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.


A community health worker shows a visual aid

Photo credit: Dimagi

With funding from USAID, World Vision and Dimagi will conduct operations research to test if the use of CommCare will increase the uptake of healthy actions, improve knowledge of important information points, and improve communications and coordination between community health workers (CHWs) and higher trained workers.

CommCare is a phone-based application to strengthen community health programs. CHWs use software running on a phone during each client visit to improve quality of care and data reporting. When the CHW is within range of a cellular network, data is automatically submitted to a central server for use in program management, monitoring and health surveillance.

World Vision’s study will focus on improving the uptake of a list of identified “Healthy Actions” and knowledge of key “Important Information” points. It will also study the improvement that the phone make between the CHWs for coordination with midwives and other health experts. World Vision expects the following:

  1. Utilization – increased percentage of healthy actions taken by pregnant women
  2. Knowledge Access – increased knowledge by pregnant women of the important information points
  3. Access- increased use of midwives and expert services via phone calls

The primary CommCare module the study will focus on promotes essential care during and immediately after pregnancy. The module reinforces the training the CHWs will have received based on the American College of Nurse-Midwives Home Based Life Saving Skills. The module is designed to quickly bring a CHW through key points of identifying and responding to emergency signs including difficulty breathing, low birth weight, and hypothermia. The module then helps the CHW promote simple but effective hygiene and preventive care to reduce infections such as infected cord stumps, pneumonia, and tetanus.

A key challenge World Vision encountered was that the CHWs in the Herat region are low-literate. CommCare was, therefore, adapted for low-literate users by including audio prompts and images. These multimedia prompts have been found to also help engage the client more, as the CHWs play the audio clips and show images to their clients.

The following video demonstrates how the CommCare application works:

CommCare-Sense House Visit 1 from Derek Treatman on Vimeo.

Click here to learn more about this project.

Apps for Development.

Voting is open for the World Bank’s apps for development competition.

“The Apps for Development Competition aims to bring together the best ideas from both the software developer and the development practitioner communities to create innovative apps using World Bank data.”

I like the idea.  But many of the apps appear to be solutions looking for a problem, probably due to the requirements that entries use World Bank data and address the Millennium Development Goals.  Many entries were not meant to address field-level development needs, which is disappointing. But it is a great initiative, which can be adjusted in future efforts.

The Microsoft sponsored ImagineCup 2011 student IT competition is under way too. Its theme is imagine a world where technology helps solve the toughest problems, also based on the Millennium Development Goals. Deadlines loom so pass the word to interested students.

It will be very interesting to see what comes out of these contests, and if someone can analyze them, see what we can learn about ramping up efforts to develop technologies to solve real-world problems.

Personally, I would like to see the GBI portal become a clearinghouse for practical apps for development – an app store for development, if you will.

Using mobile devices to collect and share health data can make healthcare cheaper, faster and more equitable …. You can’t see health data as they flow from clinic to decision-maker — but they are absolutely critical for informing good policies and allocating resources appropriately.

Read the article at Time to get mHealth moving – SciDev.Net.

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.

Working with diverse partners, the mHealth Alliance (mHA) advances mHealth through research, advocacy, and support for the development of interoperable solutions and sustainable deployment models. The mHA, hosted by the United Nations Foundation, sponsors events and conferences, leads cross-sector mHealth initiatives, and hosts HUB (HealthUnBound), a global online community for resource sharing and collaborative solution generation.

Some FAQs about mHealth

Q. What is mHealth?

A. mHealth stands for mobile-based or mobile-enhanced solutions that deliver health. The ubiquity of mobile devices in the developed or developing world presents the opportunity to improve health outcomes through the delivery of innovative medical and health services with information and communication technologies to the farthest reaches of the globe.

Q. What is the mHealth Alliance vision?

A.  The mHealth Alliance seeks to mobilize innovation to deliver quality health services to the furthest reaches of the wireless networks. At the leading edge of the mHealth ecosystem, they seek to unite existing mHealth projects and guide governments, NGOs, and mobile firms to deliver innovative, interoperable solutions in the exploding mHealth field.

Q.  How did the mHealth Alliance begin?

A. The idea for the mHealth Alliance emanated from a July 2008 conference in Bellagio, Italy, on the future of mHealth, during which participants committed to forming a non-profit mHealth Alliance to maximize the impact of mobile health, especially in emerging economies, by ensuring interoperability and open-standards based solutions.

Launched at the GSM Mobile World Congress in February 2009 by the Rockefeller Foundation, United Nations Foundation, and Vodafone Foundation, the mHA now includes the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the GSM Association among its founding partners.

Q. What are the key areas of focus for the mHealth Alliance in terms of public health problems?

A. The mHA is committed to ensuring the positive impact of mobile/ICT-based services across all health sectors, geographies and communities. The mHA has chosen to focus initially on maternal and child health with the inception and launching of the Maternal mHealth Initiative (MMI), as a way to model the potential of mHealth and developing the necessary reference models and prototype solutions. By focusing on mHealth solutions for the full continuum of maternal care, from pre to post-natal health, the mHA is able to identify a set of common needs that can also be applied to a wide variety of health areas.


A Peace Corps Volunteer harnesses the power of text messaging for good health

Written by by Shannon Cummings

In a few short years, messaging (also called “SMS” for Short Message Service), has seemingly replaced phone conversations, letter writing and the traditional two cans attached by a long string as the primary form of communication for young people worldwide. Imagine if young texters in the developing world could get quick and accurate answers to their most personal sexual health questions anonymously, by simply sending an SMS. In Namibia, Peace Corps Volunteer Rashid Khan has developed a program that does just that. Khan is harnessing the global texting trend to fight rampant sexual health misinformation that contributes to a towering HIV infection rate and many unwanted pregnancies.

When Khan arrived in country, he immediately became aware of the lack of knowledge and resources Namibian youth had regarding sexual health. “After talking to local youth, both formally and informally, it became very clear that there exist serious misconceptions about pregnancy, sex, circumcision and other important topics,” explained Khan. And he was right—in his region “lack of knowledge” was listed among the top factors driving the HIV infection rate by the 2008 National HIV Sentinel survey. As a whole, the country of Namibia has an 18% HIV infection rate.

After discussing possible ways to address this problem, Khan learned of an automated, menu-based health information system started by two volunteers in the Philippines. This program allows consumers to access an abundance of pre-written health information through text messages. Khan recognized the potential to implement a similar system in Namibia, where cellular phone service is widespread and text messaging in the cheapest and most frequently used way to communicate. Together with Jennifer Moore, a fellow Namibian PC Volunteer, he developed the Health Education Response System (HER) in February of 2009.

Rashid Khan

Optimistic, but not content, Khan realized that “a fully automated system could only address the most basic of questions.” Searching for a more complete solution, he stumbled upon a North Carolina-based text line designed to answer sexual health questions from teenagers called the “Birds and the Bees Text Line.” Realizing that the demand in Namibia was present for such a service, Khan designed software so that by sending a question via SMS, consumers receive a tailored answer from a trained health Volunteer that is both accurate and timely. Additionally, the program was expanded to deliver SMS in a round robin fashion to a pool of 10 Volunteers across the country. Consumers can still view the pre-written content by texting MENU, and then following the directional guide through a menu of choices. A directory of anti-retroviral (ARV) clinics with complete contact information can be accessed by texting “ARV TownName”.

In Namibia, HER has proved transformative. The system’s popularity was evidenced in June of 2009 when nearly 2400 SMSs were processed to and from 325 unique clients. One key feature of the system is the anonymity of the questioner.

“Our goal was to answer the questions people couldn’t ask anyone else—to be a reputable, anonymous source of information,” said Khan.

By filtering all SMSs through a central server so that both Volunteers and consumers are shielded from each other’s phone numbers, anonymity is preserved. This lends itself to frank and open questions that the asker may deem too private, embarrassing or demeaning to ask without the veil of anonymity.

Another powerful attribute of HER is its connection “to a complex monitoring and evaluation system that automatically tracks, compares and reports themes of conversations.” Without identifying the data source, the records can be used as a database to inform other health-related projects of frequently asked questions and common misconceptions. The hope is that this wealth of information will contribute to a more informed and effective fight against the spread of disease bred by ignorance.

On top of all of this, the program has been meticulously designed with sustainability in mind. “Sustainability and replication were goals from the beginning. I designed the software to be installable and maintainable by anyone with minimal training,” Khan said. Not only have Khan and his group been able to secure free service from MTC, Namibia’s largest mobile network, they have also partnered with Lifeline/Childline which provides counseling to clients in need. Lifeline/Childline is in talks to take over the program when Khan completes his service and leaves Namibia.

In June 2009 alone, the HER program system exchanged 2,382 SMSs with 325 unique clients.

Khan’s success implementing HER serves as a model to others motivated to make a difference in their corner of the world. When asked for the advice he would offer someone with an idea to improve his or her community, Khan remarked:

“Dive right in today. Take inspiration and help wherever you find it.”

For more information see the PeaceCorps Press Release on the project here

About this talk:

Hans Rosling reframes 10 years of UN data with his spectacular visuals, lighting up an astonishing — mostly unreported — piece of front-page-worthy good news: We’re winning the war against child mortality. Along the way, he debunks one flawed approach to stats that blots out such vital stories.

Hans Rosling

About Hans Rosling:

As a doctor and researcher, Hans Rosling identified a new paralytic disease induced by hunger in rural Africa. Now he looks at the bigger picture of social and economic development with his remarkable trend-revealing software. Rosling developed the breakthrough software behind his visualizations through his nonprofit Gapminder, founded with his son and daughter-in-law. The free software — which can be loaded with any data — was purchased by Google in March 2007. (Rosling met the Google founders at TED.)

Rosling began his wide-ranging career as a physician, spending many years in rural Africa tracking a rare paralytic disease (which he named konzo) and discovering its cause: hunger and badly processed cassava. He co-founded Médecins sans Frontièrs (Doctors without Borders) Sweden, wrote a textbook on global health, and as a professor at the Karolinska Institut in Stockholm initiated key international research collaborations. He’s also personally argued with many heads of state, including Fidel Castro.

The Maternal and Child Health Integrated Program (MCHIP) is the USAID Bureau for Global Health’s flagship maternal, neonatal and child health (MNCH) program. Awarded in September 2008, MCHIP focuses on reducing maternal, neonatal and child mortality in 30 priority countries, contributing to Millennium Development Goals (MDGs) 4 and 5.

Designed by USAID as a “Leader with Associate Cooperative Agreement” (LWA), MCHIP can be funded by USAID Missions and Regional Bureaus through traditional field support and other mechanisms. In addition, MCHIP can accept Associate Awards that Missions, Regional Bureaus or Global Offices develop with the Leader organization and oversee directly.

MCHIP takes “what works” to scale by working with USAID Missions, national and local governments, nongovernmental organizations, communities and partner agencies. Based on country context and identified gaps in providing services at the household,community and referral levels, MCHIP designs program strategies to ensure that services reach women and their families.

What MCHIP Is Doing Using Mobile Technology

Nearly half of all births in developing countries occur in facilities, yet the quality of care provided is often unknown. Reported clinical practice may differ greatly from observed practice. MCHIP has developed a Maternal and Newborn Quality of Care (MNH QoC)Toolkit consisting of five mobile, electronic data-entry tools for assessing the quality of services provided in hospitals and health facilities. These are primarily checklist tools for observing health worker performance related to services provided for labor and delivery and essential newborn care. The tools are designed to capture health worker responses to spontaneous complications, such as pre-eclampsia/eclampsia (PE/E) or postpartum hemorrhage (PPH), two of the leading causes of maternal death.

As of November 2010, MCHIP MNH QoC assessments have been conducted in five African countries, providing baseline data for quality improvement activities for maternal and newborn care at facility, regional and national levels.

Maternal and Newborn Health QoC Mobile Toolkit

  • Obstetricians and nurse-midwives are trained to use mobile phones for capturing observational health worker performance data at hospitals and health facilities;
  • Data is entered on Windows Smart Phone forms with Range, Logic, Skip and other data quality controls;
  • Data includes clinical observation checklists on labor and delivery services, antenatal care, facility inventories, health worker maternal and neonatal knowledge tests, register, maternity chart and partograph review;
  • Quantitative and qualitative data is captured via interviews, simulations and observation checklists including audio noted and pictures of partograph;
  • Data is backed up to internal SD card and then transmitted via GPRS to in-country servers; and
  • Results are uploaded to the Web in predefined table, graph and map templates.

A Tool for Improving Quality of Care

The overall goal for MCHIP is to contribute to the reduction of frequent, preventable maternal and newborn deaths through increased quality of known life-saving interventions in countries facing the highest disease burden. Mobile phones have improved the quality of data and expedited the timeliness of results reporting. Specific needs for effective interventions for screening, prevention and treatment of obstetric and newborn complications are being identified as results come in from the MNH QoC Assessments.

Data collected and analyzed provides an opportunity to guide development of program interventions to improve the quality of facility-based maternal and newborn care services. By providing a baseline and end line measures in countries where the survey is part of an evaluation of interventions being implemented, data also provides an opportunity to inform policy change and resource allocation. These indicators and data collection tools can be used in multiple countries to provide information on key screening, prevention and management of interventions of the most frequent direct maternal complications.

Click here to view the poster presented by USAID at the mHealth Summit 2010. Also check out this Youtube Video of MCHIP’s own David Cantor speak as part of the panel discussion at the Summit.

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