A demonstration of mobile phone deployment to support the treatment of acutely ill children under five in Bushenyi district, Uganda

Abstract

Abstract:Background: Benefits of mobile phone deployment for children <5 in low-resource settings remain unproven. The target population of the current demonstration study in Bushenyi District, Uganda, presented with acute fever, pneumonia, or diarrhoea and were treated by community health workers (CHWs) providing integrated community case management (iCCM). Methods: An observational study was conducted in five parishes (47 villages) served by CHWs well versed in iCCM with supplemental training in mobile phone use. Impact was assessed by quantitative measures and qualitative evaluation through household surveys, focus group discussions, and key informant interviews. Results: CHWs in targeted sites improved child healthcare through mobile phone use coupled with iCCM. Of acutely ill children, 92.6% were correctly managed. Significant improvements in clinical outcomes compared to those obtained by CHWs with enhanced iCCM training alone were unproven in this limited demonstration. Nonetheless, qualitative evaluation showed gains in treatment planning, supply management, and logistical efficiency. Provider confidence and communications were enhanced as was ease and accuracy of record keeping. Conclusion: Mobile phones appear synergistic with iCCM to bolster basic supportive care for acutely ill children provided by CHWs. The full impact of expanded mobile phone deployment warrants further evaluation prior to scaling up in low-resource settings.

Strengthening Delivery of Health Services Using Digital Devices

“… 61 Furthermore, the failure of patients to complete the full care plan in line with their initial diagnosis can often be attributed to a breakdown of referral processes. 62 , 63 The reasons behind these breakdowns can be complex and multifactorial: referrals to clinic may not account for distance clients need to travel, clients may not be able to afford the means to travel to the clinic, clients may not be able to afford taking time off from work or have child care arrangements to be able to follow up with the clinic, and the client or caregiver may not understand the referral instructions. Enhancing referral coordination activities with digital health systems can help overcome substantial barriers to strengthening referral services.…”

“…For instance, in Zambia, researchers reported a marked improvement in referrals for patients as a result of using coordinated digital health referral coordination systems. 62 In addition, the digital referral system removed barriers to arranging referrals faced by health care providers by improving the providers' ability to communicate with others, preparing patients for care, and changing plans for referral activities quickly, if needed. Similarly, in Zanzibar, the authors noted that an increased proportion of women completed the recommended 4 antenatal care visits, leading researchers to believe that digital health interventions could contribute toward the overall improvement of maternal health.…”

Where there is no doctor: can volunteer community health workers in rural Uganda provide integrated community case management?

“…One-half of 'iCCM CHWs' received mobile phones and associated training (i.e. 'iCCM plus mobile CHWs') as part of a synergy pilot intervention described elsewhere, 32,33 . From April-October 2012, CHWs conducted iCCM.…”

Evaluation of Standard and Mobile Health–Supported Clinical Diagnostic Tools for Assessing Dehydration in Patients with Diarrhea in Rural Bangladesh

“…Recent studies using mobile technology have documented robust adherence to appropriate treatment of childhood cases of diarrhea, as well as medication and IV fluid recommendations in management of diarrhea in rural settings. 23,31 Our study investigates whether an mHealth application can improve the inter-rater reliability and usability of a clinical dehydration diagnostic tool among adults and pediatric patients with acute diarrhea.…”