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Jones RT, Spencer FI, Paris LA, Soumaïla D, Kamara N, Hiscox A, Logan JG. Evaluating barriers to reaching women with public health information in remote communities in Mali. BMC Health Serv Res 2024; 24:905. [PMID: 39113052 PMCID: PMC11308311 DOI: 10.1186/s12913-024-11277-5] [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: 03/19/2024] [Accepted: 07/03/2024] [Indexed: 08/10/2024] Open
Abstract
Telecommunications offers an alternative or supplement to community-based interventions as a means of extending healthcare services and improving health outcomes in remote settings but can fail to reach target communities and achieve the desired impact if barriers to access are not overcome. We conducted seven focus group discussions and 26 interviews with community health workers, community leaders, and female members of the public who declared that they had or had not previously accessed free audio health messages provided via a mobile platform in two rural communities of Mali, Koulikoro and Bougouni. A content analysis showed that participants accessed and trusted health information from a range of sources, including radio, telephone and television, as well as town criers, local relays and community health centres. Barriers to access faced by women included economic factors, lack of network or electricity, and social factors such as illiteracy, cultural restrictions and being unaware of mobile communication. Through analysis and interpretation of the participants' responses, we have made recommendations for future campaigns for the dissemination of health-related information for women in remote settings.
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Affiliation(s)
- Robert T Jones
- Arctech Innovation, LondonEast-UK business and technical park, Dagenham, UK
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
| | - Freya I Spencer
- Arctech Innovation, LondonEast-UK business and technical park, Dagenham, UK.
| | - Laura A Paris
- Arctech Innovation, LondonEast-UK business and technical park, Dagenham, UK
| | | | | | - Alexandra Hiscox
- Arctech Innovation, LondonEast-UK business and technical park, Dagenham, UK
| | - James G Logan
- Arctech Innovation, LondonEast-UK business and technical park, Dagenham, UK
- Department of Disease Control, London School of Hygiene & Tropical Medicine, Keppel Street, London, UK
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Dam R, Mponzi W, Msaky D, Mwandyala T, Kaindoa EW, Sinka ME, Kiskin I, Herreros-Moya E, Messina J, Shah SGS, Roberts S, Willis KJ. What incentives encourage local communities to collect and upload mosquito sound data by using smartphones? A mixed methods study in Tanzania. Glob Health Res Policy 2023; 8:18. [PMID: 37246227 DOI: 10.1186/s41256-023-00298-y] [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: 07/01/2022] [Accepted: 04/07/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND To detect and identify mosquitoes using their characteristic high-pitched sound, we have developed a smartphone application, known as the 'HumBug sensor', that records the acoustic signature of this sound, along with the time and location. This data is then sent remotely to a server where algorithms identify the species according to their distinctive acoustic signature. Whilst this system works well, a key question that remains is what mechanisms will lead to effective uptake and use of this mosquito survey tool? We addressed this question by working with local communities in rural Tanzania and providing three alternative incentives: money only, short message service (SMS) reminders and money, and SMS reminders only. We also had a control group with no incentive. METHODS A multi-site, quantitative empirical study was conducted in four villages in Tanzania from April to August 2021. Consenting participants (n = 148) were recruited and placed into one of the three intervention arms: monetary incentives only; SMS reminders with monetary incentives; and SMS reminders only. There was also a control group (no intervention). To test effectiveness of the mechanisms, the number of audio uploads to the server of the four trial groups on their specific dates were compared. Qualitative focus group discussions and feedback surveys were also conducted to explore participants' perspectives on their participation in the study and to capture their experiences of using the HumBug sensor. RESULTS Qualitative data analysis revealed that for many participants (37 out of 81), the main motivation expressed was to learn more about the types of mosquitoes present in their houses. Results from the quantitative empirical study indicate that the participants in the 'control' group switched on their HumBug sensors more over the 14-week period (8 out of 14 weeks) when compared to those belonging to the 'SMS reminders and monetary incentives' trial group. These findings are statistically significant (p < 0.05 or p > 0.95 under a two-sided z-test), revealing that the provision of monetary incentives and sending SMS reminders did not appear to encourage greater number of audio uploads when compared to the control. CONCLUSIONS Knowledge on the presence of harmful mosquitoes was the strongest motive for local communities to collect and upload mosquito sound data via the HumBug sensor in rural Tanzania. This finding suggests that most efforts should be made to improve flow of real-time information back to the communities on types and risks associated with mosquitoes present in their houses.
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Affiliation(s)
- Rinita Dam
- Department of Biology, University of Oxford, Oxford, UK.
- Warwick Medical School, University of Warwick, Warwick, UK.
| | - Winifrida Mponzi
- Environmental Health and Ecological Science Department, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
| | - Dickson Msaky
- Environmental Health and Ecological Science Department, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
| | - Tumpe Mwandyala
- Environmental Health and Ecological Science Department, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
| | - Emmanuel W Kaindoa
- Environmental Health and Ecological Science Department, Ifakara Health Institute, P.O. Box 53, Ifakara, Tanzania
- The Nelson Mandela, African Institution of Science and Technology, School of Life Sciences and Bioengineering, Tengeru, Arusha, Tanzania
| | | | - Ivan Kiskin
- Department of Engineering Science, University of Oxford, Oxford, UK
- Surrey Institute for People-Centred AI, Centre for Vision Speech and Signal Processing, University of Surrey, Guildford, UK
| | | | - Janey Messina
- School of Geography and the Environment and the Oxford School of Global and Area Studies, University of Oxford, Oxford, UK
| | - Syed Ghulam Sarwar Shah
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Stephen Roberts
- Department of Engineering Science, University of Oxford, Oxford, UK
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Mukherjee S, Perveen S, Negi A, Sharma R. Evolution of tuberculosis diagnostics: From molecular strategies to nanodiagnostics. Tuberculosis (Edinb) 2023; 140:102340. [PMID: 37031646 PMCID: PMC10072981 DOI: 10.1016/j.tube.2023.102340] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/12/2023] [Accepted: 03/30/2023] [Indexed: 04/09/2023]
Abstract
Tuberculosis has remained a global concern for public health affecting the lives of people for ages. Approximately 10 million people are affected by the disease and 1.5 million succumb to the disease worldwide annually. The COVID-19 pandemic has highlighted the role of early diagnosis to win the battle against such infectious diseases. Thus, advancement in the diagnostic approaches to provide early detection forms the foundation to eradicate and manage contagious diseases like tuberculosis. The conventional diagnostic strategies include microscopic examination, chest X-ray and tuberculin skin test. The limitations associated with sensitivity and specificity of these tests demands for exploring new techniques like probe-based assays, CRISPR-Cas and microRNA detection. The aim of the current review is to envisage the correlation between both the conventional and the newer approaches to enhance the specificity and sensitivity. A significant emphasis has been placed upon nanodiagnostic approaches manipulating quantum dots, magnetic nanoparticles, and biosensors for accurate diagnosis of latent, active and drug-resistant TB. Additionally, we would like to ponder upon a reliable method that is cost-effective, reproducible, require minimal infrastructure and provide point-of-care to the patients.
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Affiliation(s)
| | - Summaya Perveen
- Infectious Diseases Division, CSIR- Indian Institute of Integrative Medicine, Jammu, 180001, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Anjali Negi
- Infectious Diseases Division, CSIR- Indian Institute of Integrative Medicine, Jammu, 180001, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India
| | - Rashmi Sharma
- Infectious Diseases Division, CSIR- Indian Institute of Integrative Medicine, Jammu, 180001, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
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4
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Herawati MH, Besral, Lolong DB, Pracoyo NE, Sukoco NEW, Supratikta H, Veruswati M, Asyary A. Service availability and readiness of malaria surveillance information systems implementation at primary health centers in Indonesia. PLoS One 2023; 18:e0284162. [PMID: 37104477 PMCID: PMC10138467 DOI: 10.1371/journal.pone.0284162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/24/2023] [Indexed: 04/28/2023] Open
Abstract
One of the most important indicators in malaria eradication is the malaria surveillance information system (SISMAL) for recording and reporting medical cases. This paper aims to describe the availability and readiness of SISMALs at primary health centers (PHCs) in Indonesia. A cross-sectional survey was implemented in seven provinces for this study. The data was analyzed using bivariate, multivariate, and linear regression. The availability of the information system was measured by assessing the presence of the electronic malaria surveillance information system (E-SISMAL) at the studied PHCs. The readiness was measured by averaging each component of the assessment. From 400 PHC samples, only 58.5% had available SISMALs, and their level of readiness was only 50.2%. Three components had very low levels of readiness: (1) the availability of personnel (40.9%), (2) SISMAL integration and storage (50.2%), and (3) the availability of data sources and indicators (56.8%). Remote and border (DTPK) areas had a 4% better readiness score than non-DTPK areas. Endemic areas were 1.4% better than elimination areas, while regions with low financial capacity were 3.78% better than regions with high financial capacity, with moderate capacity (2.91%). The availability rate of the SISMAL at PHCs is only 58.5%. Many PHCs still do not have SISMALs. The readiness of the SISMAL at these PHCs is significantly related to DTPK/remote area, high endemicity status, and low financial capacity. This study found that the implementation of SISMAL is more accessible to malaria surveillance for the remote area and regions with low financial capacity. Therefore, this effort will well-fit to address barrier to malaria surveillance in developing countries.
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Affiliation(s)
| | - Besral
- Department of Biostatistics and Population Studies, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | | | | | | | - Hadi Supratikta
- National Research and Innovation Agency, Jakarta, Indonesia
- Study Program of Management Studies, Postgraduate School, Universitas Pamulang, South Tangerang, Banten, Indonesia
| | - Meita Veruswati
- Study Program of Public Health, Faculty of Health Sciences, Universitas Muhammadiyah Prof. Dr. HAMKA, Jakarta, Indonesia
- PhD in Business and Management, Postgraduate School, Management and Science University, Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Al Asyary
- Department of Environmental Health, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
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5
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Kagarmanova A, Mwesiga MD, Sisk ML, Kabagambe C, Nyakaisiki S, Marentette T, Ahern LN. Palliative care in Uganda: quantitative descriptive study of key palliative care indicators 2018-2020. BMC Palliat Care 2022; 21:55. [PMID: 35459171 PMCID: PMC9023726 DOI: 10.1186/s12904-022-00930-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The first and most recent nationwide audit of palliative care services in Uganda was conducted in 2009. Since then, Uganda has made great strides in palliative care development, including policy, education, and services implementation. This study provides an overview of the availability of palliative care services in the country and the challenges and gaps in Uganda prior to the global COVID-19 pandemic. This lays the foundation for better understanding the challenges and changes needed to support palliative care development and access in the wake of the pandemic. METHODS We conducted a descriptive quantitative study of secondary data on nationwide morphine distribution, collated a list of accredited facilities, and analyzed key palliative care indicators collected through the mHealth surveillance project present at a subset of accredited facilities. Descriptive statistical analysis involved non-parametric tests using SPSS, mapping geographical distribution of available palliative care services using Geographic Information Systems software, and identification of challenges from the subset of accredited facilities. RESULTS There were 226 accredited palliative care facilities across Uganda's 135 districts in 2020. Thirty districts lacked any accredited palliative care facility. The estimated population coverage was 88.5%. The majority (68.1%) of accredited facilities were public, and private facilities received slightly more pain-relieving morphine. There was an alternating trend in the volumes of morphine delivered to public and private facilities. More than a third of the patients were diagnosed with non-communicable diseases, highlighting their significance alongside cancer and HIV/AIDS as conditions requiring palliative care. Palliative care accredited facilities offered six types of services: outreach, home visits, psychosocial, legal, bereavement, and spiritual support, but only for an average of 7 months a year due to lack of facilitation and transportation. CONCLUSION Palliative care in Uganda developed in quality, volume, and geographic coverage since 2009. The shift in palliative care patients' primary diagnosis from HIV/AIDS to non-communicable diseases marks an important epidemiologic transition. Although accredited facilities are present in most administrative districts, more research is needed to evaluate the actual accessibility of these services. The existing services, both private and public, are limited by the amount of pain-relieving morphine, financial and transport resources. More quality data collected on key palliative care indicators is needed into geographical accessibility of palliative care services, morphine availability trends, and patient diagnoses in order to improve the provision of palliative care in Uganda.
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Affiliation(s)
- Ainur Kagarmanova
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA
| | | | - Matthew L Sisk
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA.,Lucy Family Institute for Data and Society, University of Notre Dame, Notre Dame, IN, USA
| | | | | | - Tom Marentette
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA.,Office of Information Technologies, University of Notre Dame, Notre Dame, IN, USA
| | - Lacey N Ahern
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, IN, USA. .,Hospice Foundation/Global Partners in Care, Mishawaka, IN, USA.
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David R, Evans R, Fraser HS. Modelling Prenatal Care Pathways at a Central Hospital in Zimbabwe. Health Serv Insights 2021; 14:11786329211062742. [PMID: 34880627 PMCID: PMC8647229 DOI: 10.1177/11786329211062742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/05/2021] [Indexed: 11/19/2022] Open
Abstract
Background: Maternal mortality remains a problem in low-income countries (LICs). In
Zimbabwe, there has been an unprecedented increase in maternal mortality in
the last 2.5 decades. Effective prenatal care delivery, particularly early
visits, appropriate number of visits, and receiving recommended care is
viewed as key to reducing fatal care outcomes. Aims: This study sought to model and identify gaps requiring service and care
delivery improvement in prenatal care pathways for pregnant women visiting
Mpilo Central Hospital in Bulawayo, Zimbabwe. Methods: This was a case study of the services offered by an antenatal care department
at Mpilo Central Hospital in Bulawayo, Zimbabwe. Evidence from literature in
low-income countries was used to develop prenatal care pathway guidelines as
a tool to guide care delivery and identify gaps in care and service
delivery. One hundred cases of prenatal care records were reviewed to
determine the prenatal care pathway and care delivered to pregnant women.
This data was complemented by interviews with 20 maternity care
clinicians. Results: In 100 maternity case records studied, 53% booked for prenatal care. Of the
53% (n = 53) pregnant women who booked, their first visit on their pregnancy
was late at an average gestational age of 27.1 weeks with extremes of 30 to
40 weeks in 38% (n = 20) cases. Missing scheduled prenatal care appointments
was prevalent, with only 11% (n = 6) having attended all the expected 5
visits, whilst 60% (n = 32) missed 3 or more. There were inadequacies in the
care delivered to women in each visit compared to that expected in such
areas as obstetrics, physical examinations and haematological tests.
Maternity care clinicians attributed the cost of prenatal booking fees in
the background of poverty and poor family support systems as key factors
hindering women’s access to prenatal services. Conclusions: The current prenatal care pathway at MCH requires improvement in the areas of
referral, adherence to appointment by pregnant women and visiting prenatal
care early. Clinicians also need to adhere to standard clinical tests
recommended for each specific pregnant woman’s visit. In the Zimbabwean
setting with limited resources, where the number of visits is already low,
pathways with reduced visits may not be appropriate. An investment into
prenatal care by the government is recommended to enable the utilisation of
interventions such as e-health technologies that may improve care delivery
as well as adherence to best practices. E-health and mobile health
technologies involving e-referrals, e-booking, decision support, and
reminder systems are recommended for clinicians to manage and deliver
appropriate care to patients as well as pregnant women to adhere to
scheduled visits.
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Affiliation(s)
- Rodreck David
- School of Information Management, Victoria University of Wellington, Wellington, New Zealand
| | - Ruth Evans
- Division of Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Hamish Sf Fraser
- Brown Center for Biomedical Informatics, Brown University, Providence, RI, USA
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7
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Kumm AJ, Viljoen M, de Vries PJ. The Digital Divide in Technologies for Autism: Feasibility Considerations for Low- and Middle-Income Countries. J Autism Dev Disord 2021; 52:2300-2313. [PMID: 34121159 PMCID: PMC8200284 DOI: 10.1007/s10803-021-05084-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 12/27/2022]
Abstract
Digital technologies have the potential to empower individuals with autism and their families. The COVID-19 pandemic emphasized and accelerated the drive towards technology for information, communication, training, clinical care and research, also in the autism community. However, 95% of individuals with autism live in low- and middle-income countries (LMIC) where access to electricity, internet and the ever-increasing range of digital devices may be highly limited. The World Bank coined the term ‘the digital divide’ to describe the disparities in access to digital technologies between high-income and LMIC contexts. Here we evaluated the feasibility of six emerging technologies for autism spectrum disorders, and reflected on key considerations for implementation in LMIC contexts to ensure that we do not inadvertently widen the pre-existing digital divide.
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Affiliation(s)
- Aubrey J Kumm
- Division of Child & Adolescent Psychiatry, Centre for Autism Research in Africa (CARA), University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa
| | - Marisa Viljoen
- Division of Child & Adolescent Psychiatry, Centre for Autism Research in Africa (CARA), University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa
| | - Petrus J de Vries
- Division of Child & Adolescent Psychiatry, Centre for Autism Research in Africa (CARA), University of Cape Town, 46 Sawkins Road, Rondebosch, 7700, Cape Town, South Africa.
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Moore C, Scherr T, Matoba J, Sing'anga C, Lubinda M, Thuma P, Wright D. mHAT app for automated malaria rapid test result analysis and aggregation: a pilot study. Malar J 2021; 20:237. [PMID: 34039358 PMCID: PMC8153521 DOI: 10.1186/s12936-021-03772-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/16/2021] [Indexed: 12/29/2022] Open
Abstract
Background There are a variety of approaches being used for malaria surveillance. While active and reactive case detection have been successful in localized areas of low transmission, concerns over scalability and sustainability keep the approaches from being widely accepted. Mobile health interventions are poised to address these shortcomings by automating and standardizing portions of the surveillance process. In this study, common challenges associated with current data aggregation methods have been quantified, and a web-based mobile phone application is presented to reduce the burden of reporting rapid diagnostic test (RDT) results in low-resource settings. Methods De-identified completed RDTs were collected at 14 rural health clinics as part of a malaria epidemiology study at Macha Research Trust, Macha, Zambia. Tests were imaged using the mHAT web application. Signal intensity was measured and a binary result was provided. App performance was validated by: (1) comparative limits of detection, investigated against currently used laboratory lateral flow assay readers; and, (2) receiver operating characteristic analysis comparing the application against visual inspection of RDTs by an expert. Secondary investigations included analysis of time-to-aggregation and data consistency within the existing surveillance structures established by Macha Research Trust. Results When compared to visual analysis, the mHAT app performed with 91.9% sensitivity (CI 78.7, 97.2) and specificity was 91.4% (CI 77.6, 97.0) regardless of device operating system. Additionally, an analysis of surveillance data from January 2017 through mid-February 2019 showed that while the majority of the data packets from satellite clinics contained correct data, 36% of data points required correction by verification teams. Between November 2018 and mid-February 2019, it was also found that 44.8% of data was received after the expected submission date, although most (65.1%) reports were received within 2 days. Conclusions Overall, the mHAT mobile app was observed to be sensitive and specific when compared to both currently available benchtop lateral flow readers and visual inspection. The additional benefit of automating and standardizing LFA data collection and aggregation poses a vital improvement for low-resource health facilities and could increase the accuracy and speed of data reporting in surveillance campaigns. Supplementary Information The online version contains supplementary material available at 10.1186/s12936-021-03772-5.
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Affiliation(s)
- Carson Moore
- Department of Chemistry, Vanderbilt University, 1234 Stevenson Center Lane, Nashville, TN, 37212, USA
| | - Thomas Scherr
- Department of Chemistry, Vanderbilt University, 1234 Stevenson Center Lane, Nashville, TN, 37212, USA.
| | | | | | | | - Phil Thuma
- Macha Research Trust, Choma District, Zambia
| | - David Wright
- Department of Chemistry, Vanderbilt University, 1234 Stevenson Center Lane, Nashville, TN, 37212, USA
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Win Han Oo, Win Htike, Cutts JC, Kyawt Mon Win, Kaung Myat Thu, May Chan Oo, Galau Naw Hkawng, Agius PA, Pyae Phyo Htoon, Scott N, Kearney E, Moreira C, Pedrana A, Stoove M, Aung Thi, Ye Win Aung, Min Min Thein, Rosecrans K, Kyi Tun Lwin, Aung Kyi Min, Fowkes FJI. A mobile phone application for malaria case-based reporting to advance malaria surveillance in Myanmar: a mixed methods evaluation. Malar J 2021; 20:167. [PMID: 33771144 PMCID: PMC7995396 DOI: 10.1186/s12936-021-03701-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 03/15/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND To achieve malaria elimination in the Greater Mekong Subregion, including Myanmar, it is necessary to ensure all malaria cases are detected, treated, and reported in a timely manner. Mobile phone-based applications for malaria reporting, case management, and surveillance implemented at a community-level may overcome reporting limitations associated with current paper-based reporting (PBR), but their effectiveness in this context is unknown. METHODS A mixed methods evaluation study was undertaken to determine the effectiveness of a national Malaria Case-Based Reporting (MCBR) mobile phone application in improving malaria case reporting compared to the existing PBR reporting system in Myanmar. Methods included secondary analysis of malaria case report data, questionnaires, focus group discussions and field observations of community volunteers, interviews and direct observations of malaria programme stakeholders, and cost analysis. Using a combination of these approaches the following areas were investigated: data quality and completeness, data access and usage, capacity for timely reporting, the acceptability, functionality, and ease of use of the application and facilitators and barriers to its use, and the relative cost of MCBR compared to the PBR system. RESULTS Compared to PBR, MCBR enabled more accurate and complete data to be reported in a much timelier manner, with 63% of MCBR users reporting they transmit rapid diagnostic test outcomes within 24 h, compared to 0% of PBR users. MCBR was favoured by integrated community malaria volunteers and their supervisors because of its efficiency. However, several technical and operational challenges associated with internet coverage, data transmission, and e-literacy were identified and stakeholders reported not being confident to rely solely on MCBR data for programmatic decision-making. CONCLUSIONS Implementation of MCBR provided timely and accurate data for malaria surveillance. Findings from this evaluation study will enable the optimization of an application-based reporting system for malaria monitoring and surveillance in the Greater Mekong Subregion and advance systems to track progress towards, and certify, the achievement of malaria elimination targets.
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Affiliation(s)
| | - Win Htike
- Burnet Institute, Melbourne, Australia
| | - Julia C Cutts
- Burnet Institute, Melbourne, Australia.,Department of Medicine, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Australia
| | - Kyawt Mon Win
- National Malaria Control Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | | | | | | | - Paul A Agius
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Department of Infectious Diseases, Monash University, Melbourne, Australia
| | | | - Nick Scott
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Department of Infectious Diseases, Monash University, Melbourne, Australia
| | | | | | - Alisa Pedrana
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Department of Infectious Diseases, Monash University, Melbourne, Australia
| | - Mark Stoove
- Burnet Institute, Melbourne, Australia.,Department of Epidemiology and Preventive Medicine, Department of Infectious Diseases, Monash University, Melbourne, Australia
| | - Aung Thi
- National Malaria Control Programme, Ministry of Health and Sports, Nay Pyi Taw, Myanmar
| | | | | | | | | | | | - Freya J I Fowkes
- Burnet Institute, Melbourne, Australia. .,Department of Epidemiology and Preventive Medicine, Department of Infectious Diseases, Monash University, Melbourne, Australia. .,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
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10
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Rajvanshi H, Jain Y, Kaintura N, Soni C, Chandramohan R, Srinivasan R, Telasey V, Bharti PK, Jain D, Surve M, Saxena S, Gangamwar V, Anand MS, Lal AA. A comprehensive mobile application tool for disease surveillance, workforce management and supply chain management for Malaria Elimination Demonstration Project. Malar J 2021; 20:91. [PMID: 33593359 PMCID: PMC7885520 DOI: 10.1186/s12936-021-03623-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 02/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health care technologies are now offering accountability, quality, robustness, and accuracy in disease surveillance and health care delivery programmes. With the advent of mobile hand-held devices, these technologies have become more accessible and adaptable for use by field staff working in remote areas. The Malaria Elimination Demonstration Project started collection of data and conduct of routine operations using paper-based reporting systems. Observing the need for a robust and quality digital mobile application, a comprehensive mobile application tool was developed that allowed the project to conduct disease surveillance, workforce management and supply chain management. METHODS In June 2017, the project conceptualized a comprehensive mobile application tool in the local language (Hindi) for disease surveillance, human resources management, and supply chain management. The tool is also available in English. Solution for Community Health-workers (SOCH) mobile app is an android native application developed using android SDK and web-based tool using MVC.net framework. Construction of the application started in November 2017 and rolled out its pilot in April 2018, followed by pan-district roll out in July 2018. The application uses self-validation tools to ensure high level of data quality and integrity. RESULTS The software is available in android based hand-held devices and web-screens with built-in data analytical capabilities. Using SOCH, the project has now successfully digitized its routine surveillance, attendance, tour plans, supply chain management components. The project has documented a reduction in 91% indigenous cases in the district, 60% improvement in stock accountability, and 99.6% accuracy in data collected through the mobile application. CONCLUSION SOCH is an excellent and user-friendly tool, which can be customized for any public health management programme. The system ensures accountability and data robustness, which is needed for malaria elimination efforts throughout the country. The mobile application can be adapted for English or any other Indian or international language for use for malaria or any other disease surveillance and control programme. Another expansion feature of this mobile application is incorporation of indicators for Indoor Residual Spraying (IRS), Long-Lasting Insecticidal Nets (LLINs), and minor engineering by the residents of community under surveillance. The authors believe that it would be highly desirable and appropriate for an international organization, such as the World Health Organization (WHO), to conduct an independent comparison of all available mobile e-surveillance tools, so that a high-performing and globally suitable system can be selected for use in malaria elimination programmes. The Foundation of Disease Elimination and Controlof India has decided to make the SOCH mobile application available to anyone who would like to use it for disease surveillance and health care programmes.
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Affiliation(s)
- Harsh Rajvanshi
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India.
| | | | | | - Chaitanya Soni
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | | | | | - Vinay Telasey
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
| | - Praveen K Bharti
- Indian Council of Medical Research-National Institute of Research in Tribal Health (ICMR-NIRTH), Jabalpur, Madhya Pradesh, India
| | - Deepak Jain
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | - Mangeshi Surve
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | | | - Vilas Gangamwar
- Information Technology, Sun Pharmaceutical Industries Ltd, Mumbai, Maharashtra, India
| | - M S Anand
- Swaas Systems Pvt Ltd, Chennai, Tamil Nadu, India
| | - Altaf A Lal
- Malaria Elimination Demonstration Project, Mandla, Madhya Pradesh, India
- Foundation for Disease Elimination and Control of India, Mumbai, Maharashtra, India
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Mapping evidence of mobile health technologies for disease diagnosis and treatment support by health workers in sub-Saharan Africa: a scoping review. BMC Med Inform Decis Mak 2021; 21:11. [PMID: 33407438 PMCID: PMC7789784 DOI: 10.1186/s12911-020-01381-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/22/2020] [Indexed: 01/01/2023] Open
Abstract
Background The rapid growth of mobile technology has given rise to the development of mobile health (mHealth) applications aimed at treating and preventing a wide range of health conditions. However, evidence on the use of mHealth in high disease burdened settings such as sub-Sharan Africa is not clear. Given this, we systematically mapped evidence on mHealth for disease diagnosis and treatment support by health workers in sub-Saharan Africa. Methods We conducted a scoping review study guided by the Arksey and O’Malley’s framework, Levac et al. recommendations, and Joanna Briggs Institute guidelines. We thoroughly searched the following databases: MEDLINE and CINAHL with full text via EBSCOhost; PubMed; Science Direct and Google Scholar for relevant articles from the inception of mHealth technology to April 2020. Two reviewers independently screened abstracts and full-text articles using the eligibility criteria as reference. This study employed the mixed methods appraisal tool version 2018 to assess the methodological quality of the included studies. Results Out of the 798 articles identified, only 12 published articles presented evidence on the availability and use of mHealth for disease diagnosis and treatment support by health workers in SSA since 2010. Of the 12 studies, four studies were conducted in Kenya; two in Malawi; two in Nigeria; one in South Africa; one in Zimbabwe; one in Mozambique, and one in Lesotho. Out of the 12 studies, one reported the use of mHealth for diseases diagnosis; three reported the use of mHealth to manage HIV; two on the management of HIV/TB; two on the treatment of malaria; one each on the management of hypertension; cervical cancer; and three were not specific on any disease condition. All the 12 included studies underwent methodological quality appraisal with a scored between 70 and 100%. Conclusions The study shows that there is limited research on the availability and use of mHealth by health workers for disease diagnosis and treatment support in sub-Saharan Africa. We, therefore, recommend primary studies focusing on the use of mHealth by health workers for disease diagnosis and treatment support in sub-Saharan Africa.
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Use of mobile phones for patient self-reporting adverse drug reactions: A pilot study at a tertiary hospital in Rwanda. HEALTH AND TECHNOLOGY 2021. [DOI: 10.1007/s12553-020-00510-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lim JT, Dickens BSL, Choo ELW, Chew LZX, Koo JRH, Tam C, Park M, Cook AR. Revealing regional disparities in the transmission potential of SARS-CoV-2 from interventions in Southeast Asia. Proc Biol Sci 2020; 287:20201173. [PMID: 32842911 PMCID: PMC7482285 DOI: 10.1098/rspb.2020.1173] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 08/03/2020] [Indexed: 12/26/2022] Open
Abstract
SARS-CoV-2 is a new pathogen responsible for the coronavirus disease 2019 (COVID-19) outbreak. Southeast Asia was the first region to be affected outside China, and although COVID-19 cases have been reported in all countries of Southeast Asia, both the policies and epidemic trajectories differ substantially, potentially due to marked differences in social distancing measures that have been implemented by governments in the region. This paper studies the across-country relationships between social distancing and each population's response to policy, the subsequent effects of these responses to the transmissibility and epidemic trajectories of SARS-CoV-2. The analysis couples COVID-19 case counts with real-time mobility data across Southeast Asia to estimate the effects of host population response to social distancing policy and the subsequent effects on the transmissibility and epidemic trajectories of SARS-CoV-2. A novel inference strategy for the time-varying reproduction number is developed to allow explicit inference of the effects of social distancing on the transmissibility of SARS-CoV-2 through a regression structure. This framework replicates the observed epidemic trajectories across most Southeast Asian countries, provides estimates of the effects of social distancing on the transmissibility of disease and can simulate epidemic histories conditional on changes in the degree of intervention scenarios and compliance within Southeast Asia.
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Affiliation(s)
- Jue Tao Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Borame Sue Lee Dickens
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Esther Li Wen Choo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - Lawrence Zheng Xiong Chew
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
- Department of Geography, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
| | - Joel Rui Han Koo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Clarence Tam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Minah Park
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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Yasmin F, Nahar N, Banu B, Ali L, Sauerborn R, Souares A. The influence of mobile phone-based health reminders on patient adherence to medications and healthy lifestyle recommendations for effective management of diabetes type 2: a randomized control trial in Dhaka, Bangladesh. BMC Health Serv Res 2020; 20:520. [PMID: 32513164 PMCID: PMC7282058 DOI: 10.1186/s12913-020-05387-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 06/01/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In 2017, 80% of 425 million adults with diabetes worldwide were living in low and middle-income countries. Diabetes affected 6.9 million adults in Bangladesh and accounted for 3% of the country's total mortality. Proper management of diabetes is the key to positive health outcomes. This study investigated how mobile phone-based health intervention could increase patient adherence and thereby improve the disease outcomes for diabetes type 2 in Bangladesh. METHODS A mobile phone-based health project (including mobile phone reminders and 24/7 call center) was implemented in Dhaka District, Bangladesh from January to December 2014. A randomized control trial was carried out, recruiting randomly in intervention and control groups among the patients receiving treatment for type 2 diabetes at the Bangladesh Institute of Health Sciences Hospital, Dhaka, Bangladesh. A total of 320 patients from both groups at baseline and 273 at endline were interviewed. RESULTS A significant improvement in patient adherence to diet, physical exercise, the cessation of use of tobacco and betel nut, and blood glycaemic control was found in the intervention group, whereas no such significant improvement was found in the control group. Cost and other co-morbidities were found to be the main reasons for non-adherence. CONCLUSION A mobile-health intervention should be considered as an additional option for non-communicable disease programs.
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Affiliation(s)
- Farzana Yasmin
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany.
- Friede Springer Endowed Professorship for Global Child Health, Faculty of Health/Department of Human Medicine, University of Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Germany.
| | | | - Bilkis Banu
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
| | - Liaquat Ali
- Pothikrit Institute of Health Studies, Dhaka, Bangladesh
| | - Rainer Sauerborn
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
| | - Aurélia Souares
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany
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Yasmin F, Ali L, Banu B, Rasul FB, Sauerborn R, Souares A. Understanding patients' experience living with diabetes type 2 and effective disease management: a qualitative study following a mobile health intervention in Bangladesh. BMC Health Serv Res 2020; 20:29. [PMID: 31918704 PMCID: PMC6953219 DOI: 10.1186/s12913-019-4811-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2017, 425 million adults worldwide had diabetes; 80% were living in low and middle-income countries. Bangladesh had 6.9 million adults with diabetes; death from diabetes comprised 3% of the country's total mortality. This study looked at different factors (personal, familial, social, and financial) affecting both the life of patients with diabetes type 2 and the management of the disease. It also explored patient's perception of the mobile health intervention in the context of disease management and helped to explain the findings obtained from the quantitative part of this study. METHOD The study was a mixed-method, sequential explanatory design. A mobile health project (interactive voice call and call center) was implemented in Dhaka district, Bangladesh from January to December, 2014. Patients received treatment at the outpatient department of Bangladesh Institute of Health Science Hospital, Dhaka, Bangladesh, were included in intervention and control groups of the main study following a Randomized Control Trial. Among them, a total of 18 patients (9 + 9) were selected purposefully for the qualitative study, which was conducted in July, 2015. The sample was selected purposefully considering the age, sex, socio-economic status and proximity of living due to the political instability of the country during the data collection period. The interviews were transcribed and analyzed applying investigator triangulation. RESULTS Most patients stated that diabetes has affected their lives. In general, both groups´ evaluation of mobile health services were good and both regarded the recommendations for medication, diet, physical exercise, and other lifestyle behaviors (use of tobacco and betel nuts) as helpful. The cost of overall treatment (medications, physician consultations, laboratory investigations), the lack of availability of safe public places for physical exercise and unfavorable weather conditions (heat, rainfall) were mentioned as barriers to the overall management of the disease. CONCLUSION A patient-centered mobile health intervention supported by a collaborative patient-provider relationship, a strong family support system, available public spaces for exercise and the introduction of a functional public health insurance system could be beneficial for the better management of diabetes.
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Affiliation(s)
- F Yasmin
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany.
- Faculty of Health/Department of Human Medicine, University Witten/Herdecke, 58448, Witten, Germany.
| | - L Ali
- Bangladesh University of Health Sciences (BUHS), Mirpur-1, Dhaka, 1216, Bangladesh
| | - B Banu
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - F B Rasul
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
- BRAC James P. Grant School of Public Health, BRAC University, Mohakhali, Dhaka, 1212, Bangladesh
| | - R Sauerborn
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - A Souares
- Heidelberg Institute of Global Health, Heidelberg University Hospital, 69120, Heidelberg, Germany
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16
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Mohammed A, Acheampong PR, Otupiri E, Osei FA, Larson-Reindorf R, Owusu-Dabo E. Mobile phone short message service (SMS) as a malaria control tool: a quasi-experimental study. BMC Public Health 2019; 19:1193. [PMID: 31464623 PMCID: PMC6716929 DOI: 10.1186/s12889-019-7336-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/17/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Despite the extensive implementation of control measures and achievements in morbidity reductions, malaria continues to contribute to substantial morbidity and mortality in children under-five. Innovative approaches involving the use of mobile phones have been suggested to improve health outcomes. However, evidence of its effect on reducing the prevalence of malaria is limited. This study, therefore, aimed to assess the effect of a theory-driven mHealth intervention on the prevalence of malaria among children under-five living in rural districts of Ghana. METHODS We conducted a quasi-experimental study of a 12-month intervention using a random sample of 332 caregivers with children under-five from two rural districts, assigned to either an intervention or a control group. Caregivers in the intervention group received voice short message service (SMS) on malaria prevention based on a behavior change theory to improve their health behaviors and practice, once a week for twelve months, while caregivers in the control group received none. Pre- and post-intervention assessment of the treatment effect (ATT) on malaria in children under-five was conducted using propensity score and difference-in-difference (DiD) analyses. RESULTS Among children whose caregivers received the intervention, the prevalence of malaria decreased from 58.4% at baseline to 37.8% at endline (difference: -20.6%; 95% CI: - 31.1, - 10.1) compared with children in the control group, where a reduction of 65.0 to 59.9% (difference - 5.1%; 95% CI: - 15.5, 5.4) was observed. The treatment effect at endline revealed a statistically significant reduction in malaria prevalence (ATT: -0.214; 95% CI: - 0.36, - 0.07) compared with the baseline (ATT: -0.035; 95% CI: - 0.16, 0.09). Overall, the intervention effect showed a significant reduction in the prevalence of malaria among children under-five was positive (DiD: - 0.154; p = 0.043). CONCLUSION The results of the study indicate the effectiveness of mobile phone SMS as a control tool for reducing the burden of malaria in children under-five.
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Affiliation(s)
- Aliyu Mohammed
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | | | - Easmon Otupiri
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
| | - Francis Adjei Osei
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Public Health Unit, Komfo-Anokye Teaching Hospital, Kumasi, Ghana
| | - Roderick Larson-Reindorf
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
- Obstetrics and Gynaecology Department, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Ellis Owusu-Dabo
- School of Public Health, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana
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Cliquet Jr. A, Wiebe S, Anderson P, Saggio G, Zwiggelaar R, Gamboa H, Fred A, Bermúdez i Badia S. A Multiagent-Based Model for Epidemic Disease Monitoring in DR Congo. BIOMEDICAL ENGINEERING SYSTEMS AND TECHNOLOGIES 2019. [PMCID: PMC7120616 DOI: 10.1007/978-3-030-29196-9_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Any infectious diseases have been reported in sub-Saharan countries over the past decade due to the inefficiency of health structures to anticipate outbreaks. In a poorly-infrastructure country such as the Democratic Republic of Congo (DRC), with inadequate health staff and laboratories, it is difficult to respond rapidly to an epidemic, especially in rural areas. As the DRC’s health system has three levels (peripheral, regional and national), from the production of health data at the peripheral level to the national level that makes the decision, meantime the disease can spread to many people. Lack of communication between health centres of the same health zone and Health zones of the same Health Provincial Division does not contribute to the regional response. This article, an extended version of [1], proposes a well elaborated solution track to deal with this problem by using an agent-centric approach to study by simulation how to improve the process. A new experiment is described by arranging twenty-eight health zones of Kinshasa to show how their collaboration can provide unique health data source for all stakeholders and help reducing disease propagation. It concerns also 47 health centres, 1 medical laboratory, 1 Provincial Health Division and 4 Rapid Riposte Teams. The simulation data, provided by Provincial Health Division of Kinshasa, concerned cholera outbreak from January to December 2017. The interaction between these agents demonstrated that Health Zone Agent can automatically alert his neighbours whenever he encountered a confirmed case of an outbreak. This action can reduce disease propagation as population will be provided with prevention measures. These interactions between agents have provided models to propose to the current system in order to find out the best that can help reducing decision time.
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Affiliation(s)
| | | | | | | | | | - Hugo Gamboa
- LIBPhys, New University of Lisbon, Lisbon, Portugal
| | - Ana Fred
- Instituto de Telecomunicações and Instituto Superior Técnico, Lisbon, Portugal
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Worges M, Celone M, Finn T, Chisha Z, Winters A, Winters B, Keating J, Yukich JO. Malaria case management in Zambia: A cross-sectional health facility survey. Acta Trop 2019; 195:83-89. [PMID: 31054287 DOI: 10.1016/j.actatropica.2019.04.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 04/25/2019] [Accepted: 04/29/2019] [Indexed: 01/10/2023]
Abstract
Misdiagnosis of malaria could lead to the overuse of antimalarials resulting in the progression of underlying illness as well as increased risk of mortality. Misdiagnosis is an important consideration as a significant proportion of febrile illnesses in sub-Saharan Africa are attributable to conditions other than malaria. A health facility survey was carried out for a simple random sample of health facilities across 4 provinces of central Zambia in 2014. Twenty-nine facilities with at least 10 outpatients per day were included in the final sample. A modified service provision assessment questionnaire was used for data collection along with several other instruments. Primary outcomes included the quality and accuracy of diagnostic testing for malaria as well as health worker diagnostic and treatment practices. Laboratory technicians displayed 65.5% sensitivity and 86.0% specificity in performing malaria microscopy. Rapid diagnostic test results as reported by health workers were cross-checked by survey staff revealing 99.8% (95% CI: 98.0%-100.0%) concordance. Overall, 69.5% (177/286) (95% CI [58.8%-78.4%]) of patients were reported as febrile of which 37.0% (68/177) (95% CI [21.0%-56.6%]) had a malaria test requested or conducted by their health worker. Appropriate health worker adherence to recommended malaria case management practices (i.e. requesting/conducting malaria tests for febrile patients and providing appropriate antimalarial treatment for test positive cases or forgoing antimalarial treatment for test negative cases) was 30.5% (57/177) (95% CI [17.1%-48.4%]). Presence of fever (aOR = 10.6; 95% CI [3.6-31.2]) and self-reported headache (aOR = 2.2; 95% CI [1.0-4.9]) were significant factors in explaining health worker practices of requesting or performing malaria tests. Routine practice of IQA activities (aOR = 4.8; 95% CI [1.5-15.1]) and self-reported headache (aOR = 3.3; 95% CI [1.1-10.1])) were both significant predictors of antimalarial drug treatment or prescription among malaria untested patients. Prescriber adherence to malaria diagnostic test results in central Zambia is good, but the overall testing rate of febrile patients was low. Additionally, a number of patients observed during this survey were found to have received a clinical diagnosis of malaria without parasitological confirmation and many patients without test results received antimalarial treatment.
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Affiliation(s)
- Matt Worges
- Tulane University School of Public Health and Tropical Medicine, 1440 Canal St #2400, New Orleans, LA, 70112, USA.
| | | | | | - Zunda Chisha
- School of Economics, University of Cape Town, Cape Town, South Africa
| | - Anna Winters
- Akros, Lusaka, Zambia; University of Montana, Missoula, USA
| | | | - Joseph Keating
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Joshua O Yukich
- Center for Applied Malaria Research and Evaluation, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
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Talisuna AO, Zurovac D, Githinji S, Oburu A, Malinga J, Nyandigisi A, Jones CO, Snow RW. Efficacy of Mobile Phone Short Message Service (SMS) Reminders on Malaria Treatment Adherence and Day 3 Post-Treatment Reviews (SMS-RES-MAL) in Kenya: A Study Protocol. ACTA ACUST UNITED AC 2019; 5:217. [PMID: 31285980 PMCID: PMC6614027 DOI: 10.4172/2167-0870.1000217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Mobile phone short messaging services (SMS) have been investigated in health information reporting, provider performance, drug and diagnostic stock management and patient adherence to treatment for chronic diseases. However, their potential role in improving patients’ adherence to malaria treatment and day 3 post treatment reviews remains unclear. Methods/Design A “proof of concept” open label randomised controlled trial will be conducted at four sites in Western Kenya. Principal research questions are: 1) Can mobile phone SMS reminders improve patient adherence to malaria treatment? 2) Can mobile phone SMS reminders improve day 3 post treatment reviews? Eligible caregivers (n=1000 per arm) of children under five years old with uncomplicated malaria will be randomly assigned (one to one) to: a) the current standard of care (provider counselling and health education); and b) the current standard of care plus SMS reminders. Within each arm, caregivers will be further randomized to three different categories. In categories 1 and 2, 300 caregivers per arm per category will be visited at home on day 1 and 2 of follow up respectively, to measure appropriate timing and adherence of the second Artemether-Lumefantrine (AL) dose and doses 3 and 4. Further, caregivers in categories 1 and 2 will be required to come to the health facility for the day 3 post treatment reviews. Finally, in category 3, 400 caregivers per arm will be visited at home on day 3 to measure adherence for the full AL course. Each category will be visited at home only once to avoid biases in the measures of adherence as a result of home consultations. Primary outcomes will be adherence to the full AL course (category 3), as well as, the proportion of patients reporting back for day 3 post treatment reviews (categories 1 and 2). The primary analysis will be intention-to-treat. Costs of the intervention will be measured over the period of the intervention, and a cost-effectiveness ratio will be estimated. Discussion If successful, evidence from this trial could improve malaria treatment adherence and offer pragmatic approaches for antimalarial drug resistance surveillance and risk mitigation in Africa. Current Controlled Trials ISRCTN39512726
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Affiliation(s)
- Ambrose O Talisuna
- Department of Public Health Research, KEMRI-Welcome Trust Research Program, Kenya.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Dejan Zurovac
- Department of Public Health Research, KEMRI-Welcome Trust Research Program, Kenya.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Sophie Githinji
- Department of Public Health Research, KEMRI-Welcome Trust Research Program, Kenya
| | - Amos Oburu
- Department of Public Health Research, KEMRI-Welcome Trust Research Program, Kenya
| | - Josephine Malinga
- Department of Public Health Research, KEMRI-Welcome Trust Research Program, Kenya
| | | | - Caroline Oh Jones
- Department of Public Health Research, KEMRI-Welcome Trust Research Program, Kenya.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Robert W Snow
- Department of Public Health Research, KEMRI-Welcome Trust Research Program, Kenya.,Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, UK
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Ggita JM, Ojok C, Meyer AJ, Farr K, Shete PB, Ochom E, Turimumahoro P, Babirye D, Mark D, Dowdy D, Ackerman S, Armstrong-Hough M, Nalugwa T, Ayakaka I, Moore D, Haberer JE, Cattamanchi A, Katamba A, Davis JL. Patterns of usage and preferences of users for tuberculosis-related text messages and voice calls in Uganda. Int J Tuberc Lung Dis 2019; 22:530-536. [PMID: 29663958 DOI: 10.5588/ijtld.17.0521] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little information exists about mobile phone usage or preferences for tuberculosis (TB) related health communications in Uganda. METHODS We surveyed household contacts of TB patients in urban Kampala, Uganda, and clinic patients in rural central Uganda. Questions addressed mobile phone access, usage, and preferences for TB-related communications. We collected qualitative data about messaging preferences. RESULTS We enrolled 145 contacts and 203 clinic attendees. Most contacts (58%) and clinic attendees (75%) owned a mobile phone, while 42% of contacts and 10% of clinic attendees shared one; 94% of contacts and clinic attendees knew how to receive a short messaging service (SMS) message, but only 59% of contacts aged 45 years (vs. 96% of contacts aged <45 years, P = 0.0001) did so. All contacts and 99% of clinic attendees were willing and capable of receiving personal-health communications by SMS. Among contacts, 55% preferred detailed messages disclosing test results, while 45% preferred simple messages requesting a clinic visit to disclose results. CONCLUSIONS Most urban household TB contacts and rural clinic attendees reported having access to a mobile phone and willingness to receive TB-related personal-health communications by voice call or SMS. However, frequent phone sharing and variable messaging abilities and preferences suggest a need to tailor the design and monitoring of mHealth interventions to target recipients.
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Affiliation(s)
- J M Ggita
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - C Ojok
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - A J Meyer
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - K Farr
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
| | - P B Shete
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
| | - E Ochom
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - P Turimumahoro
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - D Babirye
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - D Mark
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - D Dowdy
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda; Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - S Ackerman
- Department of Social & Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - M Armstrong-Hough
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA
| | - T Nalugwa
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - I Ayakaka
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda
| | - D Moore
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda; London School of Hygiene & Tropical Medicine, London, England, UK
| | - J E Haberer
- Massachusetts General Hospital Global Health, Boston, Massachusetts, USA, Harvard Medical School, Boston, Massachusetts, USA
| | - A Cattamanchi
- Division of Pulmonary and Critical Care Medicine, University of California San Francisco and Zuckerberg San Francisco General Hospital, San Francisco, California, USA; Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA
| | - A Katamba
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda; Clinical Epidemiology Unit, Department of Medicine, Makerere University, Kampala, Uganda
| | - J L Davis
- Uganda Tuberculosis Implementation Research Consortium, Makerere University, Kampala, Uganda; Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, USA; Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, USA
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21
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Davies C, Graffy R, Shandukani M, Baloyi E, Gast L, Kok G, Mbokazi F, Zita A, Zwane M, Magagula R, Mabuza A, Ramkrishna W, Morris N, Porteous J, Shirreff G, Blumberg L, Misiani E, Moonasar D. Effectiveness of 24-h mobile reporting tool during a malaria outbreak in Mpumalanga Province, South Africa. Malar J 2019; 18:45. [PMID: 30791909 PMCID: PMC6385402 DOI: 10.1186/s12936-019-2683-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/14/2019] [Indexed: 11/25/2022] Open
Abstract
Background As surveillance is a key strategy for malaria elimination in South Africa, ensuring strong surveillance systems is a National Department of Health priority. Historically, real time tracking of case trends and reporting within 24 h—a requirement in South Africa’s National surveillance guidelines—has not been possible. To enhance surveillance and response efficiency, a mobile surveillance tool, MalariaConnect, was developed using Unstructured Supplementary Service Data (USSD) technology. It was rolled out in health facilities in malaria endemic areas of South Africa to provide 24-h reporting of malaria cases. Methods To evaluate the efficiency of the mobile tool to detect an outbreak data were extracted from the paper based and MalariaConnect reporting systems in Bushbuckridge from 1 January to 18 June 2017. These data were subject to time series analyses to determine if MalariaConnect provided sufficient data reliably to detect increasing case trends reported through the paper system. The Chi squared test was used to determine goodness of fit between the following indicator data generated using MalariaConnect and paper reporting systems: timeliness, completeness, and precision. Results MalariaConnect adequately tracked case trends reported through the paper system. Timeliness of reporting increased significantly using MalariaConnect with 0.63 days to notification compared to 5.65 days using the paper-system (p < 0.05). The completeness of reporting was significantly higher for the paper system (100% completion; p < 0.05), compared to confirmed MalariaConnect cases (61%). There was a moderate association between data precision and the reporting system (p < 0.05). MalariaConnect provided an effective way of reliably and accurately identifying the onset of the malaria outbreak in Bushbuckridge. Conclusion Timeliness significantly improved using MalariaConnect and in a malaria elimination setting, can be used to markedly improve case investigation and response activities within the recommended 72-h period. Although data completeness and precision were lower compared to paper reporting, MalariaConnect data can be used to trigger outbreak responses.
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Affiliation(s)
- Craig Davies
- Malaria Programme, Clinton Health Access Initiative, Pretoria, South Africa
| | - Rebecca Graffy
- Malaria Programme, Clinton Health Access Initiative, Pretoria, South Africa
| | - Mbavhalelo Shandukani
- Department of Health, Malaria and Other Vector Borne Diseases, Pretoria, South Africa
| | - Ednah Baloyi
- Department of Health, Malaria and Other Vector Borne Diseases, Pretoria, South Africa
| | - Laura Gast
- Malaria Programme, Clinton Health Access Initiative, Pretoria, South Africa
| | - Gerdalize Kok
- Mpumalanga Department of Health, Malaria Control Programme, Mbombela, South Africa
| | - Frans Mbokazi
- Mpumalanga Department of Health, Malaria Control Programme, Mbombela, South Africa
| | - Alpheus Zita
- Mpumalanga Department of Health, Malaria Control Programme, Mbombela, South Africa
| | - Mandla Zwane
- Centre for Disease Control, Mpumalanga Department of Health and Social Development, Mbombela, South Africa
| | - Ray Magagula
- Mpumalanga Department of Health, Malaria Control Programme, Mbombela, South Africa
| | - Aaron Mabuza
- Malaria Programme, Clinton Health Access Initiative, Pretoria, South Africa
| | - Wayne Ramkrishna
- Department of Health, Malaria and Other Vector Borne Diseases, Pretoria, South Africa
| | | | | | - George Shirreff
- Malaria Programme, Clinton Health Access Initiative, Pretoria, South Africa
| | - Lucille Blumberg
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases (NICD) of the National Health Laboratory Service (NHLS), Johannesburg, South Africa
| | - Eunice Misiani
- Department of Health, Malaria and Other Vector Borne Diseases, Pretoria, South Africa
| | - Devanand Moonasar
- Department of Health, Malaria and Other Vector Borne Diseases, Pretoria, South Africa. .,School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
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Steinhardt LC, Mathanga DP, Mwandama D, Nsona H, Moyo D, Gumbo A, Kobayashi M, Namuyinga R, Shah MP, Bauleni A, Troell P, Zurovac D, Rowe AK. The Effect of Text Message Reminders to Health Workers on Quality of Care for Malaria, Pneumonia, and Diarrhea in Malawi: A Cluster-Randomized, Controlled Trial. Am J Trop Med Hyg 2019; 100:460-469. [PMID: 30628566 DOI: 10.4269/ajtmh.18-0529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The use of mobile technologies in medicine, or mHealth, holds promise to improve health worker (HW) performance, but evidence is mixed. We conducted a cluster-randomized controlled trial to evaluate the effect of text message reminders to HWs in outpatient health facilities (HFs) on quality of care for malaria, pneumonia, and diarrhea in Malawi. After a baseline HF survey (2,360 patients) in January 2015, 105 HFs were randomized to three arms: 1) text messages to HWs on malaria case management; 2) text messages to HWs on malaria, pneumonia, and diarrhea case management (latter two for children < 5 years); and 3) control arm (no messages). Messages were sent beginning April 2015 twice daily for 6 months, followed by an endline HF survey (2,536 patients) in November 2015. An intention-to-treat analysis with difference-in-differences binomial regression modeling was performed. The proportion of patients with uncomplicated malaria managed correctly increased from 42.8% to 59.6% in the control arm, from 43.7% to 55.8% in arm 1 (effect size -4.7%-points, 95% confidence interval (CI): -18.2, 8.9, P = 0.50) and from 30.2% to 50.9% in arm 2 (effect size 3.9%-points, 95% CI: -14.1, 22.0, P = 0.67). Prescription of first-line antibiotics to children < 5 years with clinically defined pneumonia increased in all arms, but decreased in arm 2 (effect size -4.1%-points, 95% CI: -42.0, 33.8, P = 0.83). Prescription of oral rehydration solution to children with diarrhea declined slightly in all arms. We found no significant improvements in malaria, pneumonia, or diarrhea treatment after HW reminders, illustrating the importance of rigorously testing new interventions before adoption.
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Affiliation(s)
- Laura C Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Don P Mathanga
- Malaria Alert Centre, College of Medicine, Blantyre, Malawi
| | - Dyson Mwandama
- Malaria Alert Centre, College of Medicine, Blantyre, Malawi
| | | | | | | | - Miwako Kobayashi
- Respiratory Diseases Branch, Division of Bacterial Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ruth Namuyinga
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monica P Shah
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Andy Bauleni
- Malaria Alert Centre, College of Medicine, Blantyre, Malawi
| | - Peter Troell
- US President's Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Dejan Zurovac
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, US Centers for Disease Control and Prevention, Atlanta, Georgia
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23
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Kaunda-Khangamwa BN, Steinhardt LC, Rowe AK, Gumbo A, Moyo D, Nsona H, Troell P, Zurovac D, Mathanga D. The effect of mobile phone text message reminders on health workers' adherence to case management guidelines for malaria and other diseases in Malawi: lessons from qualitative data from a cluster-randomized trial. Malar J 2018; 17:481. [PMID: 30567603 PMCID: PMC6299948 DOI: 10.1186/s12936-018-2629-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/13/2018] [Indexed: 11/15/2022] Open
Abstract
Background Mobile health (mHealth), which uses technology such as mobile phones to improve patient health and health care delivery, is increasingly being tested as an intervention to promote health worker (HW) performance. This study assessed the effect of short messaging services (SMS) reminders in a study setting. Following a trial of text-message reminders to HWs to improve case management of malaria and other childhood diseases in southern Malawi that showed little effect, qualitative data was collected to explore the reasons why the intervention was ineffective and describe lessons learned. Methods Qualitative data collection was undertaken to lend insight into quantitative results from a trial in which 105 health facilities were randomized to three arms: (1) twice-daily text-message reminders to HWs, including clinicians and drug dispensers, on case management of malaria; (2) twice-daily text-message reminders to HWs on case management of malaria, pneumonia and diarrhoea; and, (3) a control arm. In-depth interviews were conducted with 50 HWs in the intervention arms across seven districts. HWs were asked about acceptability and feasibility of the text-messaging intervention and its perceived impact on recommended case management. The interviews were recorded, transcribed and translated into English for a thematic and framework analysis. Nvivo 11 software was used for data management and analysis. Results A total of 50 HWs were interviewed at 22 facilities. HWs expressed high acceptance of text-message reminders and appreciated messages as job aids and practical reference material for their day-to-day work. However, HWs said that health systems barriers, including very high outpatient workload, commodity stock-outs, and lack of supportive supervision and financial incentives demotivated them, limited their ability to act on messages and therefore adherence to case management guidelines. Drug dispensers were more likely than clinicians to report usage of text-message reminders. Despite these challenges, nearly all HWs expressed a desire for a longer duration of the SMS intervention. Conclusions Text-message reminders to HWs can provide a platform to improve understanding of treatment guidelines and case management decision-making skills, but might not improve actual adherence to guidelines. More interaction, for example through targeted supervision or two-way technology communication, might be an essential intervention component to help address structural barriers and facilitate improved clinical practice.
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Affiliation(s)
- Blessings N Kaunda-Khangamwa
- Malaria Alert Centre (MAC), Communicable Disease Action Centre, University of Malawi College of Medicine, Blantyre, Malawi.,School of Public Health, The University of Witwatersrand, Johannesburg, South Africa
| | - Laura C Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Austin Gumbo
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Dubulao Moyo
- Integrated Management of Childhood Diseases Program, Ministry of Health, Lilongwe, Malawi
| | - Humphreys Nsona
- Integrated Management of Childhood Diseases Program, Ministry of Health, Lilongwe, Malawi
| | - Peter Troell
- President's Malaria Initiative, Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Lilongwe, Malawi
| | - Dejan Zurovac
- KEMRI-Wellcome Trust-Research Programme, Nairobi, Kenya.,Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Don Mathanga
- Malaria Alert Centre (MAC), Communicable Disease Action Centre, University of Malawi College of Medicine, Blantyre, Malawi
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El-Khatib Z, Shah M, Zallappa SN, Nabeth P, Guerra J, Manengu CT, Yao M, Philibert A, Massina L, Staiger CP, Mbailao R, Kouli JP, Mboma H, Duc G, Inagbe D, Barry AB, Dumont T, Cavailler P, Quere M, Willett B, Reaiche S, de Ribaucourt H, Reeder B. SMS-based smartphone application for disease surveillance has doubled completeness and timeliness in a limited-resource setting - evaluation of a 15-week pilot program in Central African Republic (CAR). Confl Health 2018; 12:42. [PMID: 30386418 PMCID: PMC6199707 DOI: 10.1186/s13031-018-0177-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background It is a challenge in low-resource settings to ensure the availability of complete, timely disease surveillance information. Smartphone applications (apps) have the potential to enhance surveillance data transmission. Methods The Central African Republic (CAR) Ministry of Health and Médecins Sans Frontières (MSF) conducted a 15-week pilot project to test a disease surveillance app, Argus, for 20 conditions in 21 health centers in Mambéré Kadéi district (MK 2016). Results were compared to the usual paper-based surveillance in MK the year prior (MK 2015) and simultaneously in an adjacent health district, Nana-Mambére (NM 2016). Wilcoxon rank sum and Kaplan-Meier analyses compared report completeness and timeliness; the cost of the app, and users' perceptions of its usability were assessed. Results Two hundred seventy-one weekly reports sent by app identified 3403 cases and 63 deaths; 15 alerts identified 28 cases and 4 deaths. Median completeness (IQR) for MK 2016, 81% (81-86%), was significantly higher than in MK 2015 (31% (24-36%)), and NM 2016 (52% (48-57)) (p < 0.01). Median timeliness (IQR) for MK 2016, 50% (39-57%) was also higher than in MK 2015, 19% (19-24%), and NM 2016 29% (24-36%) (p < 0.01). Kaplan-Meier Survival Analysis showed a significant progressive reduction in the time taken to transmit reports over the 15-week period (p < 0.01). Users ranked the app's usability as greater than 4/5 on all dimensions. The total cost of the 15-week pilot project was US$40,575. It is estimated that to maintain the app in the 21 health facilities of MK will cost approximately US$18,800 in communication fees per year. Conclusions The app-based data transmission system more than doubled the completeness and timeliness of disease surveillance reports. This simple, low-cost intervention may permit the early detection of disease outbreaks in similar low-resource settings elsewhere.
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Affiliation(s)
- Ziad El-Khatib
- 1Médecins Sans Frontières (MSF), Geneva, Switzerland.,2Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,3World Health Programme, Université du Québec en Abitibi-Témiscamingue (UQAT), Quebec, Canada
| | - Maya Shah
- 1Médecins Sans Frontières (MSF), Geneva, Switzerland
| | | | - Pierre Nabeth
- 5Country Health Emergency Preparedness & IHR (CPI), WHO Health Emergencies Programme (WHE), WHO, Lyon, France
| | - José Guerra
- 5Country Health Emergency Preparedness & IHR (CPI), WHO Health Emergencies Programme (WHE), WHO, Lyon, France
| | | | - Michel Yao
- World Health Organization (WHO), Bangui, Central African Republic
| | | | | | | | | | | | | | - Geraldine Duc
- 1Médecins Sans Frontières (MSF), Geneva, Switzerland
| | - Dago Inagbe
- 1Médecins Sans Frontières (MSF), Geneva, Switzerland
| | | | | | | | - Michel Quere
- 1Médecins Sans Frontières (MSF), Geneva, Switzerland
| | - Brian Willett
- 1Médecins Sans Frontières (MSF), Geneva, Switzerland
| | | | | | - Bruce Reeder
- 1Médecins Sans Frontières (MSF), Geneva, Switzerland.,8Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Canada
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25
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Valdes Angues R, Suits A, Palmer VS, Okot C, Okot RA, Atonywalo C, Gazda SK, Kitara DL, Lantum M, Spencer PS. A real-time medical cartography of epidemic disease (Nodding syndrome) using village-based lay mHealth reporters. PLoS Negl Trop Dis 2018; 12:e0006588. [PMID: 29906291 PMCID: PMC6021112 DOI: 10.1371/journal.pntd.0006588] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/27/2018] [Accepted: 06/06/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Disease surveillance in rural regions of many countries is poor, such that prolonged delays (months) may intervene between appearance of disease and its recognition by public health authorities. For infectious disorders, delayed recognition and intervention enables uncontrolled disease spread. We tested the feasibility in northern Uganda of developing real-time, village-based health surveillance of an epidemic of Nodding syndrome (NS) using software-programmed smartphones operated by minimally trained lay mHealth reporters. METHODOLOGY AND PRINCIPAL FINDINGS We used a customized data collection platform (Magpi) that uses mobile phones and real-time cloud-based storage with global positioning system coordinates and time stamping. Pilot studies on sleep behavior of U.S. and Ugandan medical students identified and resolved Magpi-programmed cell phone issues. Thereafter, we deployed Magpi in combination with a lay-operator network of eight mHealth reporters to develop a real-time electronic map of child health, injury and illness relating to NS in rural northern Uganda. Surveillance data were collected for three consecutive months from 10 villages heavily affected by NS. Overall, a total of 240 NS-affected households and an average of 326 children with NS, representing 30 households and approximately 40 NS children per mHealth reporter, were monitored every week by the lay mHealth team. Data submitted for analysis in the USA and Uganda remotely pinpointed the household location and number of NS deaths, injuries, newly reported cases of head nodding (n = 22), and the presence or absence of anti-seizure medication. CONCLUSIONS AND SIGNIFICANCE This study demonstrates the feasibility of using lay mHealth workers to develop a real-time cartography of epidemic disease in remote rural villages that can facilitate and steer clinical, educational and research interventions in a timely manner.
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Affiliation(s)
- Raquel Valdes Angues
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, United States of America
| | - Austen Suits
- University of Washington, Seattle, Washington, United States of America
| | - Valerie S. Palmer
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, United States of America
| | | | | | | | | | | | - Moka Lantum
- MicroClinic Technologies, Ltd, Nairobi, Kenya
| | - Peter S. Spencer
- Department of Neurology, Oregon Health & Science University, Portland, Oregon, United States of America
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26
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Coetzee B, Kohrman H, Tomlinson M, Mbewu N, LeRoux I, Adam M. Community health workers' experiences of using video teaching tools during home visits-A pilot study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:167-175. [PMID: 28872210 PMCID: PMC7534510 DOI: 10.1111/hsc.12488] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/02/2017] [Indexed: 06/07/2023]
Abstract
Innovations in health, such as the use of tablet computers, show promise in broadening the scope of work of community health workers (CHWs), and play an important role in keeping CHWs and their clients up to date with advancements in health. While the use of mobile phones and tablets is innovative, the applicability of these technologies in different contexts remains poorly understood. Furthermore, little is known about the acceptability and feasibility of the use of video teaching tools on such devices across diverse contexts. In this study, we aimed to explore the acceptability and feasibility of using tablets with teaching videos (about HIV, alcohol, nutrition and breastfeeding) to support the health promotion efforts of 24 CHWs who work with pregnant mothers and mothers of young children in an urban township in South Africa. Between November 2015 and May 2016, we conducted focus groups and identified four key themes (with several sub-themes) that demonstrated factors related to the acceptability and feasibility of these devices and their content. Focus group transcripts were analysed thematically using qualitative data analysis software. The findings indicated that while the devices contained several supportive features (such as lightening the workload, and stimulating interest in their work), they also contained several restrictive features (safety and confidentiality). CHWs considered the video content an important tool to engage not only their clients but also family members and the community at large. Issues surrounding safety, privacy and confidentiality of using these devices require careful consideration prior to implementation in large-scale studies. Furthermore, stigma associated with household visits by CHWs and the nature of their work also need to be addressed by researchers and programme implementers. Overall, CHWs deemed the devices and the video content an acceptable and feasible means with which to provide health promotion and education among their clients.
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Affiliation(s)
- Bronwyne Coetzee
- Department of Psychology, Stellenbosch University, Matieland, South Africa
| | - Hannah Kohrman
- University of California, San Francisco, San Francisco, CA, USA
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Matieland, South Africa
| | - Nokwanele Mbewu
- Philani Maternal, Child Health and Nutrition Project, Elonwabeni, Cape Town, South Africa
| | - Ingrid LeRoux
- Philani Maternal, Child Health and Nutrition Project, Elonwabeni, Cape Town, South Africa
| | - Maya Adam
- Department of Pediatrics, Stanford University School of Medicine, Menlo Park, CA, USA
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Karimuribo ED, Mutagahywa E, Sindato C, Mboera L, Mwabukusi M, Kariuki Njenga M, Teesdale S, Olsen J, Rweyemamu M. A Smartphone App (AfyaData) for Innovative One Health Disease Surveillance from Community to National Levels in Africa: Intervention in Disease Surveillance. JMIR Public Health Surveill 2017; 3:e94. [PMID: 29254916 PMCID: PMC5748470 DOI: 10.2196/publichealth.7373] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 07/12/2017] [Accepted: 10/20/2017] [Indexed: 11/24/2022] Open
Abstract
Background We describe the development and initial achievements of a participatory disease surveillance system that relies on mobile technology to promote Community Level One Health Security (CLOHS) in Africa. Objective The objective of this system, Enhancing Community-Based Disease Outbreak Detection and Response in East and Southern Africa (DODRES), is to empower community-based human and animal health reporters with training and information and communication technology (ICT)–based solutions to contribute to disease detection and response, thereby complementing strategies to improve the efficiency of infectious disease surveillance at national, regional, and global levels. In this study, we refer to techno-health as the application of ICT-based solutions to enhance early detection, timely reporting, and prompt response to health events in human and animal populations. Methods An EpiHack, involving human and animal health experts as well as ICT programmers, was held in Tanzania in 2014 to identify major challenges facing early detection, timely reporting, and prompt response to disease events. This was followed by a project inception workshop in 2015, which brought together key stakeholders, including policy makers and community representatives, to refine the objectives and implementation plan of the DODRES project. The digital ICT tools were developed and packaged together as the AfyaData app to support One Health disease surveillance. Community health reporters (CHRs) and officials from animal and human health sectors in Morogoro and Ngorongoro districts in Tanzania were trained to use the AfyaData app. The AfyaData supports near- to real-time data collection and submission at both community and health facility levels as well as the provision of feedback to reporters. The functionality of the One Health Knowledge Repository (OHKR) app has been integrated into the AfyaData app to provide health information on case definitions of diseases of humans and animals and to synthesize advice that can be transmitted to CHRs with next step response activities or interventions. Additionally, a WhatsApp social group was made to serve as a platform to sustain interactions between community members, local government officials, and DODRES team members. Results Within the first 5 months (August-December 2016) of AfyaData tool deployment, a total of 1915 clinical cases in livestock (1816) and humans (99) were reported in Morogoro (83) and Ngorongoro (1832) districts. Conclusions These initial results suggest that the DODRES community-level model creates an opportunity for One Health engagement of people in their own communities in the detection of infectious human and animal disease threats. Participatory approaches supported by digital and mobile technologies should be promoted for early disease detection, timely reporting, and prompt response at the community, national, regional, and global levels.
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Affiliation(s)
- Esron Daniel Karimuribo
- Department of Veterinary Medicine and Public Health, College of Veterinary Medicine and Biomedical Sciences, Sokoine University of Agriculture, Morogoro, United Republic Of Tanzania
| | - Eric Mutagahywa
- Southern African Centre for Infectious Disease Surveillance, Sokoine University of Agriculture, Morogoro, United Republic Of Tanzania
| | - Calvin Sindato
- Southern African Centre for Infectious Disease Surveillance, Sokoine University of Agriculture, Morogoro, United Republic Of Tanzania
| | - Leonard Mboera
- National Institute for Medical Research, Dar es Salaam, United Republic Of Tanzania
| | - Mpoki Mwabukusi
- Southern African Centre for Infectious Disease Surveillance, Sokoine University of Agriculture, Morogoro, United Republic Of Tanzania
| | | | - Scott Teesdale
- Innovative Support to Emergencies Diseases and Disasters, San Francisco, CA, United States
| | - Jennifer Olsen
- Skoll Global Threats Fund, San Francisco, CA, United States
| | - Mark Rweyemamu
- Southern African Centre for Infectious Disease Surveillance, Sokoine University of Agriculture, Morogoro, United Republic Of Tanzania
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Khatun F, Heywood AE, Hanifi SMA, Rahman MS, Ray PK, Liaw ST, Bhuiya A. Gender differentials in readiness and use of mHealth services in a rural area of Bangladesh. BMC Health Serv Res 2017; 17:573. [PMID: 28821243 PMCID: PMC5563057 DOI: 10.1186/s12913-017-2523-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traditional gender roles result in women lagging behind men in the use of modern technologies, especially in developing countries. Although there is rapid uptake of mobile phone use in Bangladesh, investigation of gender differences in the ownership, access and use of mobile phones in general and mHealth in particular has been limited. This paper presents gender differentials in the ownership of mobile phones and knowledge of available mHealth services in a rural area of Bangladesh. METHODS We interviewed 4915 randomly selected respondents aged 18 years and above. Associations between gender and knowledge of available mHealth services, use of existing mHealth services and intentions to use mHealth services in the future were examined by multivariate logistic regression analysis, controlling for the effect of categorised covariates. RESULTS Of the 4915 respondents to the survey, 61.8% of men (1213/1964) and 34.4% of women (1015/2951) owned a mobile phone. For men, mobile phone ownership was highest among those aged 18-29 years (n = 663, 76.3%), and for women among those aged 30-39 years (n = 825, 44.7%). A higher proportion of men owned phones compared to women, irrespective of socioeconomic status (SES) as indicated by asset index (p < 0.001). Although mobile phone ownership on average was lower among women, they were more likely to share their mobile phone with their family members (19.7%) compared to men (11.6%, p < 0.001). Greater number of men were more likely to be aware of the use of mobile phones for healthcare compared to women (38.5% vs 26.5%, p < 0.001). Knowledge about available mHealth services was lower among women than men; however, intention to use mHealth services in the future was high for both genders, irrespective of age, education and socioeconomic status. CONCLUSIONS Compared to men, women are less likely to own a mobile phone and less aware of available mHealth services, despite high intention to use mHealth among both genders. To optimise the use of mHealth services and to achieve equity of use, uptake strategies should target women, with a focus on the poorer and less educated groups.
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Affiliation(s)
- Fatema Khatun
- Universal Health Coverage, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh. .,School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia.
| | - Anita E Heywood
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia
| | - Syed Manzoor Ahmed Hanifi
- Universal Health Coverage, Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - M Shafiqur Rahman
- Institute of Statistical Research and Training, University of Dhaka, Dhaka, 1000, Bangladesh
| | - Pradeep K Ray
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia
| | - Siaw-Teng Liaw
- School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW, 2052, Australia.,General Practice Unit, South West Sydney Local Health District and Ingham Institute of Applied Medical Research, 1 Campbell Street, Liverpool, NSW, 2170, Australia
| | - Abbas Bhuiya
- Partners in Population and Development (PPD), Sher-E-Bangla Nagar, Agargaon, Dhaka, 1207, Bangladesh
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Njoroge M, Zurovac D, Ogara EAA, Chuma J, Kirigia D. Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya. BMC Res Notes 2017; 10:90. [PMID: 28183341 PMCID: PMC5301342 DOI: 10.1186/s13104-017-2416-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 02/02/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The growth of Information and Communication Technology in Kenya has facilitated implementation of a large number of eHealth projects in a bid to cost-effectively address health and health system challenges. This systematic review aims to provide a situational analysis of eHealth initiatives being implemented in Kenya, including an assessment of the areas of focus and geographic distribution of the health projects. The search strategy involved peer and non-peer reviewed sources of relevant information relating to projects under implementation in Kenya. The projects were examined based on strategic area of implementation, health purpose and focus, geographic location, evaluation status and thematic area. RESULTS A total of 114 citations comprising 69 eHealth projects fulfilled the inclusion criteria. The eHealth projects included 47 mHealth projects, 9 health information system projects, 8 eLearning projects and 5 telemedicine projects. In terms of projects geographical distribution, 24 were executed in Nairobi whilst 15 were designed to have a national coverage but only 3 were scaled up. In terms of health focus, 19 projects were mainly on primary care, 17 on HIV/AIDS and 11 on maternal and child health (MNCH). Only 8 projects were rigorously evaluated under randomized control trials. CONCLUSION This review discovered that there is a myriad of eHealth projects being implemented in Kenya, mainly in the mHealth strategic area and focusing mostly on primary care and HIV/AIDs. Based on our analysis, most of the projects were rarely evaluated. In addition, few projects are implemented in marginalised areas and least urbanized counties with more health care needs, notwithstanding the fact that adoption of information and communication technology should aim to improve health equity (i.e. improve access to health care particularly in remote parts of the country in order to reduce geographical inequities) and contribute to overall health systems strengthening.
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Affiliation(s)
- Martin Njoroge
- Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya
| | - Dejan Zurovac
- Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX3 7LJ UK
- Center for Global Health and Development, Boston University School of Public Health, 85 East Concord Street, Boston, MA 02118 USA
| | | | - Jane Chuma
- Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya
| | - Doris Kirigia
- Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya
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Talisuna AO, Oburu A, Githinji S, Malinga J, Amboko B, Bejon P, Jones C, Snow RW, Zurovac D. Efficacy of text-message reminders on paediatric malaria treatment adherence and their post-treatment return to health facilities in Kenya: a randomized controlled trial. Malar J 2017; 16:46. [PMID: 28122622 PMCID: PMC5267364 DOI: 10.1186/s12936-017-1702-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/19/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Short Message Service (SMS) reminders have been suggested as a potential intervention for improving adherence to medications and health facility attendance. METHODS An open-label, randomized, controlled trial to test the efficacy of automated SMS reminders in improving adherence to artemether-lumefantrine (AL) and post-treatment attendance in comparison with standard care was conducted at four health facilities in western Kenya. Children below five years of age with uncomplicated malaria were randomized to intervention (SMS reminders) or control groups. Within each study group they were further randomized to three categories, which determined the timing of home visits to measure adherence to complete AL course and to individual AL doses. A sub-set of caregivers was advised to return to the facility on day 3 and all were advised to return after 28 days. The primary outcomes were adherence to medication and return on day 3. The primary analysis was by intention-to-treat. RESULTS Between 9 June, 2014 and 26 February, 2016, 1677 children were enrolled. Of 562 children visited at home on day 3, all AL doses were completed for 97.6% (282/289) of children in the control and 97.8% (267/273) in the intervention group (OR = 1.10; 95% CI = 0.37-3.33; p = 0.860). When correct timing in taking each dose was considered a criteria for adherence, 72.3% (209/289) were adherent in the control and 69.2% (189/273) in the intervention group (OR = 0.82; 95% CI = 0.56-1.19; p = 0.302). Sending SMS reminders significantly increased odds of children returning to the facility on day 3 (81.4 vs 74.0%; OR = 1.55; 95% CI = 1.15-2.08; p = 0.004) and on day 28 (63.4 vs 52.5%; OR = 1.58; 95% CI = 1.30-1.92; p < 0.001). CONCLUSIONS In this efficacy trial, SMS reminders increased post-treatment return to the health facility, but had no effect on AL adherence which was high in both control and intervention groups. Further effectiveness studies under the real world conditions are needed to determine the optimum role of SMS reminders. Trial registration ISRCTN39512726.
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Affiliation(s)
- Ambrose O. Talisuna
- KEMRI-Welcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Amos Oburu
- KEMRI-Welcome Trust Research Programme, Nairobi, Kenya
| | | | | | | | - Philip Bejon
- KEMRI-Welcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Caroline Jones
- KEMRI-Welcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Robert W. Snow
- KEMRI-Welcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Dejan Zurovac
- KEMRI-Welcome Trust Research Programme, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
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Pearson AL, Mack E, Namanya J. Mobile Phones and Mental Well-Being: Initial Evidence Suggesting the Importance of Staying Connected to Family in Rural, Remote Communities in Uganda. PLoS One 2017; 12:e0169819. [PMID: 28095427 PMCID: PMC5240969 DOI: 10.1371/journal.pone.0169819] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 11/17/2016] [Indexed: 11/19/2022] Open
Abstract
Due to the ubiquity of mobile phones around the globe, studies are beginning to analyze their influence on health. Prior work from developed countries highlights negative mental health outcomes related to overuse of mobile phones. However, there is little work on mental health impacts of mobile phone use or ownership in developing countries. This is an important gap to address because there are likely variations in mental health impacts of mobile phones between developing and developed countries, due to cultural nuances to phone use and distinct variations in financial models for obtaining mobile phone access in developing countries. To address this gap, this study analyzes survey data from 92 households in sparse, rural villages in Uganda to test two hypotheses about mobile phone ownership and mental health in a developing country context: (i) Mobile phone ownership is higher among more privileged groups, compared to less privileged groups (ie, wealth and ethnicity); and (ii) mobile phone ownership is positively associated with a culturally-relevant indicator of mental health, ‘feelings of peace’. Results indicate that households with mobile phones had higher levels of wealth on average, yet no significant differences were detected by ethnicity. As hypothesized, mobile phone ownership was associated with increased mental well-being for persons without family nearby (in the District) (p = 0.038) after adjusting for wealth, ethnicity and amount of land for crops and land for grazing. Mobile phone ownership was not significantly associated with increased mental well-being for persons with family nearby. These findings are consistent with studies of mobile phone use in other sub-Saharan African countries which find that phones are important tools for social connection and are thus beneficial for maintaining family ties. One might infer then that this increased feeling of mental well-being for persons located farther from family stems from the ability to maintain family connections. These findings are quite different from work in developed countries where mobile phone use is a source of technology-related stress or technostress.
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Affiliation(s)
- Amber L. Pearson
- Department of Geography, Environment & Spatial Sciences, Michigan State University, East Lansing, Michigan, United States of America; and Department of Public Health, University of Otago, Wellington, New Zealand
- * E-mail:
| | - Elizabeth Mack
- Department of Geography, Environment & Spatial Sciences, Michigan State University, East Lansing, Michigan, United States of America
| | - Judith Namanya
- Department of Geography, Environment & Spatial Sciences, Michigan State University, East Lansing, Michigan, United States of America
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Ag Ahmed MA, Gagnon MP, Hamelin-Brabant L, Mbemba GIC, Alami H. A mixed methods systematic review of success factors of mhealth and telehealth for maternal health in Sub-Saharan Africa. Mhealth 2017; 3:22. [PMID: 28736731 PMCID: PMC5505928 DOI: 10.21037/mhealth.2017.05.04] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/23/2017] [Indexed: 11/06/2022] Open
Abstract
Access to health care is still limited for many women in sub-Saharan Africa (SSA), while it remains an important determinant of maternal mortality and morbidity. Information and communication technologies (ICTs), such as mhealth and telehealth, can help to facilitate this access by acting on the various obstacles encountered by women, be they socio-cultural, economic, geographical or organizational. However, various factors contribute to the success of mhealth and telehealth implementation and use, and must be considered for these technologies to go beyond the pilot project stage. The objective of this systematic literature review is to synthesize the empirical knowledge on the success factors of the implementation and use of telehealth and mhealth to facilitate access to maternal care in SSA. The methodology used is based on that of the Cochrane Collaboration, including a documentary search using standardized language in six databases, selection of studies corresponding to the inclusion criteria, data extraction, evaluation of study quality, and synthesis of the results. A total of 93 articles were identified, which allowed the inclusion of seven studies, six of which were on mhealth. Based on the framework proposed by Broens et al., we synthesized success factors into five categories: (I) technology, such as technical support to maintain, troubleshoot and train users, good network coverage, existence of a source of energy and user friendliness; (II) user acceptance, which is facilitated by factors such as unrestricted use of the device, perceived usefulness to the worker, adequate literacy, or previous experience of use ; (III) short- and long-term funding; (IV) organizational factors, such as the existence of a well-organized health system and effective coordination of interventions; and (V) political or legislative aspects, in this case strong government support to deploy technology on a large scale. Telehealth and mhealth are promising solutions to reduce maternal morbidity and mortality in SSA, but knowledge on how these interventions can succeed and move to scale is limited. Success factors identified in this review can provide guidance on elements that should be considered in the design and implementation of telehealth and mhealth for maternal health in SSA.
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Affiliation(s)
| | - Marie-Pierre Gagnon
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
- Faculty of Nursing, Université Laval, Québec, Canada
| | | | | | - Hassane Alami
- Centre de recherche du CHU de Québec-Université Laval, Québec, Canada
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Toda M, Njeru I, Zurovac D, O-Tipo S, Kareko D, Mwau M, Morita K. Effectiveness of a Mobile Short-Message-Service-Based Disease Outbreak Alert System in Kenya. Emerg Infect Dis 2016; 22:711-5. [PMID: 26981628 PMCID: PMC4806970 DOI: 10.3201/eid2204.151459] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We conducted a randomized, controlled trial to test the effectiveness of a text-messaging system used for notification of disease outbreaks in Kenya. Health facilities that used the system had more timely notifications than those that did not (19.2% vs. 2.6%), indicating that technology can enhance disease surveillance in resource-limited settings.
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Community readiness for adopting mHealth in rural Bangladesh: A qualitative exploration. Int J Med Inform 2016; 93:49-56. [DOI: 10.1016/j.ijmedinf.2016.05.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 11/21/2022]
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Davis TL, DiClemente R, Prietula M. Taking mHealth Forward: Examining the Core Characteristics. JMIR Mhealth Uhealth 2016; 4:e97. [PMID: 27511612 PMCID: PMC4997001 DOI: 10.2196/mhealth.5659] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 07/02/2016] [Accepted: 07/20/2016] [Indexed: 01/21/2023] Open
Abstract
The emergence of mobile health (mHealth) offers unique and varied opportunities to address some of the most difficult problems of health. Some of the most promising and active efforts of mHealth involve the engagement of mobile phone technology. As this technology has spread and as this technology is still evolving, we begin a conversation about the core characteristics of mHealth relevant to any mobile phone platform. We assert that the relevance of these characteristics to mHealth will endure as the technology advances, so an understanding of these characteristics is essential to the design, implementation, and adoption of mHealth-based solutions. The core characteristics we discuss are (1) the penetration or adoption into populations, (2) the availability and form of apps, (3) the availability and form of wireless broadband access to the Internet, and (4) the tethering of the device to individuals. These collectively act to both enable and constrain the provision of population health in general, as well as personalized and precision individual health in particular.
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Mapping Malaria Risk in Low Transmission Settings: Challenges and Opportunities. Trends Parasitol 2016; 32:635-645. [PMID: 27238200 DOI: 10.1016/j.pt.2016.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Revised: 04/29/2016] [Accepted: 05/02/2016] [Indexed: 11/24/2022]
Abstract
As malaria transmission declines, it becomes increasingly focal and prone to outbreaks. Understanding and predicting patterns of transmission risk becomes an important component of an effective elimination campaign, allowing limited resources for control and elimination to be targeted cost-effectively. Malaria risk mapping in low transmission settings is associated with some unique challenges. This article reviews the main challenges and opportunities related to risk mapping in low transmission areas including recent advancements in risk mapping low transmission malaria, relevant metrics, and statistical approaches and risk mapping in post-elimination settings.
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Quality improvement practices to institutionalize supply chain best practices for iCCM: Evidence from Rwanda and Malawi. Res Social Adm Pharm 2016; 13:1095-1109. [PMID: 27567145 PMCID: PMC5704638 DOI: 10.1016/j.sapharm.2016.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Accepted: 07/15/2016] [Indexed: 11/22/2022]
Abstract
Background Supply chain bottlenecks that prevent community health workers (CHWs) from accessing essential medicines significantly increase under-5 child mortality, particularly in poor and rural areas. Objective Using implementation research, interventions aimed at improving supply chain practices and access to medicines were tested in Malawi and Rwanda. These interventions included simple demand-based resupply procedures, using mobile technology and traditional methods for communication, and multilevel, performance-driven quality improvement (QI) teams. Methods Mixed-method evaluations were conducted at baseline (2010), midline (2013), and endline (2014). Baseline assessments identified common bottlenecks and established performance levels. Midline assessments identified which intervention package had the greatest impact. Endline surveys measured the progress of scale-up and institutionalization of each innovation. Results In both Rwanda and Malawi CHWs, health center staff, and district managers all cited many benefits of the establishment of resupply procedures and QI teams: such as providing structure and processes, a means to analyze and discuss problems and enhance collaboration between staff. Conclusions Implementing simple, streamlined, demand-based resupply procedures formed the basis for informed and regular resupply, and increased the visibility of appropriate and timely community logistics data. QI teams played a critical role in reinforcing resupply procedures and routinely unlocking the bottlenecks that prevent the continuous flow of critical health products. While simple, streamlined, demand-based resupply procedures provide the basis for regular, functional, and efficient resupply of CHWs, the procedures alone are not sufficient to create consistent change in product availability. Supporting these procedures with multilevel QI teams reinforces the correct and consistent use of resupply procedures.
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Poirot E, Soble A, Ntshalintshali N, Mwandemele A, Mkhonta N, Malambe C, Vilakati S, Pan S, Darteh S, Maphalala G, Brown J, Hwang J, Pace C, Stergachis A, Vittinghoff E, Kunene S, Gosling R. Development of a pharmacovigilance safety monitoring tool for the rollout of single low-dose primaquine and artemether-lumefantrine to treat Plasmodium falciparum infections in Swaziland: a pilot study. Malar J 2016; 15:384. [PMID: 27450652 PMCID: PMC4957931 DOI: 10.1186/s12936-016-1410-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Accepted: 06/21/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Countries remain reluctant to adopt the 2012 World Health Organization recommendation for single low-dose (0.25 mg/kg) primaquine (SLD PQ) for Plasmodium falciparum transmission-blocking due to concerns over drug-related haemolysis risk, especially among glucose-6-phosphate dehydrogenase-deficient (G6PDd) people, without evidence demonstrating that it can be safely deployed in their settings. Pharmacovigilance methods provide a systematic way of collecting safety data and supporting the rollout of SLD PQ. METHODS The Primaquine Roll Out Monitoring Pharmacovigilance Tool (PROMPT), comprising: (1) a standardized form to support the surveillance of possible adverse events following SLD PQ treatment; (2) a patient information card to enhance awareness of known adverse drug reactions of SLD PQ use; and (3) a database compiling recorded information, was developed and piloted. Data on patient characteristics, malaria diagnosis and treatment are collected. Blood samples are taken to measure haemoglobin (Hb) and test for G6PD deficiency. Active follow-up includes a repeat Hb measurement and adverse event monitoring on or near day 7. A 13-month prospective pilot study in two hospital facilities in Swaziland alongside the introduction of SLD PQ generated preliminary evidence on the feasibility and acceptability of PROMPT. RESULTS PROMPT was well received by nurses as a simple, pragmatic approach to active surveillance of SLD PQ safety data. Of the 102 patients enrolled and administered SLD PQ, none were G6PDd. 93 (91.2 %) returned on or near day 7 for follow-up. Four (4.6 %) patients had falls in Hb ≥25 % from baseline, none of whom presented with signs or symptoms of anaemia. No patient's Hb fell below 7 g/dL and none required a blood transfusion. Of the 11 (11 %) patients who reported an adverse event over the study period, three were considered serious and included two deaths and one hospitalization; none were causally related to SLD PQ. Four non-serious adverse events were considered definitely, probably, or possibly related to SLD PQ. CONCLUSION Improved pharmacovigilance to monitor and promote the safety of the WHO recommendation is needed. The successful application of PROMPT demonstrates its potential as an important tool to rapidly generate locally acquired safety data and support pharmacovigilance in resource-limited settings.
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Affiliation(s)
- Eugenie Poirot
- Global Health Group, University of California San Francisco, San Francisco, CA, USA. .,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
| | - Adam Soble
- Clinton Health Access Initiative, Mbabane, Swaziland
| | | | | | | | | | | | - Sisi Pan
- Clinton Health Access Initiative, Mbabane, Swaziland
| | - Sarah Darteh
- International Center for AIDS Care and Treatment Programs, Mbabane, Swaziland
| | - Gugu Maphalala
- Swaziland Health Laboratory Services, Mbabane, Swaziland
| | - Joelle Brown
- Global Health Group, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Jimee Hwang
- Global Health Group, University of California San Francisco, San Francisco, CA, USA.,President's Malaria Initiative, Malaria Branch, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cheryl Pace
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - Andy Stergachis
- Departments of Pharmacy and Global Health, Schools of Pharmacy and Public Health, University of Washington, Seattle, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Simon Kunene
- National Malaria Control Programme, Manzini, Swaziland
| | - Roland Gosling
- Global Health Group, University of California San Francisco, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Landier J, Parker DM, Thu AM, Carrara VI, Lwin KM, Bonnington CA, Pukrittayakamee S, Delmas G, Nosten FH. The role of early detection and treatment in malaria elimination. Malar J 2016; 15:363. [PMID: 27421656 PMCID: PMC4946177 DOI: 10.1186/s12936-016-1399-y] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 06/17/2016] [Indexed: 12/30/2022] Open
Abstract
Falciparum malaria persists in hard-to-reach areas or demographic groups that are missed by conventional healthcare systems but could be reached by trained community members in a malaria post (MP). The main focus of a MP is to provide uninterrupted and rapid access to rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) too all inhabitants of a village. RDTs allow trained community members to perform malaria diagnosis accurately and prescribe appropriate treatment, reducing as much as possible any delay between the onset of fever and treatment. Early treatment with ACT and with a low-dose of primaquine prevents further transmission from human to mosquito. A functioning MP represents an essential component of any malaria elimination strategy. Implementing large-scale, high-coverage, community-based early diagnosis and treatment through MPs requires few technological innovations but relies on a very well structured organization able to train, supervise and supply MPs, to monitor activity and to perform strict malaria surveillance.
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Affiliation(s)
- Jordi Landier
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.
| | - Daniel M Parker
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Aung Myint Thu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Verena I Carrara
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Khin Maung Lwin
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - Craig A Bonnington
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | | | - Gilles Delmas
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand
| | - François H Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Krah EFM, de Kruijf JG. Exploring the ambivalent evidence base of mobile health (mHealth): A systematic literature review on the use of mobile phones for the improvement of community health in Africa. Digit Health 2016; 2:2055207616679264. [PMID: 29942576 PMCID: PMC6001200 DOI: 10.1177/2055207616679264] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 10/18/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Africa is labelled the world's fastest-growing 'mobile region'. Considering such growth and the fragility of the continent's healthcare, mHealth has flourished. This review explores mHealth for community health in Africa in order to assess its still ambivalent evidence base. METHODS Using PubMed, Web of Science, OvidSP and Google Scholar, a systematic review was conducted of one decade (2005-2015) of peer-reviewed literature on mHealth in Africa. Data analysis focused on qualifications of success and failure. Impact evaluations of project assessments (n = 65) were complemented with general analyses/overviews of mHealth's effectiveness (n = 35). RESULTS Review of these texts reveals ambivalence in the appraisal of mHealth; essentially, the critical stance in general analyses/overviews is absent from project assessments. Especially weak evidence concerning sustainability and scalability is stressed in overviews. Project assessments are more optimistic. Their analysis suggests a causal connection between simplicity and success. Effective interventions are thus characterized by straightforward design and modest objectives. Greatest impediments of impact are general technology-related issues and intervention inappropriateness due to insufficient understanding of beneficiaries and specific context of use (circumstantial complications). CONCLUSION Distinguishing between these two categories of complications helps to break the deadlock that marks the mHealth debate and add nuance to claims that mHealth's evidence base is weak. Constructive realism - rather than unfounded optimism or pessimism without nuance - should guide the design of interventions. Besides anticipative of technology-related complications, such realism must lead to either basic interventions or to smart mHealth shaped by deep understanding of the context of implementation.
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Katib A, Rao D, Rao P, Williams K, Grant J. A prototype of a novel cell phone application for tracking the vaccination coverage of children in rural communities. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 122:215-228. [PMID: 26363678 DOI: 10.1016/j.cmpb.2015.08.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 07/18/2015] [Accepted: 08/13/2015] [Indexed: 06/05/2023]
Abstract
Immunization saves millions of lives against vaccine-preventable diseases. Yet, 24 million children born every year do not receive proper immunization during their first year. UNICEF and WHO have emphasized the need to strengthen the immunization surveillance and monitoring in developing countries to reduce childhood deaths. In this regard, we present a software application called Jeev to track the vaccination coverage of children in rural communities. Jeev synergistically combines the power of smartphones and the ubiquity of cellular infrastructure, QR codes, and national identification cards. We present the design of Jeev and highlight its unique features along with a detailed evaluation of its performance and power consumption using the National Immunization Survey datasets. We are in discussion with a non-profit organization in Haiti to pilot test Jeev in order to study its effectiveness and identify socio-cultural issues that may arise in a large-scale deployment.
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Affiliation(s)
- Anas Katib
- Department of Computer Science and Electrical Engineering, University of Missouri-Kansas City, Kansas City, USA.
| | - Deepthi Rao
- Department of Pathology and Laboratory Medicine, University of Kansas Medical Center, Kansas City, USA.
| | - Praveen Rao
- Department of Computer Science and Electrical Engineering, University of Missouri-Kansas City, Kansas City, USA.
| | - Karen Williams
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City, Kansas City, USA.
| | - Jim Grant
- Maison de Naissance and Global Birthing Home Foundation, Leawood, USA.
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Khatun F, Heywood AE, Ray PK, Hanifi SMA, Bhuiya A, Liaw ST. Determinants of readiness to adopt mHealth in a rural community of Bangladesh. Int J Med Inform 2015; 84:847-56. [DOI: 10.1016/j.ijmedinf.2015.06.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 06/20/2015] [Accepted: 06/25/2015] [Indexed: 11/15/2022]
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Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [PMID: 26343551 DOI: 10.1002/14651858.cd002098.pub2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care. OBJECTIVES To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation). SEARCH METHODS We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies. SELECTION CRITERIA We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions. DATA COLLECTION AND ANALYSIS For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes. MAIN RESULTS We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3), urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2), neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer (1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38 studies), which was used either alone or in combination. The main TM function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for example nurses delivering education to patients with diabetes or providing support to parents of very low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-operative assessment after minor operation or follow-up after solid organ transplantation (8) vi), screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer, (e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider varied across studies, as did the type of healthcare provider/s and healthcare system involved in delivering the intervention.We found no difference between groups for all-cause mortality for patients with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies; N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up (moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N = 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %) levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)= 42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P < 0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD: SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001; I(2) = 45% (moderate certainty evidence), in TM as compared with usual care.Seven studies that recruited participants with different mental health and substance abuse problems, reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring via TM improved blood pressure control in participants with hypertension, and a few studies reported improved symptom scores for those with a respiratory condition. Studies recruiting participants requiring mental health services and those requiring specialist consultation for a dermatological condition reported no differences between groups. AUTHORS' CONCLUSIONS The findings in our review indicate that the use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of TM may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention.
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Affiliation(s)
- Gerd Flodgren
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Headington, Oxford, Oxfordshire, UK, OX3 7LF
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Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2015; 2015:CD002098. [PMID: 26343551 PMCID: PMC6473731 DOI: 10.1002/14651858.cd002098.pub2] [Citation(s) in RCA: 342] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care. OBJECTIVES To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation). SEARCH METHODS We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies. SELECTION CRITERIA We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions. DATA COLLECTION AND ANALYSIS For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes. MAIN RESULTS We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3), urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2), neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer (1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38 studies), which was used either alone or in combination. The main TM function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for example nurses delivering education to patients with diabetes or providing support to parents of very low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-operative assessment after minor operation or follow-up after solid organ transplantation (8) vi), screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer, (e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider varied across studies, as did the type of healthcare provider/s and healthcare system involved in delivering the intervention.We found no difference between groups for all-cause mortality for patients with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies; N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up (moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N = 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %) levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)= 42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P < 0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD: SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001; I(2) = 45% (moderate certainty evidence), in TM as compared with usual care.Seven studies that recruited participants with different mental health and substance abuse problems, reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring via TM improved blood pressure control in participants with hypertension, and a few studies reported improved symptom scores for those with a respiratory condition. Studies recruiting participants requiring mental health services and those requiring specialist consultation for a dermatological condition reported no differences between groups. AUTHORS' CONCLUSIONS The findings in our review indicate that the use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of TM may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention.
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Affiliation(s)
- Gerd Flodgren
- Norwegian Institute of Public HealthThe Norwegian Knowledge Centre for the Health ServicesPilestredet Park 7OsloNorway0176
| | - Antoine Rachas
- European Hospital Georges Pompidou and Paris Descartes UniversityDepartment of IT and Public Health20‐40 Rue leBlancParisFrance75908
| | - Andrew J Farmer
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory Quarter, Walton StreetOxfordUKOX2 6GG
| | - Marco Inzitari
- Parc Sanitari Pere Virgili and Universitat Autònoma de BarcelonaDepartment of Healthcare/Medicinec Esteve Terrades 30BarcelonaSpain08023
| | - Sasha Shepperd
- University of OxfordNuffield Department of Population HealthRosemary Rue Building, Old Road CampusHeadingtonOxfordOxfordshireUKOX3 7LF
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Githinji S, Jones C, Malinga J, Snow RW, Talisuna A, Zurovac D. Development of a text-messaging intervention to improve treatment adherence and post-treatment review of children with uncomplicated malaria in western Kenya. Malar J 2015; 14:320. [PMID: 26283229 PMCID: PMC4539928 DOI: 10.1186/s12936-015-0825-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 07/28/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients' low adherence to artemisinin-based combination therapy has been reported in areas of Kenya bordering the Lake Victoria region, where the burden of malaria remains high. A randomized controlled trial is underway to determine the efficacy of short message service (SMS) text reminders on adherence to artemether-lumefantrine and post-treatment review of children under the age of five. This paper reports on the iterative process of intervention and delivery system development. METHODS An intervention development workshop involving the research team and other stakeholders was held to determine the content of the text messages. Three focus group discussions were conducted to test caregivers' understanding of the messages developed during the workshop. The tested messages were refined and incorporated into an automated SMS distribution system and piloted with 20 caregivers drawn from facilities neighbouring the study sites. The automated SMS distribution system was repeatedly refined following the pilot and implemented at the start of the trial. RESULTS The content of SMS messages underwent major revisions following the focus group discussions. Technical terms and abbreviations were replaced with simplified general terms. Message sign-off was modified to reflect the name of health facility, removing references to health workers. Day 3 post-treatment review visit reminder was modified to state the purpose of the visit while wording 'day 28' was added to the last post-treatment review visit reminder to help the caregiver recall the appointment date. The unscheduled visit prompt was modified to reflect flexibility and practicality of taking the child back to the facility if unwell. Reception of SMS reminders during the pilot was low with only 169/240 (70%) of scheduled messages delivered to the caregivers. The automated distribution system underwent major refinement and repeated testing following the pilot until effective delivery of all scheduled messages was achieved and sustained over a period of 3 months. CONCLUSIONS Text message interventions should be carefully developed, tested and refined before implementation to ensure they are written in the most appropriate way for their target population. SMS distribution systems should be rigorously tested to ensure efficient delivery of the messages before they are deployed.
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Affiliation(s)
- Sophie Githinji
- Department of Public Health Research, KEMRI-Wellcome Trust-University of Oxford Research Programme, Nairobi, Kenya.
| | - Caroline Jones
- Department of Public Health Research, KEMRI-Wellcome Trust-University of Oxford Research Programme, Nairobi, Kenya.
- Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Josephine Malinga
- Department of Public Health Research, KEMRI-Wellcome Trust-University of Oxford Research Programme, Nairobi, Kenya.
| | - Robert W Snow
- Department of Public Health Research, KEMRI-Wellcome Trust-University of Oxford Research Programme, Nairobi, Kenya.
- Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Ambrose Talisuna
- Department of Public Health Research, KEMRI-Wellcome Trust-University of Oxford Research Programme, Nairobi, Kenya.
- Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
| | - Dejan Zurovac
- Department of Public Health Research, KEMRI-Wellcome Trust-University of Oxford Research Programme, Nairobi, Kenya.
- Centre for Tropical Medicine & Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA.
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Khan NUZ, Rasheed S, Sharmin T, Ahmed T, Mahmood SS, Khatun F, Hanifi S, Hoque S, Iqbal M, Bhuiya A. Experience of using mHealth to link village doctors with physicians: lessons from Chakaria, Bangladesh. BMC Med Inform Decis Mak 2015; 15:62. [PMID: 26242574 PMCID: PMC4526289 DOI: 10.1186/s12911-015-0188-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 07/20/2015] [Indexed: 12/04/2022] Open
Abstract
Background Bangladesh is facing serious shortage of trained health professionals. In the pluralistic healthcare system of Bangladesh, formal health care providers constitute only 5 % of the total workforce; the rest are informal health care providers. Information Communication Technologies (ICTs) are increasingly seen as a powerful tool for linking the community with formal healthcare providers. Our study assesses an intervention that linked village doctors (a cadre of informal health care providers practising modern medicine) to formal doctors through call centres from the perspective of the village doctors who participated in the intervention. Methods The study was conducted in Chakaria, a remote rural area in south-eastern Bangladesh during April–May 2013. Twelve village doctors were selected purposively from a pool of 55 village doctors who participated in the mobile health (mHealth) intervention. In depth interviews were conducted to collect data. The data were manually analysed using themes that emerged. Result The village doctors talked about both business benefits (access to formal doctors, getting support for decision making, and being entitled to call trained doctors) and personal benefits (both financial and non-financial). Some of the major barriers mentioned were technical problems related to accessing the call centre, charging consultation fees, and unfamiliarity with the call centre physicians. Conclusion Village doctors saw many benefits to having a business relationship with the trained doctors that the mHealth intervention provided. mHealth through call centres has the potential to ensure consultation services to populations through existing informal healthcare providers in settings with a shortage of qualified healthcare providers.
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Affiliation(s)
- Nazib Uz Zaman Khan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.
| | - Sabrina Rasheed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tamanna Sharmin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Tanvir Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.,Institute of Development Studies (IDS), University of Sussex, Library Road, Brighton, BN1 9RE, UK
| | - Shehrin Shaila Mahmood
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Fatema Khatun
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh.,School of Public Health and Community Medicine, The University of New South Wales, Kensington, NSW, 2052, Australia
| | - Sma Hanifi
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Shahidul Hoque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Mohammad Iqbal
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Abbas Bhuiya
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68 Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
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Steinhardt LC, Onikpo F, Kouamé J, Piercefield E, Lama M, Deming MS, Rowe AK. Predictors of health worker performance after Integrated Management of Childhood Illness training in Benin: a cohort study. BMC Health Serv Res 2015. [PMID: 26194895 PMCID: PMC4509845 DOI: 10.1186/s12913-015-0910-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Correct treatment of potentially life-threatening illnesses (PLTIs) in children under 5 years, such as malaria, pneumonia, and diarrhea, can substantially reduce mortality. The Integrated Management of Childhood Illness (IMCI) strategy has been shown to improve treatment of child illnesses, but multiple studies have shown that gaps in health worker performance remain after training. To better understand factors related to health worker performance, we analyzed 9,330 patient consultations in Benin from 2001–2002, after training one of the first cohorts of 32 health workers in IMCI. Methods With data abstracted from patient registers specially designed for IMCI-trained health workers, we examined associations between health facility-, health worker-, and patient-level factors and 10 case-management outcomes for PLTIs. Results Altogether, 63.6 % of children received treatment for all their PLTIs in accordance with IMCI guidelines, and 77.8 % received life-saving treatment (i.e., clinically effective treatment, even if not exactly in accordance with IMCI guidelines). Performance of individual health workers varied greatly, from 15–88 % of patients treated correctly, on average. Multivariate regression analyses identified several factors that might have influenced case-management quality, many outside a manager’s direct control. Younger health workers significantly outperformed older ones, and infants received better care than older children. Children with danger signs, those with more complex illnesses, and those with anemia received worse care. Health worker supervision was associated with improved performance for some outcomes. Conclusions A variety of factors, some outside the direct control of program managers, can influence health worker practices. An understanding of these influences can help inform the development of strategies to improve performance. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0910-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Laura C Steinhardt
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Faustin Onikpo
- Direction Départementale de la Santé Publique de l'Ouémé et Plateau, Ministry of Public Health, Porto Novo, Benin.
| | - Julien Kouamé
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Emily Piercefield
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | | | - Michael S Deming
- Parasitic Diseases Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Alexander K Rowe
- Malaria Branch, Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Sturrock HJW, Roberts KW, Wegbreit J, Ohrt C, Gosling RD. Tackling imported malaria: an elimination endgame. Am J Trop Med Hyg 2015; 93:139-144. [PMID: 26013369 PMCID: PMC4497886 DOI: 10.4269/ajtmh.14-0256] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 02/01/2015] [Indexed: 12/31/2022] Open
Abstract
As countries move toward malaria elimination, imported infections become increasingly significant as they often represent the majority of cases, can sustain transmission, cause resurgences, and lead to mortality. Here we review and critique current methods to prevent malaria importation in countries pursuing elimination and explore methods applied in other transmission settings and to other diseases that could be transferred to support malaria elimination. To improve intervention targeting we need a better understanding of the characteristics of populations importing infections and their patterns of migration, improved methods to reliably classify infections as imported or acquired locally, and ensure early and accurate diagnosis. The potential for onward transmission in the most receptive and vulnerable locations can be predicted through high-resolution risk mapping that can help malaria elimination or prevention of reintroduction programs target resources. Cross border and regional initiatives can be highly effective when based on an understanding of human and parasite movement. Ultimately, determining the optimal combinations of approaches to address malaria importation will require an evaluation of their impact, cost effectiveness, and operational feasibility.
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Affiliation(s)
- Hugh J. W. Sturrock
- Malaria Elimination Initiative, Global Health Group, University of California, San Francisco, California
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Lourenço C, Kandula D, Haidula L, Ward A, Cohen JM. Strengthening malaria diagnosis and appropriate treatment in Namibia: a test of case management training interventions in Kavango Region. Malar J 2014; 13:508. [PMID: 25518838 PMCID: PMC4301656 DOI: 10.1186/1475-2875-13-508] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 12/14/2014] [Indexed: 12/01/2022] Open
Abstract
Background Despite its importance in control and elimination settings, malaria diagnosis rates tend to be low in many African countries. An operational research pilot was conducted in Namibia to identify the key barriers to appropriate diagnosis of malaria in public health facilities and to evaluate the effectiveness of various training approaches in improving the uptake and adherence to rapid diagnostic tests (RDTs). Methods After identifying case management weaknesses through focus group discussions, training interventions were designed to address these barriers over a six-month period. The study had three intervention districts and one control within the Kavango region of Namibia where poor case management practices were observed. The interventions included an enhanced training model, clinical mentorship, and SMS reminders. Monthly data on testing and treatment were collected for the period of April to September 2012 and, for comparison, the same months during the prior year from all 52 health facilities in Kavango. The same indicators were also obtained at district level for a follow-up period of 15 months from October 2012 to December 2013 to observe whether any improvements were sustained over time. Results All intervention arms produced significant improvements in case management practices compared to the control district (all p < 0.02). Overall, districts receiving any training improved testing rates from 25% to 66% at minimum compared to the control. The enhanced training plus mentorship arm resulted in a significantly greater proportion of fevers receiving RDTs compared to the district receiving enhanced training alone, increasing from 27% to over 90% at endline. No ACT was prescribed to untested patients after caregivers received mentorship or SMS reminders. These improvements were all sustained over the 15-month follow-up. Conclusions These changes show a reversal of improper case management practices over the six-month study period and demonstrate that implementing simple training interventions can have a significant, sustainable impact on the uptake of and adherence to malaria RDTs. Findings from this work have already informed Namibia’s roll out of a more robust case management training programme. The approaches used in Namibia may be applicable to other resource-constrained countries, providing practical guidance on sustainable approaches to febrile illness management. Electronic supplementary material The online version of this article (doi:10.1186/1475-2875-13-508) contains supplementary material, which is available to authorized users.
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Hamainza B, Killeen GF, Kamuliwo M, Bennett A, Yukich JO. Comparison of a mobile phone-based malaria reporting system with source participant register data for capturing spatial and temporal trends in epidemiological indicators of malaria transmission collected by community health workers in rural Zambia. Malar J 2014; 13:489. [PMID: 25495698 PMCID: PMC4295270 DOI: 10.1186/1475-2875-13-489] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/09/2014] [Indexed: 01/22/2023] Open
Abstract
Background Timeliness, completeness, and accuracy are key requirements for any surveillance system to reliably monitor disease burden and guide efficient resource prioritization. Evidence that electronic reporting of malaria cases by community health workers (CHWs) meet these requirements remains limited. Methodology Residents of two adjacent rural districts in Zambia were provided with both passive and active malaria testing and treatment services with malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapy by 42 CHWs serving 14 population clusters centred around public sector health facilities. Reference data describing total numbers of RDT-detected infections and diagnostic positivity (DP) were extracted from detailed participant register books kept by CHWs. These were compared with equivalent weekly summaries relayed directly by the CHWs themselves through a mobile phone short messaging system (SMS) reporting platform. Results Slightly more RDT-detected malaria infections were recorded in extracted participant registers than were reported in weekly mobile phone summaries but the difference was equivalent to only 19.2% (31,665 versus 25,583, respectively). The majority (81%) of weekly SMS reports were received within one week and the remainder within one month. Overall mean [95% confidence limits] difference between the numbers of register-recorded and SMS-reported RDT-detected malaria infections per CHW per week, as estimated by the Bland Altman method, was only −2.3 [−21.9, 17.2]. The mean [range] for both the number of RDT-detected malaria infections (86 [0, 463] versus 73.6 [0, 519], respectively)) and DP (22.8% [0.0 to 96.3%] versus 23.2% [0.4 to 75.8%], respectively) reported by SMS were generally very consistent with those recorded in the reference paper-based register data and exhibited similar seasonality patterns across all study clusters. Overall, mean relative differences in the SMS reports and reference register data were more consistent with each other for DP than for absolute numbers of RDT-detected infections, presumably because this indicator is robust to variations in patient reporting rates by location, weather, season and calendar event because these are included in both the nominator and denominator. Discussion/Conclusion The SMS reports captured malaria transmission trends with adequate accuracy and could be used for population-wide, continuous, longitudinal monitoring of malaria transmission.
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Affiliation(s)
- Busiku Hamainza
- Ministry of Health, National Malaria Control Centre, Chainama Hospital College Grounds, off Great East road, P,O, Box 32509, Lusaka, Zambia.
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