NCDs (13)

It can be fatal. Risks include blindness, kidney disease, stroke, heart attack and amputation. The risks are largely avoided through early detection, lifestyle changes and where necessary, treatment, but up to a quarter of people don’t know they have it.

Diabetes is a silent killer and according to the WHO’s 2016 Global Report its prevalence has more than doubled since 1980. According to the report, the rise mirrors increasing obesity and deceasing levels of physical activity.

With numerous apps appearing to help you improve your health, which ones might be good for diabetics? Below is a 2015 list of top diabetes apps from Healthline.

"Everyone has a role to play - governments, health-care providers, people with diabetes and those who care for them, civil society, food producers, and manufacturers and suppliers of medicines and technology are all stakeholders," says the WHO.

Apps can be part of the solution too. Which ones are working to reduce diabetes and help diabetics in African countries? eHNA's found interesting initiatives in Tanzania and Senegal. We're on the lookout for more.

Before embarking on an mHealth project, it’s often good to know something about the people you want to be the users. A study from La Paz, Bolivia, and reported in 7th Space Interactive, shows an approach for patients with Non-Communicable Diseases (NCD) to inform research on mHealth interventions for the Andean region as well as low and middle-income countries.

It identified 559 NCD patients at outpatient clinics affiliated with four hospitals in La Paz. They completed surveys about their use of standard mobiles and smartphones and their sociodemographic characteristics, health status and access to healthcare.

Respondents’ average age was 52, about a third with, at most, a sixth grade education. About 30% spoke an indigenous language in their home. Mobile phone owners were about 86% and smartphone owners were much fewer about 13%. Nearly 60% sent or received a text message at least weekly. About 9% had connectivity problems, such as no mobile signal. Nearly 20% had been without credits for calls.

Mobile phones have high penetration among NCD patients in La Paz. Smartphone use is still relatively uncommon, even by younger and more educated patients. These kinds of findings can have a direct effect on the impact of mHealth projects. It’s a good idea for African countries to find this out before embarking on mHealth programmes.

The diabetes section of the WHO and ITU initiative Be Healthy, Be Mobiles, set up in 2012, has a new partner. Sanofi, a global leader in pharmaceuticals, vaccines and medical supplies, has joined.

PMLive has a review of the new links and its benefit to using mobile technology to help prevent and treat non-communicable diseases like diabetes, cancer, cardiovascular conditions and chronic respiratory diseases, in low- and middle-income countries (LMIC). The first set of Be Healthy, Be Mobile's phases for its mDiabetes programme are in Senegal.

In 2014, a pilot during Ramadan delivered about 80,000 SMSs to about 3,500 participants, an average of about 23 each, to help patients with diabetes manage their disease. Sanofi aims to step it up to two-way SMSs, including reminders to patients on topics such as blood glucose levels and food consumption.

Lots of partners already engaged in Be Healthy, Be Mobile. They include Bupa, Verizon, the World Lung Foundation, the International Federation of Pharmaceutical Manufacturers and Associations (IFPMA), the Non-Communicable Disease (NCD) Alliance, Novartis and GSK. The ITU, WHO and Sanofi are all delighted with the expanded contributions and way ahead. It’ll be good when mDiabetes is available across all Africa.

In September 2014, WHO appointed an Assistant Director-General for Non-communicable Diseases and Mental Health. Part of the role is to help to facilitate and enhance stakeholder engagement and local, national, regional and global actions to help to achieve the WHO Global NCD Action Plan 2013–2020.

The Action Plan deals with mainly with four NCDs, cardiovascular diseases, cancers, chronic respiratory diseases and diabetes. They’re the world’s biggest killers. The WHO’s estimate is that by 2020, they’ll cause 65% of deaths. About 27% of these deaths will be in Africa.

As Africa’s healthcare resources are already stretched extensively, many countries won’t cope with the extra costs. mHealth is often seen as an important part in a prevention strategy. Examples are texting healthy lifestyle advice, appointment reminders and linking this information to medical records. A post by the Global Alliance for Chronic Disease (GACD) has two views on the idea.

Dr Caroline Free from the London School of Hygiene and Tropical Medicine (LSHTM) says that mHealth can change health behaviours and reduce NCDs. An example is the “clear benefits of mHealth interventions” such as support for smoking cessation delivered by SMS.

Professor Sir Andy Haines, also from the LSHTM, and co-author of A Framework for Mandatory Impact Evaluation to Ensure Well Informed Public Policy Decisions for The Lancet, has a slightly different view. He says that more research into evaluation and the impact of mHealth projects is needed to avoid resources used for projects that may not be effective. His view is that evidence from mHealth projects is sparse, and many trials aren’t tested in African countries before they’re rolled out. Consequently, benefits for African countries remain unclear.

The costs aren’t precise either. In this setting, it’s essential that African countries know the probable net benefits of their mHealth initiatives for NCDs. Potential net benefits are immense. Probable net benefits are much more modest. Ethiopians distinguish the difference as “What is inflated too much will burst into fragments.”

This year, after 15 years, the UN’s Millennium Development Goals (MDG) reach the end of their life. The top priority for the UN’s new Sustainable Development Goals (SDG) is eradicating poverty. Better health is goal 3 of the 17 SDGs. It’s described as “Ensure healthy lives and promote well-being for all at all ages.” The components are:

  • Reduce the global maternal mortality ratio to less than 70 per 100,000 live births
  • End preventable deaths of new born children and under fives
  • End the epidemics of AIDS, tuberculosis, malaria, neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
  • Reduce by a third premature mortality from non-communicable diseases by prevention and treatment and promote mental health and well being
  • Strengthen prevention and treatment of substance abuse
  • Halve global deaths and injuries from road traffi­c accidents
  • Ensure universal access to sexual and reproductive healthcare, including family planning, information and education, and integrating reproductive health into national strategies and programmes
  • Achieve universal health coverage, including financial risk protection, access to quality essential healthcare and safe, elective, quality and affordable essential medicines and vaccines for all
  • Substantially reduce deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination
  • Strengthen WHO’s Framework Convention on Tobacco Control
  • Support research and development of vaccines and medicines for the communicable and non-communicable diseases
  • Substantially increase health financing and the recruitment, development, training and retaining health workers
  • Strengthen the capacity for early warning, risk reduction and management of national and global health risks.

These are wide-ranging. As a strategic framework for African countries’ eHealth plans, they reveal a need for an equivalent wide-ranging and integrated investment, and avoiding a set of independent initiatives. This requires moves towards interoperability, analytics and a socio-technical architecture that extends from healthcare to people and communities. Each of these needs an expansion to current endeavours and a sustainable investment.

Les taux de mortalité infantiles et maternels du Mali comptent parmi les plus élevés du monde. Ils s’élèvent à 196 pour mille personnes et 464 pour cent mille naissances vivantes. En moyenne, huit femmes meurent chaque jour de complications de la grossesse. La réponse du Ministère de la Santé consiste notamment en l’utilisation de la téléphonie mobile pour renforcer le système de santé en faveur de l’unité dédiée au couple mère-enfant et pour améliorer le système de santé national en général.

Le développement du secteur des communications du Mali a contribué à la fourniture d’une plateforme de soutien. Le parc mobile a été multiplié par 14 entre 2005 et 2011, atteignant plus de 10 millions fin 2011. Le Mali est passé de la 12e place sur 14 pays au sein de l’UEMOA (Union économique et monétaire ouest-africaine) à la 8e place, et de la 41e place en Afrique sub-saharienne à la 28e.

Aujourd’hui, nous tweetons, nous envoyons des SMS et nous sommes sur Facebook. Nous vivons l’avènement incontestable des médias sociaux dans nos vies quotidiennes et l’expérience internationale montre que les TIC, particulièrement la mSanté, peuvent contribuer au développement harmonieux de nos pays.

C’est pour cette raison que le Ministère de la Santé du Mali, via l’Agence nationale de télésanté et d’informatique médicale, a déployé des infrastructures de flotte mobile de plus de 600 téléphones mobiles, mis à disposition des agents de santé au niveau périphérique pour soutenir les services de santé. Les projets incluent Pesinet pour le paludisme, Médimobile et d’autres projets pilotes.

Les projets prévoient notamment le suivi de la santé d’enfants de moins de 5 ans et un meilleur partage d’information sur les décès maternels et infantiles. Entre janvier 2012 et mars 2013, 11 décès maternels et 162 décès infantiles ont été signalés, 73 % d’entre eux à domicile et 27 % dans des structures de santé. Plus de 24 000 cas de paludisme chez les femmes enceintes ont été rapportés, dont 670 décès : 522 enfants de moins de 5 ans, 145 enfants de plus de 5 ans et 3 femmes enceintes.

Une amélioration significative d’environ 91 % a été observée en termes de précision et d’intégralité des données, en comparaison avec les données issues du Système national d’information sanitaire dont le taux équivalent est d’environ 40 % et qui n’utilise pas encore la mSanté.

Le ministère de la Santé du Mali cherche à étendre ces résultats positifs et est un partenaire clé du projet conjoint OMS-UIT concernant l’utilisation de la mSanté pour les maladies non-transmissibles. Des maladies comme le diabète, les cancers du sein ou du col de l’utérus, le contrôle de l’hypertension artérielle en lien avec d’autres maladies cardiovasculaires, la prévention des crises aiguës de drépanocytose et d’asthme pourraient toutes bénéficier de la mSanté pour améliorer la prise en charge des patients, renforcer les capacités des professionnels de la santé et mettre les bonnes informations à la disposition des autorités sanitaires pour assurer des décisions prises sur des bases factuelles. Ceci constitue la marche à suivre pour tous les pays en développement.

En dépit de résultats positifs, des défis persistent. Les ressources financières sont limitées, la gestion du changement est difficile et des problèmes importants d’interopérabilité entre les divers plateformes technologiques existent. Le Mali n’est pas le seul pays confronté à ces difficultés et valorise la collaboration visant à enseigner et à partager ses expériences pour saisir les opportunités croissantes en télésanté et mSanté en Afrique.

Mali’s infant and maternal mortality rates are among the highest in the world. They’re 196 per thousand people and 464 per hundred thousand live births. On average eight women die every day from pregnancy complications. Part of the Ministry of Health’s response is the use of mobile phones to reinforce the health system in favor of the mother and child unit and to improve the National Health System generally.

The development of Mali’s communications sector has helped to provide a platform for support. Mobile customers increased 14-fold between 2005 and 2011, reaching more than 69%, million by the end of 2011. Mali went from 12th out of 14 countries in the West African Economic and Monetary Union (WAEMU) to 8th, and from 41st in Sub-Saharan Africa to 28th.

Today, we tweet, we send SMSs, and we are on Facebook. We experience the indisputable advent of social media in our daily lives, and international experience shows that ICTs, especially mHealth, can help countries’ harmonious development.

This is why Mali’s Ministry of Health, through the Telehealth and Medical Informatics National Agency, deployed a mobile fleet infrastructure of more than six hundred mobile phones, available to health workers in the periphery to support health services. Projects include Pesinet, for malaria, MédiMobile, and other pilot projects.

The projects include monitoring the health of children below the age of 5 and better information sharing on maternal and child deaths. Between January 2012 and March 2013, 11 maternal deaths and 162 child deaths were reported, 73% of these at home, and 27% in health facilities. Over 24,000 cases of malaria in pregnant women were reported, with 670 deaths:  522 children below the age of 5, 145 children over 5 years of age, and 3 pregnant women.

There is a significant improvement of about 91% in data accuracy and completeness compared to data from the National Health Information System that has an equivalent rate of about 40% and doesn’t use mHealth yet.

Mali’s Ministry of Health is keen to extend these positive results and is a key partner in the joint WHO-ITU project on the use of mHealth for Non-Communicable Diseases (NCD). Diseases like diabetes, breast or cervical cancer, hypertension control related to other cardiovascular diseases, prevention of acute attacks in sickle cell and asthma could all benefit from mHealth, to improve care for patients, strengthen the capacity of health professionals, and make the right information available to health authorities to ensure decisions are based on evidence, is the path for all developing countries.

Despite the positive results, challenges remain. Financial resources are limited, managing change is difficult, and there are substantial interoperability issues between the various technology platforms. Mali does not face these challenges alone and values collaboration to learn and share its experiences for the benefit of Africa’s rapidly expanding eHealth and mHealth opportunities.

As African countries face an increasing burden of chronic conditions, especially with the expansion of non-communicable diseases (NCD), reliance on eHealth can increase too. Formulating an eHealth strategy for NCDs should include looking at successes in high-income countries where NCDs and chronic conditions have been, and are increasingly challenging for many years. A study in Health Affairs profiled four high-income countries with different eHealth ICT strategies for chronic care. They were Australia, Canada, Denmark, and the USA, each with different health systems. The goal was to identify common challenges and opportunities that offer learning opportunities. It found four key themes.

  • National eHealth strategies need adopting for chronic care
  • Countries struggle to ensure that clinical information follows patients seamlessly between care settings
  • Where nations can pursue telehealth solutions for chronic care, the initiatives often stand-alone efforts and aren’t well integrated into other eHealth solutions, such as EHRs
  • Countries have made progress in improving patients’ access to their clinical data but have not succeeded entirely in engaging patients use their data to improve care and their health.

These are important findings. It seems that scale-up isn’t a challenge just for African countries, but there are still lessons to learn. 

The recent forecast by UNICEF of twice as many children in Africa over the next 15 years sets an essential priority for eHealth to challenge, as eHNA reported. There are plenty of others that need addressing too. A survey of six African countries by the Pew Research Global Attitudes Project found that people want their governments to tackle seven priorities:

  • Improve the quality of hospitals and other healthcare facilities
  • Prevent and treat HIV/AIDS
  • Provide better access to drinking water
  • Provide better access to prenatal care
  • Deal with hunger
  • Prevent and treat infectious diseases
  • Increase child immunization.

The six countries included in the survey are Ghana, Kenya, Nigeria, Senegal, South Africa and Uganda. They’re not consistent about the top priority. Three say better hospitals, two say dealing with HIV/AIDS and one says combatting hunger.

Alongside these findings, WHO has forecast that non-communicable diseases (NCD) are increasing in Africa. It says that “They are the leading causes of death in all regions except Africa, but current projections indicate that by 2020 the largest increases in NCD deaths will occur in Africa. In African nations deaths from, NCDs are projected to exceed the combined deaths of communicable and nutritional diseases and maternal and perinatal deaths as the most common causes of death by 2030.”

Pew’s seven priorities, plus UNICEF’s forecast demographic challenge and WHO’s NCD challenges set the priorities for Africa’s eHealth and mHealth. Two themes are:

  • Developing and procuring good solutions
  • Setting an investment balance across all the priorities.

These will need to integrate with initiatives with other services, making your effective eHealth response more challenging.

A new mHealth project, mDiabetes, has been launched in Senegal. It’s the first project established for a French-speaking country under “Be He@lthy Be mobile”, a joint global initiative by WHO and the International Telecommunication Union (ITU).The initiative uses SMSs and is currently in its first phase of implementation, with a larger and wider-reaching programme scheduled for roll out in November 2014. mDiabetes aims to combat diabetes with an ambitious and innovative campaign designed to improve prevention by raising awareness among diabetic patients and training health professionals. To accommodate illiterate patients and to make the initiative more effective, the Minister of Health and Social Action is planning to incorporate voice notes and voice messages.

The WHO has estimated that there will be roughly 552 million diabetics in the world by 2030, 75% of whom will live in low-income countries where diabetes will be the seventh cause of death. The WHO believes that mHealth could significantly contribute to slowing down the increase.

There’s a variety of major stakeholders in the project. They include the Senegalese Ministry of Health and the Ministry of Communication, ITUWHO, the Senegalese Association for the Assistance and Support of Diabetes Patients, (ASSAD), the African branch of the International Diabetes Federation, the NGO UNFM, the Marc Sankalé Diabetes Center, Alcatel-Lucent, Sonatel/Orange, BUPA, the global international health insurance and services company, and Sanofi.

The aim is to help implement strategies for preventing and combating diabetes and other non-communicable diseases. For diabetics, it’s an opportunity to interact directly with health professionals for better management of their disease.

“We are convinced of the value of this project for improving the conditions for diabetes patients in Senegal and are genuinely delighted to be involved as a technological partner in contributing to the success of the mDiabetes project. This is an ambitious initiative which could ultimately be replicated in other countries in the fight against diabetes or any other disease,” said Alpin Verlet, Managing Director of Alcatel-Lucent for West and Central Africa.

Sending SMS or voice messages has several objectives:

  • Educate and raise awareness among the population
  • Provide information on the diabetes and lifestyle to limit its occurrence
  • Appointment reminders, lifestyle, dietary advice, and complying with treatments to limit complication risks
  • Ttrain health professionals
  • Provide and implement tools for prevention, screening, diagnosis, treatment and monitoring, particularly in rural areas.

mDiabetes has a wider value beyond Senegal. It’s transfer to other African countries should follow rapidly.