
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Simon Israel-Korn
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Movement Disorders Institute, Department of Neurology, Sheba Medical Center, Tel Hashomer, Ramat Gan & Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jason Alacapa
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- metaHealth Insights and Innovation, Manila, Philippines
| | - Abha Mishra
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Department of Anthropology, University of Delhi, New Delhi, India
| | - Shawna Pandya
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- University of Alberta, Alberta Health Services and Project PoSSUM, Edmonton, AB, Canada
| | - Starr Schroeder
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Penn Medicine Lancaster General Hospital and Project PoSSUM, Lancaster, PA, United States
| | - Ashish Atreja
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Icahn School of Medicine, Mount Sinai Hospital, Mount Sinai, New York, NY, United States
| | - Maciej Banach
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Polish Mother's Memorial Hospital Research Institute (PMMHRI) in Lodz, Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
| | - Daniel Ray
- Pandemic Health System REsilience PROGRAM (REPROGRAM) Consortium, REPROGRAM Telemedicine Sub-committee, Sydney, NSW, Australia
- Farr Institute of Health Informatics, University College London (UCL) & NHS Foundation Trust, Birmingham, United Kingdom
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Utility of Short Message Service (SMS) for Remote Data Collection for HIV in Low- and Middle-Income Countries. Curr HIV/AIDS Rep 2020; 17:654-662. [PMID: 33010003 PMCID: PMC7532340 DOI: 10.1007/s11904-020-00534-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Short message system (SMS) communication is widespread in low- and middle-income countries (LMICs), and may be a viable approach to address challenges with in-person data collection for HIV-related research and monitoring and evaluation. We reviewed the literature to characterize potential benefits and challenges with using SMS for remote data capture, including examples from HIV and sexual and reproductive health. RECENT FINDINGS In our review, we found that studies that have used SMS to capture sensitive, self-reported data found this was an acceptable and feasible strategy, and may reduce social desirability bias of self-reported data; but studies are limited. Shared phones and privacy concerns have been described as challenges, but can be addressed with enhanced security features. Response rates to SMS surveys varied significantly by topic, population, and setting. SMS may improve generalizability and precision of health and behavior data for HIV in research and programs, but use in LMICs is limited. SMS systems should be carefully designed to overcome potential implementation hurdles.
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Subramanian L. Enabling health supply chains for improved well-being. SUPPLY CHAIN FORUM 2020. [DOI: 10.1080/16258312.2020.1776091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Miyazaki K, Nozaki I, Tojo B, Moji K. Assessing the feasibility of introducing an electronic health information system into Tuberculosis clinics and laboratories in Myanmar. Glob Health Med 2020; 2:247-254. [PMID: 33330815 PMCID: PMC7731357 DOI: 10.35772/ghm.2020.01020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 08/06/2020] [Accepted: 08/21/2020] [Indexed: 06/12/2023]
Abstract
Myanmar has launched an advanced tuberculosis examination policy, which involves specimen exchanges among clinics and referral laboratories. However, with the current paper-based operation, it is difficult to trace information accurately. Therefore, since April 2017, we introduced a pilot operation consisting of an electronic health information system (HIS) that uses QR codes for data sharing in the tuberculosis laboratory at seven facilities. This study aimed to assess the feasibility of introducing the electronic HIS into tuberculosis clinics and laboratories based on staff perception, workload and workflow, and data accuracy, and to clarify its advantages and disadvantages. The analysis was descriptive, and it involved a semi-structured interview for the staff, workflow observations to evaluate the workload and describe the change in workflow, and evaluation of the data accuracy by comparing the numbers yielded by the paper-based and HIS-based reports. The HIS was positively accepted as it improved work efficiency, while the operation still depended on paper-based reports. Parallel data registration using both paper-based and HIS-based reports increased the workload. Data discrepancies were found when comparing the paper-based and HIS-based reports, and these discrepancies were not directly attributed to the HIS introduction but individual factors. Crucial facilitating factors of the HIS were its operability and user-friendliness, because it does not require specific training. The additional workload translates into the need for additional human resources, and the parallel data registration remains a challenge. However, we consider that these challenges could be overcome as coverage of the HIS expands.
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Affiliation(s)
- Kazuki Miyazaki
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Ikuma Nozaki
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Bumpei Tojo
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Kazuhiko Moji
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Mohan D, Bashingwa JJH, Tiffin N, Dhar D, Mulder N, George A, LeFevre AE. Does having a mobile phone matter? Linking phone access among women to health in India: An exploratory analysis of the National Family Health Survey. PLoS One 2020; 15:e0236078. [PMID: 32687527 PMCID: PMC7371204 DOI: 10.1371/journal.pone.0236078] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/30/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The disruptive potential of mobile phones in catalyzing development is increasingly being recognized. However, numerous gaps remain in access to phones and their influence on health care utilization. In this cross-sectional study from India, we assess the gaps in women's access to phones, their influencing factors, and their influence on health care utilization. METHODS Data drawn from the 2015 National Family Health Survey (NFHS) in India included a national sample of 45,231 women with data on phone access. Survey design weighted estimates of household phone ownership and women's access among different population sub-groups are presented. Multilevel logistic models explored the association of phone access with a wide range of maternal and child health indicators. Blinder-Oaxaca (BO) decomposition is used to decompose the gaps between women with and without phone access in health care utilization into components explained by background characteristics influencing phone access (endowments) and unexplained components (coefficients), potentially attributable to phone access itself. FINDINGS Phone ownership at the household level was 92·8% (95% CI: 92·6-93·0%), with rural ownership at 91·1% (90·8-91·4%) and urban at 97.1% (96·7-97·3%). Women's access to phones was 47·8% (46·7-48·8%); 41·6% in rural areas (40·5-42·6%) and 62·7% (60·4-64·8%) in urban. Phone access in urban areas was positively associated with skilled birth attendance, postnatal care and use of modern contraceptives and negatively associated with early antenatal care. Phone access was not associated with improvements in utilization indicators in rural settings. Phone access (coefficient components) explained large gaps in the use of modern contraceptives, moderate gaps in postnatal care and early antenatal care, and smaller differences in the use of skilled birth attendance and immunization. For full antenatal car, phone access was associated with reducing gaps in utilization. INTERPRETATION Women of reproductive age have significantly lower phone access use than the households they belong to and marginalized women have the least phone access. Existing phone access for rural women did not improve their health care utilization but was associated with greater utilization for urban women. Without addressing these biases, digital health programs may be at risk of worsening existing health inequities.
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Affiliation(s)
- Diwakar Mohan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | | | - Nicki Tiffin
- Wellcome Centre for Infectious Disease Research in Africa, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Health Intelligence Initiative, Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Diva Dhar
- Bill and Melinda Gates Foundation, New Delhi, Delhi, India
| | - Nicola Mulder
- Computational Biology Division, University of Cape Town, Cape Town, South Africa
| | - Asha George
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Amnesty E. LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Health Intelligence Initiative, Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Dolan SB, Alao ME, Mwansa FD, Lymo DC, Bulula N, Carnahan E, Beylerian E, Werner L, Shearer JC. Perceptions of factors influencing the introduction and adoption of electronic immunization registries in Tanzania and Zambia: a mixed methods study. Implement Sci Commun 2020; 1:38. [PMID: 32885195 PMCID: PMC7427960 DOI: 10.1186/s43058-020-00022-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/17/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND As technology has become cheaper and more accessible, health programs are adopting digital health interventions (DHI) to improve the provision of and demand for health services. These interventions are complex and require strong coordination and support across different health system levels and government departments, and they need significant capacities in technology and information to be properly implemented. Electronic immunization registries (EIRs) are types of DHI used to capture, store, access, and share individual-level, longitudinal health information in digitized records. The BID Initiative worked in partnership with the governments of Tanzania and Zambia to introduce an EIR at the sub-national level in both countries within 5 years as part of a multi-component complex intervention package focusing on data use capacity-building. METHODS We aimed to gather and describe learnings from the BID experience by conducting a framework-based mixed methods study to describe perceptions of factors that influenced scale-up of the EIR. Data were collected through key informant interviews, a desk review, EIRs, and health management information systems. We described how implementation of the EIRs fulfilled domains described in our conceptual framework and used cases to illustrate the relationships and relative influence of domains for scale-up and adoption of the EIR. RESULTS We found that there was no single factor that seemed to influence the introduction or sustained adoption of the EIR as many of the factors were interrelated. For EIR introduction, strong strategic engagement among partners was important, while EIR adoption was influenced by adequate staffing at facilities, training, use of data for supervision, internet and electricity connectivity, and community sensitization. CONCLUSIONS Organizations deploying DHIs in the future should consider how best to adapt their intervention to the existing ecosystem, including human resources and organizational capacity, as well as the changing technological landscape during planning and implementation.
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Affiliation(s)
- Samantha B. Dolan
- Dolan Consulting LLC, PATH, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Mary E. Alao
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | | | - Dafrossa C. Lymo
- Immunisation and Vaccines Development, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Ngwegwe Bulula
- Immunisation and Vaccines Development, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
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Possibility of introducing telemedicine services in Asian and African countries. HEALTH POLICY AND TECHNOLOGY 2020. [DOI: 10.1016/j.hlpt.2020.01.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lee S, Begley CE, Morgan R, Chan W, Kim SY. Addition of mHealth (mobile health) for family planning support in Kenya: disparities in access to mobile phones and associations with contraceptive knowledge and use. Int Health 2020; 11:463-471. [PMID: 30576546 DOI: 10.1093/inthealth/ihy092] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/27/2018] [Accepted: 11/06/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recently mobile health (mHealth) has been implemented in Kenya to support family planning. Our objectives were to investigate disparities in mobile phone ownership and to examine the associations between exposure to family planning messages through mHealth (stand-alone or combined with other channels such as public forums, informational materials, health workers, social media and political/religious/community leaders' advocacy) and contraceptive knowledge and use. METHODS Logistic and Poisson regression models were used to analyze the 2014 Kenya Demographic and Health Survey. RESULTS Among 31 059 women, 86.7% had mobile phones and were more likely to have received higher education, have children ≤5 y of age and tended to be wealthier or married. Among 7397 women who were sexually active, owned a mobile phone and received family planning messages through at least one channel, 89.8% had no exposure to mHealth. mHealth alone was limited in improving contraceptive knowledge and use but led to intended outcomes when used together with four other channels compared with other channels only (knowledge: incidence rate ratio 1.084 [95% confidence interval {CI} 1.063-1.106]; use: odds ratio 1.429 [95% CI 1.026-1.989]). CONCLUSIONS Socio-economic disparities existed in mobile phone ownership, and mHealth alone did not improve contraceptive knowledge and use among Kenyan women. However, mHealth still has potential for family planning when used with existing channels.
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Affiliation(s)
- Seohyun Lee
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Charles E Begley
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Robert Morgan
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Wenyaw Chan
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sun-Young Kim
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
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Arsenijevic J, Tummers L, Bosma N. Adherence to Electronic Health Tools Among Vulnerable Groups: Systematic Literature Review and Meta-Analysis. J Med Internet Res 2020; 22:e11613. [PMID: 32027311 PMCID: PMC7055852 DOI: 10.2196/11613] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 05/26/2019] [Accepted: 09/26/2019] [Indexed: 01/19/2023] Open
Abstract
Background Electronic health (eHealth) tools are increasingly being applied in health care. They are expected to improve access to health care, quality of health care, and health outcomes. Although the advantages of using these tools in health care are well described, it is unknown to what extent eHealth tools are effective when used by vulnerable population groups, such as the elderly, people with low socioeconomic status, single parents, minorities, or immigrants. Objective This study aimed to examine whether the design and implementation characteristics of eHealth tools contribute to better use of these tools among vulnerable groups. Methods In this systematic review, we assessed the design and implementation characteristics of eHealth tools that are used by vulnerable groups. In the meta-analysis, we used the adherence rate as an effect size measure. The adherence rate is defined as the number of people who are repetitive users (ie, use the eHealth tool more than once). We also performed a meta-regression analysis to examine how different design and implementation characteristics influenced the adherence rate. Results Currently, eHealth tools are continuously used by vulnerable groups but to a small extent. eHealth tools that use multimodal content (such as videos) and have the possibility for direct communication with providers show improved adherence among vulnerable groups. Conclusions eHealth tools that use multimodal content and provide the possibility for direct communication with providers have a higher adherence among vulnerable groups. However, most of the eHealth tools are not embedded within the health care system. They are usually focused on specific problems, such as diabetes or obesity. Hence, they do not provide comprehensive services for patients. This limits the use of eHealth tools as a replacement for existing health care services.
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Affiliation(s)
- Jelena Arsenijevic
- Utrecht University School of Governance, Faculty of Law Economics and Governance, Utrecht, Netherlands
| | - Lars Tummers
- Utrecht University School of Governance, Faculty of Law Economics and Governance, Utrecht, Netherlands
| | - Niels Bosma
- Utrecht University School of Economics, Faculty of Law Economics and Governance, Utrecht, Netherlands
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Griffiths F, Watkins JA, Huxley C, Harris B, Cave J, Pemba S, Chipwaza B, Lilford R, Ajisola M, Arvanitis TN, Bakibinga P, Billah M, Choudhury N, Davies D, Fayehun O, Kabaria C, Iqbal R, Omigbodun A, Owoaje E, Rahman O, Sartori J, Sayani S, Tabani K, Yusuf R, Sturt J. Mobile consulting (mConsulting) and its potential for providing access to quality healthcare for populations living in low-resource settings of low- and middle-income countries. Digit Health 2020; 6:2055207620919594. [PMID: 32341793 PMCID: PMC7175047 DOI: 10.1177/2055207620919594] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 03/12/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The poorest populations of the world lack access to quality healthcare. We defined the key components of consulting via mobile technology (mConsulting), explored whether mConsulting can fill gaps in access to quality healthcare for poor and spatially marginalised populations (specifically rural and slum populations) of low- and middle-income countries, and considered the implications of its take-up. METHODS We utilised realist methodology. First, we undertook a scoping review of mobile health literature and searched for examples of mConsulting. Second, we formed our programme theories and identified potential benefits and hazards for deployment of mConsulting for poor and spatially marginalised populations. Finally, we tested our programme theories against existing frameworks and identified published evidence on how and why these benefits/hazards are likely to accrue. RESULTS We identified the components of mConsulting, including their characteristics and range. We discuss the implications of mConsulting for poor and spatially marginalised populations in terms of competent care, user experience, cost, workforce, technology, and the wider health system. CONCLUSIONS For the many dimensions of mConsulting, how it is structured and deployed will make a difference to the benefits and hazards of its use. There is a lack of evidence of the impact of mConsulting in populations that are poor and spatially marginalised, as most research on mConsulting has been undertaken where quality healthcare exists. We suggest that mConsulting could improve access to quality healthcare for these populations and, with attention to how it is deployed, potential hazards for the populations and wider health system could be mitigated.
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Affiliation(s)
- Frances Griffiths
- Warwick Medical School, University of Warwick, UK
- Centre for Health Policy, University of the Witwatersrand, South Africa
| | | | | | - Bronwyn Harris
- Warwick Medical School, University of Warwick, UK
- Centre for Health Policy, University of the Witwatersrand, South Africa
| | | | - Senga Pemba
- St Francis University College of Health and Allied Sciences, Tanzania
| | - Beatrice Chipwaza
- St Francis University College of Health and Allied Sciences, Tanzania
| | | | | | | | | | | | | | - David Davies
- Warwick Medical School, University of Warwick, UK
| | | | | | | | | | | | - Omar Rahman
- Independent University Bangladesh, Bangladesh
| | - Jo Sartori
- Warwick Medical School, University of Warwick, UK
| | | | | | - Rita Yusuf
- Independent University Bangladesh, Bangladesh
| | - Jackie Sturt
- The Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, UK
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Dick S, O’Connor Y, Heavin C. Approaches to Mobile Health Evaluation: A Comparative Study. INFORMATION SYSTEMS MANAGEMENT 2019. [DOI: 10.1080/10580530.2020.1696550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Samantha Dick
- Business Information Systems, Cork University Business School, University College Cork, Cork, Ireland
| | - Yvonne O’Connor
- Business Information Systems, Cork University Business School, University College Cork, Cork, Ireland
| | - Ciara Heavin
- Business Information Systems, Cork University Business School, University College Cork, Cork, Ireland
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Goggin K, Hurley EA, Staggs VS, Wexler C, Nazir N, Gautney B, Khamadi SA, Maloba M, Lwembe R, Finocchario-Kessler S. Rates and Predictors of HIV-Exposed Infants Lost to Follow-Up During Early Infant Diagnosis Services in Kenya. AIDS Patient Care STDS 2019; 33:346-353. [PMID: 31369296 DOI: 10.1089/apc.2019.0050] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Early infant diagnosis (EID) involves age-specific tracking and testing of HIV-exposed infants during the first 18 months of life and rapid initiation of life-saving treatment for those infected. In Kenya, pre-2013 data estimate EID lost to follow-up (LTFU) at 39-65%, yet no study has documented LTFU rates and predictors throughout the EID cascade since Option B+ fundamentally changed services by placing all HIV-positive expectant mothers on lifelong treatment. Using an explanatory mixed-method design, we assessed LTFU rates and predictors among 870 mother-infant dyads enrolled in EID in six urban/peri-urban Kenyan government hospitals. Mothers completed baseline surveys, and dyads were tracked through EID. We selected 12 baseline variables and modeled odds of LTFU at 9 and 18 months using mixed logistic regression. Qualitative interviews were conducted with 61 mothers to assess barriers and facilitators to completing EID. Thematically coded transcripts were used to interpret quantitative predictors of LTFU. By the 18-month test, 145 dyads (22%) were LTFU, with three-quarters of LTFU occurring between 9- and 18-month tests. Odds of LTFU at 18 months decreased by 10% for each additional year of maternal age and by 66% with HIV status disclosure. Qualitative data revealed how disclosure facilitated essential social support for EID completion and how older mothers attributed maturity and life experience to successful engagement in care. Findings suggest LTFU rates in Kenya have declined, but gaps remain in ensuring universal coverage. Efforts to improve retention should focus on increasing support for younger mothers and those who have not disclosed their HIV status.
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Affiliation(s)
- Kathy Goggin
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri
- School of Medicine and University of Missouri-Kansas City, Kansas City, Missouri
- School of Pharmacy, University of Missouri-Kansas City, Kansas City, Missouri
| | - Emily A. Hurley
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri
| | - Vincent S. Staggs
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, Kansas City, Missouri
- School of Medicine and University of Missouri-Kansas City, Kansas City, Missouri
- Biostatistics and Epidemiology Core, Children's Mercy Kansas City, Kansas City, Missouri
| | - Catherine Wexler
- Department of Family Medicine and University of Kansas Medical Center, Kansas City, Missouri
| | - Niaman Nazir
- Department of Preventive Medicine, University of Kansas Medical Center, Kansas City, Missouri
| | | | | | - May Maloba
- Global Health Innovations, Dallas, Texas
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Celes RS, Rossi TRA, de Barros SG, Santos CML, Cardoso C. [Telehealth as state response strategy: systematic reviewLa telesalud como estrategia de respuesta del Estado: revisión sistemática]. Rev Panam Salud Publica 2018; 42:e84. [PMID: 31093112 PMCID: PMC6385855 DOI: 10.26633/rpsp.2018.84] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/07/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To identify telehealth initiatives described in the literature as a strategy for national health policies. METHOD A systematic review was performed to identify articles focusing on the use of telehealth as a state response strategy to health problems or needs. The Virtual Health Library, PubMed, and Google Scholar were searched using the following keywords: "telessaude politicas", "implantacao telessaude", "telehealth policy", "telehealth America", "telehealth Asia", "telehealth Antartida", "telehealth Europe", "telehealth Africa", "telehealth Oceania". Data collection was performed from March 2016 to February 2017. RESULTS Twenty-one articles describing telehealth initiatives in various countries, published in Portuguese, Spanish, and English, were analyzed. Concentration of studies on specific areas or regions was not detected. Most articles were published from 2014 to 2017. Telehealth initiatives have been used mainly to decrease health costs, for continued education of health care professionals, consultations between health care professionals, to strengthen primary health care, and to improve the access to health care in remote areas. CONCLUSIONS Telehealth is used as state policy across the five continents, with variations in the degree of implementation. The main differences in telehealth among countries refer to infrastructure, financing, engagement of patients and caretakers, and position of the state regarding the role of telehealth.
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Affiliation(s)
- Rafaela Santana Celes
- Universidade do Estado da Bahia, Programa de Residência Multiprofissional, Salvador (BA), Brasil.
| | | | - Sandra Garrido de Barros
- Universidade Federal da Bahia (UFBa), Faculdade de Odontologia, Departamento de Odontologia Social e Pediátrica, Salvador (BA), Brasil.
| | | | - Carla Cardoso
- Universidade do Estado da Bahia, Departamento de Ciências da Vida, Salvador (BA), Brasil.
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Mburu S, Oboko R. A model for predicting utilization of mHealth interventions in low-resource settings: case of maternal and newborn care in Kenya. BMC Med Inform Decis Mak 2018; 18:67. [PMID: 30016943 PMCID: PMC6050709 DOI: 10.1186/s12911-018-0649-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background In low-resource settings, there are numerous socioeconomic challenges such as poverty, inadequate facilities, shortage of skilled health workers, illiteracy and cultural barriers that contribute to high maternal and newborn deaths. To address these challenges, there are several mHealth projects particularly in Sub-Sahara Africa seeking to exploit opportunities provided by over 90% rate of mobile penetration. However, most of these interventions have failed to justify their value proposition to inspire utilization in low-resource settings. Methods This study proposes a theoretical model named Technology, Individual, Process-Fit (TIPFit) suitable for user-centred evaluation of intervention designs to predict utilization of mHealth products in low-resource settings. To investigate the predictive power of TIPFit model, we operationalized its latent constructs into variables used to predict utilization of an mHealth prototype called mamacare. The study employed single-group repeated measures quasi-experiment in which a random sample of 79 antenatal and postnatal patients were recruited from a rural hospital. During the study conducted between May and October 2014, the treatment involved sending and receiving SMS alerts on vital signs, appointments, safe delivery, danger signs, nutrition, preventive care and adherence to medication. Results Measurements taken during the study were cleaned and coded for analysis using statistical models like Partial Least Squares (PLS), Repeated Measures Analysis of Variance (RM-ANOVA), and Bonferroni tests. After analyzing 73 pretest responses, the model predicted 80.2% fit, and 63.9% likelihood of utilization. However, results obtained from initial post-test taken after three months demonstrated 69.1% fit, and utilization of 50.5%. The variation between prediction and the actual outcome necessitated improvement of mamacare based on feedback obtained from users. Three months later, we conducted the second post-test that recorded further drop in fit from 69.1 to 60.3% but utilization marginally improved from 50.5 to 53.7%. Conclusions Despite variations between the pretest and post-test outcomes, the study demonstrates that predictive approach to user-centred design offers greater flexibility in aligning design attributes of an mHealth intervention to fulfill user needs and expectations. These findings provide a unique contribution for decision makers because it is possible to prioritize investments among competing digital health projects. Electronic supplementary material The online version of this article (10.1186/s12911-018-0649-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen Mburu
- School of Computing and Informatics, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya.
| | - Robert Oboko
- School of Computing and Informatics, University of Nairobi, P.O. Box 30197-00100, Nairobi, Kenya
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Enablers and inhibitors: A review of the situation regarding mHealth adoption in low- and middle-income countries. HEALTH POLICY AND TECHNOLOGY 2018. [DOI: 10.1016/j.hlpt.2017.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW HIV prevention and care is changing rapidly; guideline revisions and programmatic scale-up require innovative approaches to in-service training and care extension to improve provider practice and care access. We assessed recent (≤12 months) peer-reviewed publications on electronic health (eHealth), telemedicine, and other innovative provider-targeted interventions for HIV-related care. RECENT FINDINGS Key developments included systems merging electronic medical records (EMR) with provider clinical decision aids to prompt action, demonstration eHealth, and telemedicine projects, reviews or descriptions of technology to improve connectivity in lower resource settings, and a few trials on provider-centered interventions. Most publications were program reports and few data were available regarding efficacy of eHealth interventions for providers on patient HIV-related outcomes, notably identification and management of antiretroviral treatment failure in Kenya. Better evidence is needed for strategies to train providers and care extenders with the goal to improve impact of HIV prevention and care interventions. SUMMARY Rapid technology introduction and expansion may change the paradigm for improving provider knowledge and practice. Although new, the developments are promising for HIV provider-targeted eHealth and innovations for traditional training. More rigorous testing with randomized trials is needed to demonstrate impact on services for people living with HIV.
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Lee S, Cho YM, Kim SY. Mapping mHealth (mobile health) and mobile penetrations in sub-Saharan Africa for strategic regional collaboration in mHealth scale-up: an application of exploratory spatial data analysis. Global Health 2017; 13:63. [PMID: 28830540 PMCID: PMC5568212 DOI: 10.1186/s12992-017-0286-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 08/10/2017] [Indexed: 11/10/2022] Open
Abstract
Background Mobile health (mHealth), a term used for healthcare delivery via mobile devices, has gained attention as an innovative technology for better access to healthcare and support for performance of health workers in the global health context. Despite large expansion of mHealth across sub-Saharan Africa, regional collaboration for scale-up has not made progress since last decade. Methods As a groundwork for strategic planning for regional collaboration, the study attempted to identify spatial patterns of mHealth implementation in sub-Saharan Africa using an exploratory spatial data analysis. In order to obtain comprehensive data on the total number of mHelath programs implemented between 2006 and 2016 in each of the 48 sub-Saharan Africa countries, we performed a systematic data collection from various sources, including: the WHO eHealth Database, the World Bank Projects & Operations Database, and the USAID mHealth Database. Additional spatial analysis was performed for mobile cellular subscriptions per 100 people to suggest strategic regional collaboration for improving mobile penetration rates along with the mHealth initiative. Global Moran’s I and Local Indicator of Spatial Association (LISA) were calculated for mHealth programs and mobile subscriptions per 100 population to investigate spatial autocorrelation, which indicates the presence of local clustering and spatial disparities. Results From our systematic data collection, the total number of mHealth programs implemented in sub-Saharan Africa between 2006 and 2016 was 487 (same programs implemented in multiple countries were counted separately). Of these, the eastern region with 17 countries and the western region with 16 countries had 287 and 145 mHealth programs, respectively. Despite low levels of global autocorrelation, LISA enabled us to detect meaningful local clusters. Overall, the eastern part of sub-Saharan Africa shows high-high association for mHealth programs. As for mobile subscription rates per 100 population, the northern area shows extensive low-low association. Conclusions This study aimed to shed some light on the potential for strategic regional collaboration for scale-up of mHealth and mobile penetration. Firstly, countries in the eastern area with much experience can take the lead role in pursuing regional collaboration for mHealth programs in sub-Saharan Africa. Secondly, collective effort in improving mobile penetration rates for the northern area is recommended. Electronic supplementary material The online version of this article (doi:10.1186/s12992-017-0286-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Seohyun Lee
- Department of Management, Policy and Community Health, University of Texas Health Science Center at Houston, School of Public Health, 1200 Pressler Street, Houston, TX, 77030, USA.,Center for Global Health Research, Seoul National University, Graduate School of Public Health, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea
| | - Yoon-Min Cho
- Department of Public Health, Seoul National University, Graduate School of Public Health, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea.,Center for Global Health Research, Seoul National University, Graduate School of Public Health, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea
| | - Sun-Young Kim
- Department of Public Health, Seoul National University, Graduate School of Public Health, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea. .,Center for Global Health Research, Seoul National University, Graduate School of Public Health, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea.
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Bitta MA, Kariuki SM, Chengo E, Newton CRJC. An overview of mental health care system in Kilifi, Kenya: results from an initial assessment using the World Health Organization's Assessment Instrument for Mental Health Systems. Int J Ment Health Syst 2017; 11:28. [PMID: 28416966 PMCID: PMC5392905 DOI: 10.1186/s13033-017-0135-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 04/06/2017] [Indexed: 11/10/2022] Open
Abstract
Background Little is known about the state of mental health systems in Kenya. In 2010, Kenya promulgated a new constitution, which devolved national government and the national health system to 47 counties including Kilifi County. There is need to provide evidence from mental health systems research to identify priority areas in Kilifi’s mental health system for informing county health sector decision making. We conducted an initial assessment of state of mental health systems in Kilifi County and documented resources, policy and legislation and spectrum of mental, neurological and substance use disorders. Methods This was a pilot study that used the brief version of the World Health Organization’s Assessment Instrument for Mental Health Systems Version 2.2 to collect data. Data collection was based on the year 2014. Results Kilifi county has two public psychiatric outpatient units that are part of general hospitals. There is no standalone mental hospital in Kilifi. There are no inpatients or community based facilities for people with mental health problems. Although the psychiatric facilities in Kilifi have an essential drugs list, supply of drugs is erratic with frequent shortages. There is no psychiatrist or psychologist in Kilifi with only two psychiatric nurses for a population of approximately 1.2 million people. Schizophrenia was the commonest reason for visiting outpatient facilities (47.1%) while suicidal ideation was the least common (0.4%). Kenya’s mental health policy, which is being used by Kilifi County, is outdated and does not cater for the current mental health needs of Kilifi. There is no specific legislation to protect the rights of people with mental health problems. No budget exists specifically for mental health care. There have been no efforts to integrate mental health care into primary care in Kilifi, and there is no empirical research work to evaluate its feasibility. Conclusion There is an urgent need to increase resources allocated for mental health in particular infrastructure and human resource. Policy and legislations need to be established to protect the rights of people with mental illnesses, and mental health should be integrated with primary care to increase access to services.
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Affiliation(s)
- Mary A Bitta
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), P O Box 230, Kilifi, 80108 Kenya
| | - Symon M Kariuki
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), P O Box 230, Kilifi, 80108 Kenya
| | - Eddie Chengo
- Ubuntu Afya Clinic for People with Epilepsy, Malindi, Kenya
| | - Charles R J C Newton
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), P O Box 230, Kilifi, 80108 Kenya.,Department of Psychiatry, University of Oxford, Oxford, UK
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