A Case for App Development in Combating Maternal and Child Health Mortality in Developing Countries.

The bond between a mother and child transcends culture, race, religion and economic power. A mother would protect her child with all her strength. The progress therefore of any wise nation rests on how it treats its ‘Mothers and Children’. It is no surprise that the millennium development goals on child and maternal health follow each other, that is, goals 4 and 5. These goals aim to reduce under-5 mortality rates by two-thirds, reduce maternal mortality ratio by three quarters between 1990 and 2015 and achieve universal access to reproductive health by 2015. The global burden shows that 6.9million children under the age of five and about 287,000 mothers die from preventable causes yearly. Although there has been a 47% improvement in maternal mortality from 1990, a mother living in sub-Saharan Africa is 300 times more likely to die in pregnancy or childbirth than her counterpart in industrialised countries, this health indicator accounts for the largest difference between the poor and rich countries. At least 20% of the burden of disease in children below the age of 5 is related to poor maternal health and nutrition, as well as quality of care at delivery and during the new-born period. A motherless child is ten times more likely to die within two years of mothers’ death. The recent report by UNICEF shows that the rate of decline in child mortality is still insufficient to meet MDG4 target in sub-Saharan Africa and South Asia regions, which account 81 percent of global child mortality.

Despite these gloomy figures, there seems to be a light at the end of the tunnel. This light is being powered by mhealth (mobile health). The global mobile phone subscriptions hit a whopping 6.8 billion in 2012 with developing nations accounting for 5.2 billion. There has been an exponential growth rate of use of mobile phones in developing countries since its introduction in the early 2000’s. The use of mobile devices have become ubiquitous across the world. The developing nations although playing ‘catch-up’ are doing a great job the closing the mobile technology gap.  More recently, reports have showed that smartphones have increased their sale in Africa, edging out features phones. The figures show a 51% sale of smartphones over feature phones, with a projected growth of up to 85% by 2017. This growth is in no small part due to the activities of mobile phone giants like Windows/Nokia, Android/Samsung, Blackberry, iOS/Apple in developing nations. The growth of smartphones in developing nations have seen a concomitant growth in the use of mobile web in the last twelve months. Africa’s mobile web use doubled between 2012 and 2013 from 11.3% to 23.7% respectively. It also showed that about 25% of all web access from across the African continent came from mobile phones.

With the growth of mobile technology in developing nations in the past decade, it is little surprise to see various mhealth initiatives springing up in these countries. The major sponsors and funders of mhealth projects and initiatives in developing countries are Non-profit Organisations, the Government of the country and donor Organisations. This follows the usual trend of sponsorship on health projects in developing nations. There is low funding and support in research and academic projects relating to mhealth projects in developing nations.

The most used feature in a mobile phone in tackling maternal and child health is the SMS and voice calls. Mhealth initiatives and projects across developing nation’s use these features because they are cheaper, easy to use, consume less data, do not need advanced broadband internet connective. There is also little technical know-how involved in using these functions unlike the use and development of mobile apps. However, with the recent growth and sales of smartphones in developing countries this trend is expected to change sooner rather than later.

Smartphones have a major role in reducing maternal and child health figures in low and middle income nations. With its functions including SMS, voice call, video-call, app, internet and GPS, smartphones are equipped and ready to bring down maternal and child health rates in developing countries. The number of mhealth apps specifically geared towards fighting maternal and child health aren’t so much in the various app stores and markets. Although there are some new apps developed suited to combating maternal and child health, like the mobile ultrasound app developed by the Mobisante team, the smartphone based quantitative diagnostic solution by i-calQ, and the recently developed anaemia detecting app. This problem is not as a lack of app developers (although there are not so much of them in developing nations as compared to the more developed countries), but from the lack of awareness of the massive role mobile devices and in extension mhealth has to play in their health. As a medical personnel and tech savvy individual, I recently had the chance of interacting with some app developers and heads of technology companies across my country (Nigeria). The problem was not the TOTAL lack of technical know-how amongst the developers in general programing, but the lack of ‘support’.

This lack of support includes; lack of technical knowledge, medical and public health knowledge, little or no financial support, no regulatory bodies that guides health app development in the country and the list goes on. These problems generally apply in most developing nations across the world. In developed countries where medical personnel’s and app developers form teams for app development, various competitions to encourage app development and also have regulatory bodies like the U.S Food and Drug Administration taking mhealth into its strides. This has greatly improved health app development in these developed nations. 

Most of the strategies needed in attaining millennium development goals four and five have already been put on ground by experts. These strategies include the child survival strategy, integrated management of childhood illnesses, promotion of antennal care and postnatal care etcetera. Therefore, mobile app development as a tool in combating maternal and child health mortality should inculcate these strategies. Marrying the functions of feature phones and some of the key aspects of each of these strategies have largely been successful in many mhealth initiatives. However, inculcating one or two of these strategies as a whole into mobile devices (smartphones and tabs) as apps will greatly help to reduce maternal and child mortality rate.

The need therefore for the provision of supports and scaling-up needed in the development of mobile health apps to tackle maternal and child health mortality rates in developing countries cannot be over-emphasized. With proper support of these mobile app development, will not only tackle maternal and child health mortality rates, but will also help reduce the surge of preventable diseases in Africa and developing countries as a whole.

Using ICT to Fix Immunization in Africa

By Emmanuel Owobu and Charles Akhimien

“You let a doctor take a dainty, helpless baby, and put that stuff from a cow, which has been scratched and had dirt rubbed into her wound, into that child. Even, the Jennerians now admit that infant vaccination spreads disease among children. More mites die from immunization than from the disease they are supposed to be inoculated against.”

(G.B. Shaw, 1929)

The world has come a long way since George Bernard Shaw fulminated against immunization in the 1920s. Immunization is now regarded as one of the most cost-effective public health interventions for preventing disease and death. Children in all countries are routinely immunized against major diseases, and the practice is now at the very core of Nigeria is of huge importance to the immunization world. The most populous country in Africa, Nigeria has a high child mortality rate and a low immunization coverage rate.

Particularly disturbing is the fact that of the 6 million Nigerian children born every year, more than 1 million fail to get fully vaccinated by their first birthday. The problems militating against immunization in Africa are extremely diverse. Access to lifesaving vaccines in many parts of Africa is not equitable, with large disparities between socioeconomic class and rural-urban segments of the population.

Problems of ignorance exist as many parents are unaware of the benefits of vaccines. Worse still are problems of misinformation. For example, the oral polio vaccine has faced considerable resistance from certain parts of Northern Nigeria, where it is erroneously believed to cause a reduction in fertility late in life.

Perhaps the biggest challenge of immunization in Africa is the problem of inadequate, moribund infrastructure. Nigeria typifies this, as she is bedevilled by epileptic power supply. This austerely affects maintenance of the cold chain for the vaccines. The inevitable outcome is increased waste, poor supply chain and low immunisation coverage.

Tackling the problem of immunization requires innovative, long-term solutions. Mobile health (mhealth) offers an innovative, low-cost, practical solution that involves the use of mobile devices such as phones and tablets in healthcare delivery and service provision. In the last decade there has been an explosion in the use of mobile technology in Africa. With a population of approximately 160million, Nigeria has a total of 113.1 million registered mobile phone users. Therefore the infinite potential of mhealth necessitates its integration into current healthcare systems in Africa, particularly with regards to immunization.

Mobile phone tools like SMS, video calls, internet, and apps are now being used to create a vortex for effective dissemination of health information. One such mhealth tool is GOBIF3, which is a mobile application in the final stages of development that would serve as a vaccine tracker and immunization schedule reminder to monitor vaccines given, educate parents on immunization and routinely remind parents and care-givers of immunization days and appointments. This would thus enable parents and healthcare personnel easily monitor the immunization status of infants and young children in Africa.

mHealth: 5 ways smartphones can improve healthcare delivery in Africa.

I recently visited an old friend who just completed his one year National Youth Services Corps at a remote village in the South Eastern part of Nigeria. Dr Peter Adebiyi, a city boy who had lived his whole life in the comfort of Lagos City, recounted his tale. “Owobupikin (as he fondly calls me), that village was awesome!”

He started his posting almost a year ago amid fears of a hostile reception, from stories he heard about the community. On his first day reporting to the health centre, he said “I was very late because I didn’t expect to see more than ten people, but I saw about a hundred patients. I was so shocked that I almost turned back.” He attended to about half of them and asked the remaining half to come back the next day. Tuesday morning he was up and out early, ready for the days’ work; but to his amazement he saw only two patients, a little kid who came to dress his wound and a pregnant mother for her antenatal clinic. “What went wrong? Was I so terrible the day before that the others decided to avoid me” Further investigations revealed that Tuesdays was the major market day and Fridays was the minor market day for the community. Dr Peter decided to visit the ward councillor and other village heads, he wanted the health centre to run efficiently and effectively. His plan was simple, let everyone know his clinic days, let there be a working emergency contact number, separate antenatal clinic and postnatal clinic days from others, start a health education day etc. How would he do this he thought? He didn’t imagine himself visiting every home in the community, then it came to him… Mobile Phone.

Dr Peter, who uses a smart phone and a tablet, decided to setup a small group of people headed by himself, the task was; “get every phone number of every villager, arrange them according to sex, age, clinic days, pregnancy status, family status etc. with all the phone numbers at his disposal, he went online and registered for cheap bulk sms services, and decided that he, the nurses and other healthcare workers would send weekly reminders for clinic days, vaccination days, basic health tips (like hand washing, malaria prevention, sexually transmitted diseases). He said, “What surprised me the most was that they knew about Facebook, in fact, the youth association had a Facebook page” he joined the page, there he would discuss with them health and other health related issues, some would add him up and chat with him on personal health issues. With all this going on, he had to still read and prepare for his professional exams, he said “I had to download a lot of medical drug and disease apps plus read and research a lot on the internet”. Sometimes, some of the younger members of the community would quiz him about some information they read off the internet. He said “by the time I was leaving, the community, the health centre was able to generate its own funds from frequent use, clinic days where properly run, health information was getting to the people and there was an overall improved health care awareness in the community.

Mobile Phones have become ubiquitous in Africa, but the smart phone industry is still lagging behind. This shouldn’t be seen as a disadvantage, but an opportunity to act as if the future is now. Over a decade ago, not many people would have anticipated the recent explosion in the mobile phone industry in Africa as seen today. Although smart phones are currently being used by high earned members of the society like the healthcare workers, with the continued growth of the mobile phone industry in Africa, smart phones would soon be a part of our daily lives, even infiltrating the most remote of areas.

Here are five ways smart phones can help:

Voice/ Video calls: Voice calls between patient and doctors, doctors and other healthcare givers would improve patient-doctor relationship, reduce the crowds in rural health centre as most patients can easily get information directly from their doctors or healthcare givers rather than coming all the way to the health centre. Video calls would improve patient doctor interaction in-real time. Imagine seeing your doctor in your living room, kitchen, market place etc. and showing him that rash or swelling that has being bothering you. Doctor-healthcare provider information sharing. Also, simple procedures can be thought in real-time by more qualified healthcare providers.

SMS : As in the case of Dr Peter, patients can be alerted and reminded of clinic days, vaccination days, antenatal days, given health tips, etc. The SMS is currently being used in a lot of mHealth in Africa. Examples include; cellphones4HIV in South Africa, Project done to improve early infant diagnosis of HIV in Mozambique, free AIDS test by text in Ethiopia, Mobile midwife project in Ghana, Learning by living project in Nigeria.

Social media: The rise of social media especially among the young is almost coincidental with the rise in smart phone use not only in Africa but globally. Facebook in particular is very big in Africa, and Dr Peter summed up how it can be used in healthcare delivery in rural areas. Other social media sites like Twitter, Google hangout, YouTube are also experiencing increased use in Africa.

Applications: Mobile apps on smart phones vary from simple medical books and drugs to the sophisticated yet easy to use ECG application. Imagine an app that can take ultrasound scan pictures of a pregnant mother and send it to the doctors phones as an investigation tool while lying in bed in the comfort of her home. Doctors can use these apps in remote areas where access to basic healthcare diagnostics tools are absent in making lifesaving and early diagnosis of diseases.

Internet: The internet has made the world a global village, and Africa is hugely benefiting from it. The internet provides medical information, data research on improving healthcare delivery in rural communities in Africa. In fact, the internet brings to life the experience of Dr Peters in the rural community, from his bulk sms, to facebook with members of the community, to personal research and discussion with younger members of the community on recent health issues.

The potential of smartphones to improve healthcare delivery in Africa is enormous. It is time for Africa to fully tap into the opportunity provided by the rapidly growing mobile phone industry to improve the health of its citizens.

Mobile Health: The Future is NOW

Mama Tayo, a pregnant mother of three lovely kids is in labor for her fourth child, but this is a different experience. She is bleeding from her private part. This never happened in her previous deliveries. She quickly picks up her mobile phone and calls the local mid-wife (Nurse Sarah) and her husband who is on night shift as a security guard in a bank outside the community. Nurse Sarah, realizing the situation was out of her comfort zone calls the doctor in the local health center. In the health center, Mama Tayo has to be referred to a hospital with better facilities suitable for a surgery. Another call is made to a private hospital in town and Papa Tayo is sent a text message on the new developments. Now in a taxi cum ambulance, Nurse Sarah is on the phone with the nurses and doctors from the private hospital. Vital signs, estimated volume of blood loss, contraction strengths, uterine size, dilatation etc are being communicated. On getting to the hospital, she is immediately prepped for surgery.  Papa Tayo is asked to make a deposit. He runs to a nearby ATM machine, makes the withdrawal and the surgery is performed. Mama Tayo is delivered of a beautiful baby girl. Mobile communication just reduced maternal and infant mortality by ONE each.

mHealth (or mobile health) is a sub-group of eHealth (electronic health). It  involves the use of mobile devices (phones, tablets laptops) in healthcare delivery and service provision. The use of mobile telecommunication in healthcare delivery and service is blowing up exponentially. As a public health enthusiast and a tech addict, I am really excited about the prospects of the future of healthcare delivery. Let’s put my excitement aside and talk about the ‘prospects’ of the mobile health communication in the near future.

The United Nations reported in October 2012 that about 6 billion people worldwide have mobile phone subscriptions. In some countries like South Africa, Peru, Singapore, Iran, it is estimated that there are a higher proportion of  mobile phones to the human beings in the country. In Nigeria, about 72.3% of the over 150 million citizens have access to mobile phones. Also, internet users in Africa have risen from 3% in 2006 to 11% in 2011. This has made accessing health and health related information a lot easier. Health tips in form of text messages, calls from special numbers made by mobile carriers, relative ease to accessing the internet has improved peoples knowledge of certain diseases like HIV/AIDS, malaria, breast cancer, etc.

mHealth is not only catering for the needs of the patients. The doctors, nurses and other health workers have come to appreciate the use of mobile health in making diagnosis, exchanging ideas on treatment plans and in the case of mama Tayo, getting vital patient history in emergency. It is estimated that about 81% of physicians use medical applications on smart phones and tablets in seeking medical information. Also, the ease in storing patient records, making and monitoring of patient’s referrals, and reporting of new cases of diseases marked for elimination and eradication.

Mobile health has made information aspects of public health like epidemiology, bio-statistics and reproductive health etc available not only to the developed nations, but also to the people of the under-developed nations.

With all the talk of mobile health revolutionizing healthcare delivery, it has to be noted that its implementation is very expensive especially to governments of third world nations. The cost of putting the necessary infrastructure and man-power together has been one of the major factors militating against its implementation and overall success in these countries. Notwithstanding, the chorus is loud and clear for all to hear. Embracing mobile health will help bridge the gap to attaining better and quality health care delivery.

Mama Tayo named her daughter Ibukun, meaning blessings. Definitely, the Ibukun of mobile health is here for all to share.

Mobile Technology: Effect on Africa's Development Post 2015

The millennium development goals, was in the year 2000 officially established to tackle global social, economic and health crisis. The year 2015 was agreed by the member states of the United Nations and other reputable international organisations as the target year to attain these goals. With various international and local organisations meeting to discuss the post 2015 developmental agenda, there is a need to infuse into these plans the role of mobile technology for a sustained developmental growth in Africa.

The rapid progress towards attaining the millennium development goals by African nations over the last couple of years has come as a much needed encouragement to member states of the United Nations. It has been observed that African nations allocating a higher percentage of government funds to health, education and agriculture are making headway towards achieving the millennium development goals. Poverty is declining slowly; with the rate of poverty falling from 56.5% to 47.5% in 2008. This is due in part to the strong economic growth of African economy over the past decade. It was observed that 30 countries in sub-Saharan Africa have accelerated progress in the last three years on reaching the MDGs and about sixteen other nations are on track to achieving their goals.

This growth in the economy of African Nations ‘coincidentally’ plays its way into the boom of mobile technology in Africa. Mobile technology has greatly improved the socio-economic development of African Countries. There has been a methodological rise in small and medium scale enterprises directly and/or indirectly involved in mobile technology. This has greatly improved income generation among Africans. Furthermore, the increased income generation and reduced poverty has increased the spending power of the local citizenry. Universal basic education which used to be seen as a luxury is now being seen as a necessity. More and more parents now see the need to enrol their wards into primary school to gain the necessary basic skills and knowledge for a better life. Healthcare is gradually becoming accessiblein some communities through the establishment of mhealth infrastructure. The growth of mobile technology has seen a lot of Africans having the feeling of ‘being among’ the trend of global development. Most parents and guardians now see education as means of attaining improved socio-economic status.

Mobile technology is directly and indirectly making huge strides in the socio-economic development of Africa.  Most recently, UNESCO and mobile phone giants Nokia partnered to use mobile technology to help teachers improve English language literacy skills among primary school students in Nigeria. The provision, enrolment and completion of basic primary education post 2015 is definitely key to the continued and sustained socio-economic growth of Africa.

Mobile  technology has a huge role play in the development of Africa come post 2015. It is anticipated that the post 2015 impact of mobile technology will make a huge contribution towards combating poverty in Africa. With the continued pace and anticipated growth of socio-economic development in Africa, mobile technology is a major front-runner in the race to developing Africa.

Fighting Malaria in Rural Communities

“Doctor my baby body dey hot, he don dey cry since yester night and him body dey shake, doctor abeg help me, wetin do am?”

This is a common cry from a local farmer and mother to her healthcare provider. The inevitable diagnosis to these series of symptoms is usually malaria especially in a malaria crippled region like the one we live. Malaria kills about 1 million people every year with about 91% of the deaths in Africa, 86% being children under 5 years. The equivalent to this is really heart-breaking, it estimates that one child dies every 30 seconds.

Nigeria as a nation exerts up to 25% of the malaria disease burden in Africa and about 97% of the country’s population are at risk of the disease. The economic burden of malaria cannot be overemphasized. The direct health cost and productivity of malaria to the African economy is about $12 billion a year.

The rural communities and villages suffer most from the damaging effects of malaria as they are usually located in relatively inaccessible parts of the country. Also, malaria has often been described as the ‘disease of the poor’. With most of the people living in villages and rural communities being very low income earners, it is little wonder that the burden of the disease plagues the rural dwellers. Fighting malaria in rural communities is a key aspect of prevention, control and management of malaria nationwide.

Educating the local populace on the different ways malaria can be contracted and on the various ways of preventing and controlling the vector that causes the disease is paramount in the fight against malaria. The use of wide-ranging avenues such as local markets, village squares, age grade meetings and home-to-home visits for awareness promotion and education on malaria would increase coverage of these prevention interventions and improve the chances of significantly reducing the malaria burden within these communities. Collaboration of grass-root civil society organizations, local health centers, schools, places of worship and other community establishments will increase the chances of implementing these interventions successfully. Furthermore, ensuring that interventions are culturally sensitive to the communities is very important as this could be the factor that determines whether community members approve, accept and adhere to messages being passed across to them.

The power of the primary health centers in our local communities to serve as avenues for successfully fighting malaria has largely remained unexplored due to its limited capacity in terms of available resources (such as funds, human resources, materials, tools and equipment). Diagnostic equipment, cheap and readily available anti malaria drugs, insecticide treated mosquito nets and basic amenities like power and clean water are glaringly missing from many primary health care centers that are supposed to provide the basic health care needs to citizens of our local communities. Addressing these resource shortages in the communities will go a long way to support the fight against malaria.

Finally, economically empowering communities to enable them take charge and sustain the health interventions in their communities will most likely guarantee the success of the fight against malaria and other diseases.

REFERENCES

Okorosobo, Tuoyo: “Economic Burden of Malaria in six Countries of Africa”: European Journal of Business and Management. 2011; vol.3; iss.6; pg.42-63

World Health Organization (2012): “World Malaria Report 2012”. December, 2012

Country Coordinating Mechanism, Nigeria. Malaria. [Cited 2013 April, 24] available from:  http://www.ccmnigeria.org/index.php?Itemid=1&option=com_content&view=article&id=87

Barriers to Accessing Healthcare Services in Rural Communities: Immunization in View

“Good health is one of the most important ingredients for a happy and productive life, yet, many people do not have access to health care and live in conditions that spread disease”

                                                                           Robert Alan Silverstein

Immunization is one of the most effective primary public health interventions aimed at preventing diseases. The promotion and implementation of immunization policies and programs are critical public health roles in the control and prevention of vaccine preventable diseases. 

Despite the existence immunization programs aimed at delivering immunization services to the public free of charge, many individuals and groups still lack access to these services. The success of a nation’s immunization coverage acts as a microscope used to view its ability to provide accessible and affordable healthcare to its citizens especially its rural populace. This article therefore examines the common barriers to accessing immunization services in rural communities.

BARRIERS TO ACCESSING IMMUNIZATION SERVICES

Intra-personal Barriers

Fear, norms, illiteracy, lack of information are all well documented factors militating against the effective delivery of vaccines for vaccine preventable diseases. Intrapersonal barriers are usually generated from within the individuals involved and are often as a result of environmental, social and cultural factors. A classic example is the fear that childhood immunization prevents the child from attaining developmental milestones and causes childhood illnesses and paralysis.

Interpersonal Barriers

The great Aristotle stated that “Man is by nature a social animal”. There are constant interactions between neighbours living in the same community. They share their thoughts, ideas, fears and knowledge on various issues of life, with immunization not being an exception. Also, local community age groups, women associations, and religious bodies tend to have very strong influence on the citizens of rural communities. Therefore, dissemination of  wrong information on the benefits of immunization, its schedule and role in primary healthcare, by individuals and groups could negatively affect the rate at which community members access immunization services.

Community Barriers

Bad leadership, inaccessible geographical locations and 
hostile cultural practices limits communities from accessing vaccines for immunization. Bias against different groups can also cause inequality in the distribution of vaccines thereby resulting in a wide disparity in immunization coverage in communities.

Organizational Barriers

Sometimes organizations that play a role in the storage, distribution, monitoring of vaccine supply and immunization data collation sometimes act as barriers to effective immunization coverage through inappropriate storage, inequitable distribution, inefficient monitoring of supply and limited data collation. Furthermore, limited financial support by the government as well as ineffective policies and laws definitely hampers the development of a fully functioning immunization system.

          

REFERENCES

N. Huls: “Access to Health”: Review Digest: Human Rights and Health. 2013; pg.26-46

Public Health Agency of Canada [PHAC], 2006; Andre, Booy, Bock, Clemens, Datta, John et al., 2008; PHERO, 2000

Z. Abdulhussein, S. Deamond, R. Elliot et al: “Barriers to Receiving and Reporting Childhood Immunisations: Parents’ Perspectives. 2011