Camel without refrigerator attached. Photo Credit: Art Center College of Design

The PATH initiative, which advances malaria vaccines, recently predicted that over ten times more vaccine storage will be needed in the developing world over the next 15 years. However, transporting and managing vaccines in developing countries faces many obstacles, including inhospitable climates, poor infrastructure, lack of electricity and disparate communities.

As a result, over 1 million people die every year in developing nations due to vaccine-preventable diseases. In some cases, vaccines may be reaching these populations, but when they do, they are no longer functional because they were not adequately cooled. Most vaccines must be stored within a certain temperature range in order to remain functional. Health organizations are increasingly turning to technology to help them do just that.

Fridge about to be loaded onto camel. Photo Credit: Art Center College of Design

Many NGOs and ministries of health make use of mobile vaccine refrigerators that harness solar energy to power the internal chamber that holds the vaccines. A particularly innovative and resourceful vaccine refrigerator came on the backs of camels. Naps’ Camel Fridge was designed back in 2005 and operates off of solar power. The fridge uses solar panels to harness energy, and sits on the backs of camels that transport the fridges to rural destinations. Over 1,500 of these camel fridges have been sold to WHO and UNICEF programs.

But if a shipment of vaccines arrives spoiled, it is important to know where in the logistics chain the temperature was breached so that changes can be made to prevent a recurrence.

However, some issues with these mobile refrigerators are temperature maintenance and vaccine spoilage. A practical gadget that has made cold chain storage more efficient is a technology that involves vaccine monitoring. SmartConnect, a technology developed by Inveneo that uses existing cell phone networks for data communication, can monitor vaccines by sending information about the arrival time and temperatures of vaccines in transit. That way, officials will know not only if a vaccine has spoiled, but when and where the problem may have occurred.

Sure Chill Vaccine Refrigerator Photo Credit: True Energy

SmartConnect is not the only project making use of SMS technology. True Energy’s Sure Chill Vaccine Refrigerators, which are WHO pre-certified, can store vaccines at a constant optimal temperature, without power, for up to ten days while using a vaccine vial monitoring system that records temperature changes and can send an SMS to indicate those changes.

True Energy has already shipped multiple units to Senegal and Vietnam under project Optimize, a WHO/PATH collaboration, and aims to ship many more units to countries like South Sudan, Kenya, Nigeria, Yemen, India and many more.

Incorporating mobile monitoring technologies and improving the efficiency of the fridges could make a tremendous impact on the success of many vaccination programs.  And if PATH’s prediction rings true, they will be greatly needed.

Photo Credit: Stop TB Partnership

Earlier this month, the Indus Hospital in Karachi, Pakistan reported a substantial increase in Tuberculosis (TB) detection rates after the start of a program that uses mobile technology and financial incentives to get people to test for the disease.

Since the implementation of the program in January 2011, reported TB cases more than doubled at the hospital. Doctors reported a total of 420 cases in the first quarter of 2011, up from 200 in the last quarter of 2010, before the program was in place.

The program is anchored by a financial incentive scheme and use of mobile technology. In the program, doctors and community health workers who screen for TB are rewarded with a financial incentive through their mobile banking account. Health professionals are rewarded based on both the number of sputum samples that they collect and the number of patients that test positive for active TB following sputum test results.

Mobile banking centers that have emerged in Karachi make this program possible. Health professionals use SMS to send their TB data to the Indus Hospital TB Reach mobile data collection system and in return receive a text message which tells them how many cases they have helped to detect. The incentives are then tabulated and distributed at the mobile banking centers on a monthly basis by the data collection system, called OpenMRS Mobile.

Tackling TB is a big deal in Pakistan and the South Asian region as a whole. According to estimates by the World Health Organization, Pakistan developed nearly 300,000 new cases of TB in 2009, making them 8th on the list of countries most burdened by TB. Case detection is imperative in treating TB because according to TB Reach, for every 10 additional cases detected, an estimated 5 lives are saved and 100 infections are prevented.

The Indus Hospital received a grant from the Stop TB partnership’s TB Reach program. The TB Reach program focuses on promoting increased case detection of TB cases, ensuring their timely treatment, all while maintaining high cure rates within the national TB programs. Working in two “waves,” the first wave targeted 19 countries with $18.4 million worth of funding. The project at the Indus Hospital in Karachi is a product of the first wave. Under its Wave-2 funding, TB Reach has approved US$ 31 million for 45 projects in 29 countries.

The Indus Hospital program’s success has caught local attention as the Indus Hospital health workers are now training local private general practitioners on TB screening and detection. Furthermore Indus Hospital has launched a communications campaign complete with billboards, posters and local cable television ads that encourage people to get tested for TB. The Indus Hospital, also Pakistan’s first hospital to go paperless, hopes to expand the program nationally and even beyond.

Nurse using app on Palm Pre 2 smartphone in Botswana. Photo Credit: HP

On June 6th, Hewlett Packard (HP) announced it will collaborate with a non-profit organization in Botswana to provide technology to monitor and treat malaria outbreaks. HP announced it will begin a yearlong clinical trial that will equip medical professionals in Botswana with Palm Pre 2 smartphones designed to collect information on malaria outbreaks.

HP will supply the technology to the non-profit group Positive Innovation for the Next Generation (PING) who will train health workers to collect the data on malaria outbreaks. The data will be collected and stored through an application on the smartphones provided. The application can store photos, videos, audio files as well as GPS information which can be used to generate a geographic map of the areas affected by outbreaks, which has never before been done in Botswana.

The program hopes to increase the rates of mosquito net distribution and provide advanced warnings to regions at risk of an outbreak. Within a day, health workers can achieve results that would normally takes weeks to produce.

Malaria is one of the most widespread infectious diseases, and according to the World Health Organization (WHO), takes nearly one million lives every year, mostly in Africa. WHO has predicted as much as 10% of the African population is under the threat of malaria. Therefore, controlling outbreaks and being able to predict devastating malaria epidemics is crucial to alleviating its burden.

What’s also noteworthy here is that HP is plunging into the mobile health monitoring market, one example of HP’s plans to contribute to global healthcare. Instead of putting money into pockets, HP is aiming to contribute technology and other innovative solutions to tackle challenges that are hindering healthcare around the world. This shouldn’t surprise anyone however, since HP was one of the founding members of the mHealth alliance.

This program indicates the rising importance of mobile health technology as a key player in tackling health burdens in developing countries. Using mobile technologies, whether to collect data from isolated populations or to monitor disease prevalence presents an avenue for NGO’s and governments to reduce health service costs and increase accessibility. HP hopes to scale up this program to all of Africa, contingent upon success in Botswana.

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Mobile maternal health clinic on the road. Photo Credit: UNFPA

Nearly a year after the devastating floods in Pakistan, calls are being made by UNICEF health officials to expand capacities of mobile health clinics in the country. The clinics were first developed in response to the 2005 earthquakes in the northern region of Pakistan. Although the mobile clinics have touched hundreds of thousands of lives, more will be needed with expanded capabilities to ensure their long term impact.

In October 2005, the UNFPA joined hands with the Pakistani government and created mobile health clinics, whose main focus was on maternal health needs. By 2008, these clinics had treated over 850,000 patients, mostly for maternal and child health related issues. The clinics, still running, are staffed by women and are stocked with equipment and supplies for quality maternal health care. Since 2005, UNICEF has also become a key funder for mobile health clinics in Pakistan.

The UNICEF funded mobile health clinics tackle a variety of health issues, with an emphasis on maternal and child health. These clinics are staffed by three health workers, and treat up to 300 patients on a daily basis. After the emergence of the floods that affected 20 million people in Pakistan in July 2010, these health clinics became pivotal in reaching isolated populations.

Healthcare for women and children is better now than it was before the floods and the earthquake. However, despite the welcomed success of these mobile health clinics, there has been a call to expand the capacities for the mobile health clinics in order to make them more sustainable. This is where the world of ICT can step in and lend a helping hand.

The potential for impact is highest is rural and isolated areas where resources are poor and hardest to reach. According to a UNDP report, “ICT is yet to be widely mainstreamed to assist developing countries in addressing traditional development problems with innovative solutions and approaches that are both effective and more easily scalable and replicable.”

ICT services can complement existing initiatives such as the mobile health clinics in Pakistan to attenuate health burdens such as maternal mortality, which is what the UNFPA funded clinics focused on. This would be crucial in rural areas where ICT services would be invaluable. ICT services can potentially offer live video or audio feeds to health professionals when examining patients as well as educational classes to women from urban based instructors using the mobile clinics already in use.

Once ICT services are in place, NGO’s and government agencies can directly improve citizen access to information and at the same time, immediately strengthen their own capacities to help the citizens. Pakistan and other developing nations will only continue to reap the benefits for years to come.

photo of mosquito biting skin

Photo Credit: TopNews

Yesterday commemorated the fourth World Malaria Day and increasingly ICTs are being used in the battle to fight against this deadly disease.

 

In 1997, Dr. Julia Royall was named the chief of international programs at the U.S. National Library of Medicine (NLM) at the National Institutes of Health to create a telecommunications network to support scientists working on the Malaria Multilateral Initiative in Africa.

 

picture of Dr Julia Royall

Dr. Julia Royall Photo Credit: NIH

Dr. Royall explains that she soon became interested in, “NLM’s attempt to reach the end user with information”.

 

In 2007-2008, Dr. Royall  was a Fulbright Scholar in Uganda and traveled to a Mifumi, a remote village in the Eastern district or Tororo, Uganda to conduct research on 300 received bed nets that had been received.

 

Along with a team of medical students from Uganda’s Makerere University Faculty of Medicine they conducted an observational survey to see how the 300 families were using bed nets to protect themselves from malaria carrying mosquitoes.

 

She quickly discovered that nets were not being used properly due to widespread misunderstandings about the disease and the purpose of how to use the nets themselves within the community.

 

In the village, they eat outside at dusk when mosquitos presence is at a peak; believe that health effects of malaria are due to “witchcraft”; and standing water around houses attracts the bugs near windows and doorways.

 

The World Health Organization has reported a child dies of malaria every 30 seconds in Africa.

 

After this baseline research, Dr. Royall passionately pursued developing a new method to demonstrate that information can be targeted to improve health awareness among underserved populations in Africa.

 

She decided to work with the local community to produce informational tutorials on malaria prevention, which Dr. Royall deems as “health information intervention”.

Dr. Royall with Makerere University Medical Students Photo Credit: NIH

Dr. Royall with Makerere University Medical Students Photo Credit: NIH

Collaborating with Makerere University medical faculty, students, and a team of artists and translators, she produced an interactive tutorial to try and discover if ICTs have an impact on malaria mortality rates.

 

Dr. Royall field tested the malaria tutorial in the Mifumi village villages by students and then translated into three local languages: Luganda, Runyankole, and Luo. She wanted to see how this ICT could be used:

 

We wanted to see if such a ‘health information intervention’ from NLM through medlineplus.gov could make a difference

 

Makerere University medical students then took the lead in making and distributing booklets, posters and audio CD formats to be used on the radio, an important communication tool in rural Uganda.

 

Dr. Royall was adamant about making the content culturally relevant to ensure overall sustainability. Cultural context also has an affect on the results of preventative malaria campaigns.

“We had to be careful,” she said, “about working with these communities to define what the products would look like.”

screen shot of the tutorials

Screen shot of the tutorials in English

 

Her health information intervention tutorials have resulted in reduced mortality in Eastern Uganda:

ICT interventions, are making a difference at the village level

 

Dr. Royall’s virtual tutorials have promise for other malaria prevention projects facing similar barriers. All of the materials are available online here to anyone with access to the Internet in the five languages (Luo, Japadhola, Luganda, Runyankole Swahili and English)

In addition to the tutorials, health workers can use a laminated presentation to explain how malaria works and there is also an audio version in the five languages available for radio broadcast and illiterate communities.

 

View this video on her story:

Today is World Health Day 2011 and theme this year is on antimicrobial resistance. In developing countries, one of the most pressing health issues is malaria, with a high morbidity and mortality rate. Rapid diagnosis and prompt treatment are most basic managerial elements on how to circumvent this vicious disease. The attachment of a microscope onto a cell phone, known as Cellscope, can help with these diagnoses.

View the Prezi below to see how the innovative mHealth tool can help rural health workers.


MobiHealthNews held their first webinar, last Thursday, February 11,to discuss mobile health news and trends that will likely emerge during the Healthcare Information and Management Systems Society (HIMSS) 2011 annual gathering this year in Orlando. The webinar, which was attended by health professionals and practioners around the world was the first of its kind to predict future innovations and trends in mobile health.

Brian Dolan, MobiHealthNews editor, discussed the increasing expansion of peripheral health devices. Most of these were manufactured to assist medical practitioners in the developed world, but a few stood out as contenders for development context:

iHealth blood pressure dock

  • iPhone ECG case developed by AliveCor called the iPhonECG is a great new device. This gadget turns your Apple iPhone 4 into Electrocardiogram (ECG) by putting it into a special $100 case, however it has not been approved for sale in the U.S. yet. This would possess the capability to help healthcare works in the field monitor electrical activity of the heart and detect any heart disease, allowing them to assess the patient’s level of risk more accurately.
  • Cellscope which turns a cell phone into a high-magnification microscope.is a revolutionary approach to curing infectious disease are a huge upcoming trend that will launch throughout the year and gain FDA approval.

    The CellScope

The HIMSS will hold its annual conference on February 20-24, where hundreds of corporate and non-for-profit members come together to collaborate on their mission to transform healthcare through effective use of IT and management systems.. Each year a few innovations stand out among the crowd. Two years ago, one of the big themes that emerged was that an electronic medical records (EMR) vendor developed a smartphone application. Last year, tablets such as the iPad, emerged as catalysts for mHealth devices to grow in usage.

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