Mobile applications (apps) can bring health research and its potential downstream benefits closer to underserved populations. Drawing on experience developing an app for detecting and referring cases of cutaneous leishmaniasis in Colombia, called Guaral/app, we review key steps in creating such mobile health (mHealth) tools. These require consideration of the sociotechnical context using methods such as systems analysis and human-centered design (HCD), predicated on engagement and iteration with all stakeholders. We emphasize usability and technical concerns and describe the interdependency of technical and human considerations for mHealth systems in rural communities.

Background Detection and management of neglected tropical diseases such as cutaneous leishmaniasis present unmet challenges stemming from their prevalence in remote, rural, resource constrained areas having limited access to health services. These challenges are frequently compounded by armed conflict or illicit extractive industries. The use of mobile health technologies has shown promise in such settings, yet data on outcomes in the field remain scarce. Methods We adapted a validated prediction rule for the presumptive diagnosis of CL to create a mobile application for use by community health volunteers. We used human-centered design practices and agile development for app iteration. We tested the application in three rural areas where cutaneous leishmaniasis is endemic and an urban setting where patients seek medical attention in the municipality of Tumaco, Colombia. The application was assessed for usability, sensitivity and inter-rater reliability (kappa) when used by community health volunteers (CHV), health workers and a general practitioner, study physician. Results The application was readily used and understood. Among 122 screened cases with cutaneous ulcers, sensitivity to detect parasitologically proven CL was >95%. The proportion of participants with parasitologically confirmed CL was high (88%), precluding evaluation of specificity, and driving a high level of crude agreement between the app and parasitological diagnosis. The chance-adjusted agreement (kappa) varied across the components of the risk score. Time to diagnosis was reduced significantly, from 8 to 4 weeks on average when CHV conducted active case detection using the application, compared to passive case detection by health facility-based personnel. Conclusions Translating a validated prediction rule to a mHealth technology has shown the potential to improve the capacity of community health workers and healthcare personnel to provide opportune care, and access to health services for underserved populations. These findings support the use of mHealth tools for NTD research and healthcare.

RESUMENIntroducción: Esta investigación corresponde a un estudio descriptivo de la innovación tecnológica robótica desarrollada en Colombia, aplicada al proceso de rehabilitación en pacientes con pérdida funcional de la mano posterior a eventos traumáticos. Materiales y métodos:Se seleccionaron dos pacientes: un paciente con lesión medular cervical traumática nivel C6 y otro con rigidez postraumática secundaria a fractura de mano. Resultados:Con el uso del exoesqueleto de mano en el paciente con lesión medular cervical mejoró la funcionalidad según escala DASH; además, disminuyó la intensidad del dolor y refirió mejoría de su autoestima y calidad de vida. En el paciente con fractura de mano, luego de un proceso de rehabilitación asistido por órtesis robótica se evidenció una recuperación funcional según escala DASH, igualmente mejoró los arcos de movilidad articular y disminuyó la intensidad del dolor según la escala visual análoga.Discusión: Se concluye que con el uso de las órtesis robóticas se mejoró la funcionalidad de la mano y disminuyó el dolor en ambos pacientes. Nivel de evidencia:El propósito del estudio es generar evidencia clínica (nivel III) de la utilidad de las órtesis robóticas en la solución de problemas de salud pública mundial relacionada con este tipo de discapacidad.Palabras clave: exoesqueleto, órtesis robótica, escala DASH, escala EVA, escala ASIA ABSTRACT Introduction: This research corresponds to a descriptive study on innovation of robotic technologies developed in Colombia, applied to the process of rehabilitation in patients with functional loss of the hand due to traumatic events.

No abstract

No abstract