Population Health Surveillance Using Mobile Phone Surveys in Low- and Middle-Income Countries: Methodology and Sample Representativeness of a Cross-sectional Survey of Live Poultry Exposure in Bangladesh

The World's consumption of free web-based Otolaryngology-Head and Neck Surgery educational resources: A global assessment of video usage trends

Objectives

Online educational platforms with open access have seen a growing adoption in the field of medical education. However, the extent of their global usage is still unclear. To fill this knowledge gap, our objective is to examine the usage patterns of two renowned open-access resources in Otolaryngology. This includes identifying the most sought-after topics and understanding the demographics of their users.

Methods

Retrospective study of web analytics data between 2016 and 2021 extracted from the Headmirror.com and Mayo Clinic Otolaryngology YouTube channel platforms analyzing demographic and education topic trends via descriptive, geospatial, time-series, t-tests, and ANOVA analyses.

Results

Viewership spanned 124 countries in 7 different geographic regions, with 72 countries comprising low- to middle-income countries, mostly represented ages of 25-34 years old, came from high-income countries rather than low-income (p < .001), and used mobile phones followed by computers for device access. Video-educational material comprised of subspecialty topics on Rhinology and Sinus Surgery (25%) at the highest end and Facial Trauma (1%) at the lowest. Controlling for the age of the video content, the most-accessed videos comprised of subspecialty topics on Head and Neck Surgery at the highest end and Laryngology at the lowest with significant differentiation across topics of interest (p < .044).

Conclusions

This assessment of web-analytics platforms from two widely used otolaryngology free, online-access materials showed increasing global usage trends with significant differentiating factors along viewership demographics, as well as sought-after subspecialty topics of interest. In turn, our results not only lay the groundwork for characterizing the global otolaryngology audience but also for future development of targeted educational materials and accessibility initiatives aimed at ameliorating global educational disparities in the field.

Developing Population Health Surveillance Using mHealth in Low-Resource Settings: Qualitative Assessment and Pilot Evaluation

BACKGROUND

Population surveillance data are essential for understanding population needs and evaluating health programs. Governmental and nongovernmental organizations in western Myanmar did not previous have means for conducting robust, electronic population health surveillance.

OBJECTIVE

This study involved developing mobile health (mHealth)-based population health surveillance in a rural, low-resource setting with minimal cellular infrastructure in western Myanmar. This was an early formative study in which our goal was to establish the initial feasibility of conducting mHealth population health surveillance, optimizing procedures, and building capacity for future work.

METHODS

We used an iterative design process to develop mHealth-based population health surveillance focused on general demographics (eg, total census, age category, sex, births, and deaths). Interviews were conducted with international consultants (nurse midwives) and local clinicians (nurses and physicians) in Myanmar. Our analytic approach was informed by the Systems Engineering Initiative for Patient Safety work systems model to capture the multilevel user needs for developing health interventions, which was used to create a prototype data collection tool. The prototype was then pilot-tested in 33 villages to establish an initial proof of concept.

RESULTS

We conducted 7 interviews with 5 participants who provided feedback regarding the domains of the work system, including environmental, organizational, sociocultural, technological, informational, and task- and people-based considerations, for adapting an mHealth tool. Environmental considerations included managing limited electricity and internet service. Organizational needs involved developing agreements to work within existing government infrastructure as well as leveraging the communal nature of societies to describe the importance of surveillance data collection and gain buy-in. Linguistic diversity and lack of experience with technology were both cited as people- and technology-based aspects to inform prototype design. The use of mobile tools was also viewed as a means to improve the quality of the data collected and as a feasible option for working in settings with limited internet access. Following the prototype design based on the findings of initial interviews, the mHealth tool was piloted in 33 villages, allowing our team to collect census data from 11,945 people for an initial proof of concept. We also detected areas of potentially missing data, which will need to be further investigated and mitigated in future studies.

CONCLUSIONS

Previous studies have not focused heavily on the early stages of developing population health surveillance capacity in low- and middle-income countries. Findings related to key design considerations using a work systems lens may be informative to others developing technology-based solutions in extremely low-resource settings. Future work will involve collecting additional health-related data and further evaluating the quality of the data collected. Our team established an initial proof of concept for using an mHealth tool to collect census-related information in a low-resource, extremely rural, and low-literacy environment.

Frequency and patterns of exposure to live poultry and the potential risk of avian influenza transmission to humans in urban Bangladesh

Avian influenza is endemic in Bangladesh, where greater than 90% of poultry are marketed through live poultry markets (LPMs). We conducted a population-based cross-sectional mobile telephone survey in urban Dhaka, Bangladesh to investigate the frequency and patterns of human exposure to live poultry in LPMs and at home. Among 1047 urban residents surveyed, 74.2% (95% CI 70.9-77.2) reported exposure to live poultry in the past year, with the majority of exposure occurring on a weekly basis. While visiting LPMs was less common amongst females (40.3%, 95% CI 35.0-45.8) than males (58.9%, 95% CI 54.0-63.5), females reported greater poultry exposure through food preparation, including defeathering (13.2%, 95% CI 9.5-17.9) and eviscerating (14.8%, 95% CI 11.2-19.4) (p < 0.001). A large proportion of the urban population is frequently exposed to live poultry in a setting where avian influenza viruses are endemic in LPMs. There is thus not only ample opportunity for spillover of avian influenza infections into humans in Dhaka, Bangladesh, but also greater potential for viral reassortment which could generate novel strains with pandemic potential.