Background There is a high prevalence of skin diseases sub-Saharan Africa, including skin neglected tropical diseases (NTDs) that could lead to lifelong disabilities and deformities if not diagnosed and treated early. To achieve early detection and early treatment of these skin diseases, we developed a mobile health app, eSkinHealth. Objective This paper outlines a protocol for evaluating the effect of our eSkinHealth app in the early detection and effective management of skin diseases in Côte d’Ivoire. Methods A mixed methods pilot trial will be conducted in Côte d’Ivoire and will consist of 3 phases: (1) the development and improvement of the eSkinHealth app, (2) a pilot trial to evaluate the usability of the eSkinHealth app for local medical staff in Côte d’Ivoire, and (3) a pilot trial to evaluate the effectiveness of early detection and case management of targeted skin NTDs (Buruli ulcer, leprosy, yaws, and lymphatic filariasis) with the eSkinHealth app in Côte d’Ivoire. The pilot study will be implemented as a 2-arm trial with local health care providers and patients with skin NTDs over a 3-month follow-up period. The local health care providers will be assigned to an intervention group receiving the eSkinHealth app to be used in their daily practices or a control group. Training will be provided on the use and implementation of the app and the diagnostic pipeline to the intervention group only, while both groups will receive training on skin diseases. Our primary outcome is to evaluate the early detection and effective management of skin diseases using the eSkinHealth app in Côte d’Ivoire by the number of cases diagnosed and managed. Additionally, we will evaluate the eSkinHealth app with validated questionnaires and in-depth interviews. Procedures of our methods have been reviewed and approved by the Institutional Review Board of the Ministry of Health, Côte d’Ivoire and by Tulane University in 2021. Results This study was funded in 2021. We started the enrollment of patients in February 2022, and data collection is currently underway. We expect the first results to be submitted for publication in 2023. Conclusions Our eSkinHealth app is a field-adapted platform that could provide both direct diagnostic and management assistance to health workers in remote settings. The study will provide evidence for the usability and the effectiveness of the eSkinHealth app to improve the early detection and case management of skin NTDs in Côte d’Ivoire and, furthermore, is expected to contribute to knowledge on mobile health approaches in the control of skin NTDs. Trial Registration ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/study/NCT05300399 International Registered Report Identifier (IRRID) DERR1-10.2196/39867

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BACKGROUND The prevalence of skin diseases is extremely high in sub-Saharan Africa. Among these are skin neglected tropical diseases (skin NTDs) that could lead to lifelong disabilities and deformities if not diagnosed and treated early. To achieve early detection and early treatment of these skin diseases, we developed a mobile health (mHealth) app, eSkinHealth. OBJECTIVE We evaluated the usability and effectiveness of our eSkinHealth app in the detection and effective management of skin diseases in rural Côte d’Ivoire. METHODS A 2-arm trial with local healthcare providers and patients with skin NTDs was implemented over a 3-month follow-up period. The healthcare providers were assigned to an intervention group receiving the eSkinHealth app to be used in their daily practices or a control group with usual care. A total of 4 nurses and 8 community healthcare workers (CHWs) were selected to participate in the study for each arm. Training was provided on the use and implementation of the app and the diagnostic pipeline to the intervention group only, while both groups received training on skin diseases. For usability study, we evaluated the eSkinHealth app with validated questionnaires and in-depth interviews. For effectiveness study, our primary outcome was to evaluate the early detection and effective management of our targeted skin NTDs (Buruli ulcer, leprosy, lymphatic filariasis, scabies, and yaws) and other skin diseases using the eSkinHealth app by the number of cases reported and managed. Procedures of our methods were reviewed and approved by the IRB of the Ministry of Health, Côte d’Ivoire and by Tulane University. RESULTS The mean age of our participants (providers) was 40.5 and 42.5 for intervention and control arms, respectively, and all were male (n=24). The System Usability Score (SUS) was applied to 12 users of the eSkinHealth app in the intervention arm. The average scores at baseline, the midpoint (6 weeks), and the end of the study (12 weeks) were 72.3 (SD 11.5), 72.3 (SD 12.4), and 86.3 (SD 10.8), respectively. All participants interviewed, including four dermatologists and program managers in addition to our participants, were satisfied with the app. Especially, CHWs felt empowered by equipped with the tool. Seventy-nine cases of skin NTDs were reported in the intervention arm as compared to 17 cases in the control arm (p value=0.0019). CONCLUSIONS Our eSkinHealth is a field-adapted platform that could both provide direct diagnostic and management assistance to health workers in remote settings. The study provided evidence for the usability and the effectiveness of the eSkinHealth app to improve the early detection and case management of skin NTDs and other skin diseases in Côte d’Ivoire and, furthermore, are expected to contribute to knowledge on mobile health approaches in the control of skin NTDs. CLINICALTRIAL ClinicalTrials.gov NCT05300399; https://clinicaltrials.gov/ct2/show/NCT05300399.

This study investigated the usability of a mobile phone-based system, “eSkinHealth”, for healthcare providers in Côte d’Ivoire. The eSkinHealth can be used both online and offline to address the poor Internet connectivity of these rural settings. Data recorded in the mobile application were synchronized with an online database, and specialists in Abidjan, Côte d’Ivoire and in Japan advised local healthcare providers on difficult cases. In this pilot study, 21 healthcare providers used the eSkinHealth and completed questionnaires assessing the usability. The average score of a system usability scale for eSkinHealth was 84.2 (SD 11.7), which can be interpreted as excellent. The average registration for patient information (e.g., name, sex, age, area of residence) was 8.6 (SD 15.5). Further studies with more targeted areas and participants are needed to evaluate the usability of eSkinHealth in rural Côte d’Ivoire.