Tag Archive for: malaria

Ethiopia is at a pivotal moment in its efforts to improve the health status of its people and move the country into a new phase of social and economic development. The country’s massive Health Extension Program (HEP) program has placed over 34,000 community health workers in 14,000 health posts in less than 8 years. Now, health authorities are exploring ways to improve the program with mobile solutions.

Sponsored by The Bill & Melinda Gates Foundation, Vital Wave Consulting authored the “mHealth in Ethiopia: Strategies for a new Framework” report for the Ethiopian Ministry of Health. The report offers a framework for addressing specific information, communication and inventory management issues with mHealth interventions.

Download the report by clicking the link below – and let us know what you think in the comments!

Photo Credit: medatanzania.org

In Tanzania, a new voucher program started in late July that provides discounted insecticide treated bed nets for pregnant women and children. This program also takes advantage of mobile technology as retailers can inform local clinics when their shops are getting low on life saving supplies by text messaging.

The program which is being overseen by MEDA, a Canadian organization, integrates health clinics, wholesalers, retailers and bed net manufacturers. Pregnant women and families with children in rural areas are eligible to receive a voucher from health clinics to get discounted insecticide treated bed nets from health supply retailers at 500 Tanzania shillings (about $0.35).

Once a woman takes a voucher to a retailer and pays a discounted price, she receives a bed net in return. The retailer then uses his or her cell to send a text message back to MEDA, which helps run the program. That SMS provides crucial monitoring data that includes the number of bed nets provided to the community and how many are needed in their next shipment.

The use of mobile technology to monitor bed net stocks and shipments is the feature that set this bed net initiative apart from others.

Each shipment contains a predetermined number of bed nets for a specific region based on their unique needs. Once the bed nets are delivered and the vouchers are collected, the retailers receive monetary compensation.

Long lasting insecticide treated bed nets. Photo Credit: medatanzania.org

In the “fight” against malaria, insecticide treated bed nets are a cost effective and proven weapon, especially for families in rural communities. According to the Global Fund, more than 300 million bed nets have been distributed in Sub-Saharan Africa since 2008. Moreover, Tanzania is a hard hit country as 2 million out of the 44 million people are affected by malaria.

Distributing vouchers for discounted bed nets is not a new method of tackling malaria. However, this approach produces a different sentiment amongst bed net owners than simply passing out bed nets to families for free.

Health workers have found that when a family makes a small investment in the net, it becomes a more valued commodity. Initiatives that pass out bed nets for free sometimes fail because families adopt the mentality that bed nets are valueless and easily replaceable.

This program distributes paper vouchers to the women that visit health clinics. Paper vouchers can easily be lost or ruined altogether. Therefore, keeping track of paper vouchers is often an obstacle. The next step is eliminating paper vouchers and developing text message based vouchers to make the process more efficient.

One the biggest issues in mHealth and mobile campaigning in the developing world is the lack of evaluation. Well, the Lancet published an article last week that measured the effectiveness of mobile phone text message reminders on Kenyan health workers’ adherence to malaria treatment guidelines.

What the study found was that text messages can be a cost effective way to improve the care for malaria treatment in African children. Even though the study focused on malaria treatment, the results of the study suggest that using text messages can be an effective weapon to fight many different health burdens with.

According to the study, half of children received the correct treatment at the end of the study, more than double the starting figure. At the beginning of the study, 20.5% of children were correctly managed, this increased to 49.6% after the six month study.

The effect appeared to persist after the texts stopped. Six months after the trial ended, 51.4% of children were receiving the correct treatment due to the text messaging.

Professor Bob Snow, who headed the research group, said, “The role of the mobile phone in improving health providers’ performance, health service management and patient adherence to new medicines across much of Africa has a huge potential.”

Despite the positive numbers, the authors acknowledge that “we do not fully understand why the intervention was successful”. They speculate that the presence of the texts themselves serve as a reminder and reinforce the importance of the message itself.

One of the conclusions in the study is that “text-message reminders should be used to complement existing interventions—which themselves should be qualitatively improved—to target weak points” in health management practices.

The study however, sheds light on the importance of evaluating an mHealth campaign. Through evaluations, stakeholders can figure out whether a program is meeting its goals and how much of an impact it is making on the health issue it was designed for.

Currently in the developing world, numerous mHealth programs are being implemented on a small scale basis without monitoring and evaluation components. This not only leaves the project unfinished, but it is irresponsible as well. If a given program is appropriate to scale up to a wider population, we would never have the statistics to prove it. Then again, that hasn’t stopped NGO’s and governments before.

Evaluating mHealth programs is not a complicated task. Perhaps stakeholders are afraid to discover that their programs are not actually producing the impact they envisioned in the board room. This study has shown that positive results can indeed manifest from text messaging campaigns, and it is worthwhile to evaluate such campaigns.

The world needs to know what works and what doesn’t for the sake of the populations that are supposed to be the beneficiaries of the programs they are involuntarily thrown into. Otherwise, stakeholders are shooting in the dark with the well-being of innocent people.

Photo Credit: geardiary.com

A new faction has joined in the war against malaria: graduate students. A group of students developed a malaria diagnostic tool that will be rolled out in India and Ethiopia this summer.  Called, the Lifelens project, the tool uses a micro lens on the camera of mobile phones that can ultimately test for and diagnose malaria.

Created by Harvard Business School student Cy Khormaee and UC Davis doctoral student Wilson To, the lifelens product attaches a $50 micro lens to the camera of a Windows 7 enabled smartphone.

With the camera in place, the phone can then capture high-resolution images of the cells in a drop of blood that is placed on the micro lens. Windows 7 software quickly analyzes the images, confirming the presence or absence of malaria. Once the images are analyzed, the results can be sent to public health workers and other health professionals via SMS for further assessment and data collection.

Current standard practices in malaria diagnosis involve administering a rapid diagnostic test (RDT). This method takes a blood sample, usually off of the finger of the patient, and then exposed to a cotton swab containing a solution that reacts with malaria antigens that may be in the blood. However, this method is inefficient and produces many false positives, with only a 40% accuracy rate.

Photo Credit: springwise.com

The lifelens tool acts as a powerful microscope and can easily be sterilized for further immediate usage. It is also more accurate than RDT since it detects malaria cells directly. To and Khormaee say that in the long run, the lifelens tool will be more cost effective than current RDT detection methods.

However, there are some obstacles. The lifelens tool only operates on a Windows 7 enabled smartphone. These phones cost hundreds of dollars and may be affordable in resource poor areas. Also, the lifelens tool is not the only novel technological tool in the malaria detection space. Disposable tests are already in wide use, and others are developing diagnosis technologies, including a DNA-based one that could, like Lifelens, test for malaria and other illnesses.

The lifelens project received an award in the Microsoft sponsored Imagine Cup competition that featured innovative technological tools that use Microsoft software. With this award in hand, To and Khormaee plan to roll out a testing phase for their tool in India and Ethiopia.

Virtually all deaths from malaria occur in the developing world with 90% occurring in Africa. Any advancement in malaria diagnosis is highly valued. The lifelens project is aiming to change the way infectious disease diagnosis is handled. “Malaria is just the beginning,” says To. “We’re building a platform.”

It was recently announced that an initiative called Mobiles Against Malaria will be launched in Bamako, Mali. The initiative will be executed using mothers who are community health workers in an effort to use mobile phones to prevent, diagnose and treat malaria in a more effective way than it has been.

The project is being funded by Akvo, a foundation created in 2008 that uses open source web and mobile software to attract funders to a spread of projects being done in the developing world.

CHW's at work. Photo Credit: Akvo

Mobile phones will be used by the mothers who were recruited as community health workers(CHW) to record data from neighborhoods on malaria. The CHW’s will visit each household in a particular neighborhood ready to ask pre-formulated questions.

The answers to the questions will be gathered on the mobile phones. For example, some of the questions asked may be ‘how many people live in the house’ and ‘how many people are ill’ and ‘what is the number of newborns’.

After gathering all of the necessary answers, the data will be sent via SMS to a central database located at a local hospital. It is hoped that NGO’s and local organizations will take advantage of the databases to analyze the trends and assist households in need of help. Officials hope the SMS data collection system will shed light on estimating how many insecticide-treated nets are needed in the poor areas in Bamako.

These community health workers will travel to malaria impacted areas around the capital city of Bamako to administer a revamped program. An older version was implemented using CHW’s who tested 2,796 children for malaria with a finger prick test after visiting nearly 100,000 households. That framework will be enriched by the introduction of the SMS-based frontline data collection.

The use of mothers as the CHW’s is a hallmark feature of this program. That along with using the SMS based frontline data collection sets this malaria detection program apart from other ones going on in Africa. Using mothers presents several advantages:

  • mothers are trusted in the community
  • they easily gain trust from other women from whom data is being collected
  • they can persuade women to visit hospitals using that established trust
  • they often have insider knowledge to the neighborhoods they work in
  • they ensure use of treated mosquito nets
  • they support treatment adherence

Along with attaining malaria specific data such as households using insecticide treated bednets, officials hope the program will create easier access to information on the burden. They also hope the cell phone-based application will improve patient management via a cell phone risk assessment and triaging tree, strengthen patient history documentation in the field, enable clinical communication (text, image, audio) between community health workers and clinics, and provide access to previously unrecorded health information.

The program aims to use mothers and cell phones to decrease costs of malaria detection and treatment while improving the access to treatment and treatment adherence. The program will train and utilize 50 CHW’s and 2 hospitals over the span of a year. It hopes that using mobile phones will build off of prior success.



Text to Change (TTC), an mHealth non-profit organization based in the Netherlands, announced earlier this month that they will receive a €2.7 million grant to expand its services. TTC provides an SMS-based educational service to improve the health of citizens in eight countries in Africa and one in South America.

Already a big contributor in mHealth development, TTC hopes to become a leader in the field with the reception of its multi-million Euro grant from the Dutch Ministry of Foreign Affairs via Connect4Change (C4C), a consortium funded by the Dutch Ministry of Foreign Affairs that develops mobile based solutions on issues of poverty in Africa and Latin America. TTC will partner with C4C to expand its services to 11 more countries in Africa and South America by the end of this year.

Implementing ICT in the 11 countries is a top priority for both TTC and C4C. They are hoping the mutual partnership will make establishing ICT services an easier task as the expansion continues. According to TTC, the game plan calls for TTC to provide “low” technologies like SMS and mobile voice services while C4C provides “high” technologies such as mobile internet and video transfer. Therefore, TTC and C4C will play different roles.

C4C will also invest its time reaching out to local entities on the ground to strengthen ICT networks. TTC will focus on improving health outcomes through their established mobile phone initiatives.

TTC sets up their mobile platform through the recipient country’s mobile service infrastructure already in place. They then subscribe mobile phone users to their programs which use SMS communication to inform people of HIV testing, treatment clinics, and other health related services at no cost to the recipients.

TTC SMS system Photo Credit: TTC

TTC programs offer the information through a free educational quizzing service where participants are quizzed about a specific health topic. As participants answer the questions correctly, they are sent more rounds of questions, again at no cost. If the participant can answer enough questions correctly, he/she receives incentives such as phone credit, t-shirts and health products.

Thus far, TTC has reached thousands of individuals with their programs on HIV/AIDS, malaria, and reproductive health. Furthermore, to assess the impact of ICT in the countries they are currently working in, TTC will even conduct large scale ICT evaluations over the next few years in those countries.

TTC is poised to make an impact in ICT through their mobile services. Their work is just another example of how mobile phones are being used as a medium to educate, inform and save lives. The tag-team partnership with C4C will be expanded to all 11 target countries by the end of this year. However, we will have to wait some time before confirming the outcome of this joint strategic approach.

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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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.


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