• Ebola
  • Has Ebola energised Africa's eHealth strategies?

    Following on from the Wilton Park event, (Re)building health systems in West Africa: what role for ICT and mobile technologies, there’s plenty of enthusiasm for expanding eHealth’s role after the Ebola crises. A report in mPowering summarise the key findings as:

    • ICT and mobile are a critical part of rebuilding health systems, but must be interoperable, integrated logically and responds to the actual, not perceived health workers needs
    • Data and information sharing can enable rapid responses to emergencies, but only if the most relevant data is collected and used
    • There’s a role and responsibility for all sectors that must work together with common objectives
    • Efforts need to be government-led
    • Moving from fragmented, project-based activities needs new kinds of collaborations with clear roles and shared responsibilities to support resilient health systems
    • Aid and investment must support countries to develop the infrastructure, infostructure and skilled health workforces needed to respond to future health emergencies.

    Pape Amadou Gaye, President and CEO of IntraHealth International, set out his views on the foundations for more and better eHealth. These underpin the changes identified at the conference, and aim to deal with the challenge of the advent of digital solutions that has improved data collection techniques and quality that has not yet liberated data too often lying dormant in government databases and left to departments that may not be prepared to use or disseminate them properly.

    Taking full advantage of eHealth’s promise of building stronger health systems, three challenges need addressing:

    • Governance, information management and behaviour-change training to address the remaining cultural and bureaucratic bottlenecks and encourage the adoption and creation of new governance platforms for mHealth and ICT that will help build trust, instil transparency, and move forward effectively
    • Culture for using and sharing data can be improved and be part of routine practice, training, and mentality, so cultivate data use, and foster greater sharing and collaboration
    • Infrastructure, where the simplicity and wide availability of mobile phones offer ample opportunities for mHealth and global information-sharing, but there are still limitations to overcome, including countries needing sufficient networks, bandwidth, and electricity to harness mHealth’s real power.

    All these are vital components of eHealth strategies. Is the core message from the event that Africa’s health systems need to reset their eHealth strategies?

  • Rapid paper-strip test for Ebola in sight

    The 2014 Ebola epidemic is the largest in history, affecting several countries in West Africa. While the number of reported cases are slowing down, its still far from being eradicated . An article in Medical News Today, says a tool may soon be available that can provide real time results for suspected Ebola patients and speed up decision making and reaction time of health workers. 

    It works like a home pregnancy test, and should help health workers assess potential disease outbreaks. Standard approaches for testing viral infections accurately and reliably require technical expertise and expensive equipment such as a Polymerase Chain Reaction (PCR) and Enzyme-Linked Immunosorbent Assay (ELISA). Developing and rural areas far away from big hospitals and laboratories don’t have immediate access to these machines and facilities. Concern when fever strikes is to establish quickly whether patients have the Ebola virus, or if they have less severe illnesses like the common cold or flu. It means patients have to be quarantined.

    The color-changing paper-strip test, developed by Kimberly Hamad- Schifferli, a professor at Massachusetts Institute of Technology (MIT) in Boston, and colleagues, addresses these problems He heads a mechanical and biological engineering laboratory that develops nanoscale tools, His view is that the test “Is not meant to replace PCR and ELISA because we can't match their accuracy. But this is a complementary technique for places with no running water or electricity."

    The test uses three strips of paper and silver nanoparticles that has different colours determined by their size. To detect Ebola, the researchers used red nanoparticles carrying antibodies that bind only to Ebola virus proteins. For dengue, they used green nanoparticles, and for yellow fever, they used orange. Another antibody captures- the nanoparticles with the attached virus proteins to fix them in a particular position on the strip. These are different for Ebola, dengue and yellow fever.

    The team tested the tool using small amounts of blood spiked with proteins from the three different viruses. It showed the correct colour in the appropriate location on the paper strip, depending on which virus protein was being tested.

    This simple test has the potential to dramatically cut down reaction time of healthcare workers by diagnosing Ebola patients in the field. This allows them to make faster decisions and save lives. The initiative could easily be coupled with an mHealth system to report all cases to the district clinics or healthcare administrative departments so they can prepare the facilities for incoming Ebola patients. 

  • Ten lessons for eHealth for Ebola

    The scale and rapidity of the Ebola outbreak has many lessons for healthcare. For eHealth, Amanda Puckett, a technical advisor at IntraHealth International has identified ten from a conference in Accra, Ghana. They’re derived these from three themes:

    • Information systems and disease surveillance has always been an issue in West Africa, but Ebola forced the issue
    • The lack of information on transmission and case notification
    • Severely disrupted health services that revealed grave weaknesses in the health systems.

    The ten principles fit eHealth generally:

    1. It’s not just about the technology, it’s about deploying technology responsibly
    2. There’s important value in face-to-face engagement
    3. Governance, leadership, and ownership are key
    4. Users must be the centre of design and implementation
    5. Implement what is meaningful
    6. Real time doesn’t mean real fast
    7. Partnership takes us far
    8. Investments in infrastructure pay off
    9. Users of technology and data can benefit from training
    10. It’s a process with a committed community.

    Acfee's principles extend this by emphasising that eHealth must be easy to use. Sustainability and realising benefits depends on it. Investment in people’s eHealth capacity is also essential, which is a lot more that training, it’s part of people’s personal eHealth development. eHealth affordability is also vital for Africa’s healthcare. 

    One theme in the ten that stands out is leadership. Effective eHealth leadership ensures that all the other components, and many more, are delivered, so it’s a core requirement of successful and sustainable eHealth in Africa. 

  • Venture Bus Tours supporting ICT innovation in Africa

    Applications for the USA-based Venture Bus Tours in Africa are now open. For the third year in a row, Ampion will run its pan-African startup competition. The initiative provides on the road support to entrepreneurs by paring them with experienced mentors from leading tech centres in Africa and globally to develop ICT solutions for the African market. An article in IT News Africa says 40 new companies are expected to come out of this year’s Venture Bus Tour. Last year, Ampion received more than 2000 applicants from 43 countries.

    For 2015, the five Ampion Venture Buses will cross 14 African countries. Each tour culminates at a Grand Final as part of continent’s most renowned tech conferences, such as DEMO Africa, Nigeria, AfricaCom, South Africa and the Transform Africa Summit in Rwanda. Along the road, the Venture Bus and its participants visit all major tech and startup-communities in each region to hold local events and link up with thousands of Africa’s most promising ICT talents.

    This year, Ampion’s partnering with corporate and public partners to select a focus topic for each Venture Bus. In East, West and Southern Africa, one of these topics is citizen engagement and democratic participation through ICT. In West and East Africa the focus is on financial-tech and modern banking. In East Africa, the focus it’s eHealth and healthcare innovation. The Southern African Venture Bus will focus on hardware development.

    These innovations are already having an impact in African countries. One of the winners of the 2014 tour is Halt Ebola, an app enabling rural population to receive and exchange vital healthcare information through voice messages and robo-calls in their tribal language. Given the Ebola situation in West Africa, this innovation can fill a gap and provide a real solution to an African problem. It looks as thought there’ll be many more healthcare innovations out of this year’s tour. 

  • Does WHO need better surveillance data?

    In January this year, WHO set up an independent Ebola Interim Assessment Panel. Four important themes in its extensive report are relevant for eHealth.

    1. The Ebola outbreak started in 2013, but a Public Health Emergency of International Concern (PHEIC) under the International Health Regulations 2005 was not declared until 8 August 2014
    2. There are disincentives for countries to report outbreaks quickly and transparently
    3. The outbreak was particularly challenging because of the characteristics of the virus, and healthcare systems and public health infrastructure in affected countries were extremely fragile, suffering from structural weaknesses, inadequate surveillance and few laboratories
    4. Messaging needs to be continuously refined so as to be responsive to the changing epidemiological situation.

    These are all activities where eHealth can help. Does the report change the eHealth priorities for Africa, some African countries? The report emphasises how WHO can be changed to be more effective, there’s also an onus on countries to improve their information and communication. Investment in mHealth, surveillance, primary care, diagnostics and general eHealth skills could help.

    The head of the panel was Dame Barbara Stocking. She was the chief executive of Oxfam, a leading aid charity. She was also a senior manager in England’s NHS.

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    Image from Vox

  • Liberian chiefs get cell phones to help battle Ebola

    The Ebola outbreak may not be in the news, but it hasn’t been defeated entirely. Mr. Delino Kollie, a local businessman in the Bong County, Liberia and prominent health worker in the area, is providing mobile phones to town chiefs along the Liberian-Guinean border to help report any new case of Ebola. An article in allAfrica says that Mr. Kollie has advised chiefs to contact authorities if they suspect anyone entering their towns from Guinea has the disease.

    Mr. Kollie believes Liberians need to tighten their borders and take precautionary measures to prevent a recurrence of the outbreak in the country. Chiefs have commended Mr. Kollie for being patriotic, and are urging their government to deploy surveillance teams along the borders with Guinea and Sierra Leone as increased cases continue to be reported from Liberia’s two neighbours.

    It's a simple and effective connectivity solution. Integrating it into existing information systems and processes is the next challenge.

    Some twenty towns are expected to benefit from Mr. Kollie's gesture, helping to save lives and stop the spread of the virus. 

  • Big Data's on its way to track Ebola

    Tracking and mapping Ebola’s spread is a manual endeavour. Infection Control Today (ICT) has a report on a project at Florida Atlantic University’s (FAU) College of Engineering and Computer Science that aims to develop an innovative model of Ebola’s spread that uses Big Data analytics techniques and tools. It’s financed by a Rapid Response Grant (RAPID) from the USA’s National Science Foundation.

    The programme will use data from many sources including Twitter feeds, Facebook and Google. It’ll be entered into an mHealth decision support system that models Ebola’s spread pattern, then create dynamic graphs and predictive models on the outcome and impact on individuals and communities. These will improve the precision on predictions.

    Computer power for the project is a combination of FAU’s Cloud system and LexisNexis HPCC Systems®, an open-source platform for Big Data. LexisNexis will provide the research team with the Big Data needed to develop and model the program for Ebola spread patterns and their expertise in Big Data analytics. An aim is to track the movement of people and their contacts in locations affected by Ebola and comply with privacy laws.

    The USA and the UK have had Ebola patients, so the project can benefit their health systems. If it succeeds, the project can transform data management and healthcare’s response in African countries too.

  • Ebola's ended in Liberia

    The WHO announced that the Ebola epidemic has ended in Liberia on 9 May after 42 days without new Ebola virus disease (EVD) cases. International SOS says that when the Ebola outbreak continues in neighbouring countries, importation remains a risk. A large-scale outbreak seems unlikely because of current levels of preparedness. These include mHealth services, such as Epi Info 7™ and USAID’s twelve projects for Ebola, both reported on eHNA.

    Just because the epidemic’s ended doesn’t mean that Ebola’s gone. The New England Journal of Medicine describes  “A patient who recovered from EVD and was subsequently found to have severe unilateral uveitis during convalescence. Viable Zaire ebolavirus (EBOV) was detected in aqueous humor 14 weeks after the onset of EVD and 9 weeks after the clearance of viremia.” Uveitis is inflammation of the eye’s middle layer. Ebola living in fluid other than blood isn’t seen as contagious.

  • Ghana's new Ebola call centre's coming

    The Vodafone Ghana Foundation is set to collaborate with Ghana Health Services (GHS) and Vantage Medical Solutions, with support from the World Health Organization (WHO), to launch an Ebola health worker to health worker call service. An article in ITNEWS Africa says the call centre will provide health workers with access to technical advice, guidance, information, and support from trained operators on infection, prevention and control.

    It’ll be operated by 63 health workers, trained in the Ebola Virus Disease (EVD) and infection prevention and control They’ll be supervised by GHS and WHO. Healthline 255 is the first medical call centre in Africa to offer a health worker to health worker service.

    Whilst the number of Ebola cases maybe dwindling in West Africa, new cases are still reported. WHO says that up to 15 April, the outbreak, , has infected 25,826 people, resulting in 10,704 deaths. It’s persisted for more than a year.

    WHO Country Representative to Ghana, Dr Madga Robalo emphasised the importance of training saying, “Since the Ebola outbreak, as many as 864 health workers were infected with Ebola in the West African affected countries of which 503 health workers died. It is crucial that we provide constant support and training to keep our health workers safe as our first line of defence.”

    Dr Robalo added that Ebola has no boundaries and that health is ultimately a “shared responsibility”. This partnership illustrates the need to work together using comparative strengths, resources and ICT solutions to fight this pandemic. If the initiative is a success, it could benefit other countries too.

  • How can eHealth help Ebola survivors?

    It seems that surviving Ebola isn’t the end. WHO has said that some survivors will have subsequent health problems. Dr Nanyonga calls it "post-Ebola syndrome." They have a range of symptoms seen in survivors of previous outbreaks, resulting in long-term disability. Visual problems can affect about 50% of survivors. Some have “body aches" such as joint, muscle and chest pain, and some suffer headaches and extreme fatigue that restrict their return to their former lives, which is particularly debilitating for manual workers such as farmers, labourers and housewives.

    There’s a need for more information about post-Ebola syndrome. Dr Nanyonga says “We need to understand why these symptoms persist, whether they are caused by the disease or treatment, or perhaps the heavy disinfection,” and has developed an assessment tool to establish the most common and disabling symptoms that can help to determine the treatments needed. Dr Ramsay, the WHO field coordinator in Kenema, Sierra Leone’s third largest city, says it’s essential that potentially disabling physical and psychological problems are diagnosed and treated quickly.

    Dr Aylward, WHO’s assistant director general says not much is known about the long-term implications. WHO is planning clinics in Sierra Leone, Liberia and Guinea to monitor the follow-on health effects of more than 25,000 survivors. The need for structured follow up shows the value of setting up and maintaining a regional and international Ebola registry to assemble data for analysis and monitoring.