• NCDs
  • EU’s BigData@Heart aims to improve heart disease treatments

    A report on Cardiovascular Disease (CVD) published by Springer says CVD prevalence in sub-Saharan Africa’s increasing. Limited access to prevention and continuing care are seen as constraints to improvements. The EU’s BigData@Heart project may contribute to the development of treatments for heart disease patients. It has lessons for Africa’s health systems.

    It’s a large-scale, five-year, €19 million project. Its aim’s to use data and advanced analytics to develop a translational research platform of phenotypical resolution to improve patient outcomes and reduce societal burdens of atrial fibrillation (AF), heart failure (HF) and acute coronary syndrome (ACS). Data sources include real-world evidence, best-practices in drug development and personalised medicines.

    Four outputs are:

    ·         New universal, computable, definitions of diseases and outcomes relevant for patients, clinicians, industry and regulators

    ·         Informatics platforms linking, visualising and harmonising data sources, completeness and structures

    ·         Data science techniques to develop new definitions of disease, identify new phenotypes, and construct personalised predictive models

    ·         Guidelines that allow for cross-border use of big data sources acknowledging ethical and legal constraints and data security.

    It can have considerable value for Africa. The continents health systems and cardiologists could move their CVD services ahead in the wake of BigData@Heart’s progress. 

  • KardioPro helps to tackle cardiometabolic disease

    Cardiometabolic disease, a cluster of inter-related risk factors that can lead to atherosclerotic vascular disease and type 2 diabetes, is the world’s leading cause of morbidity and mortality. It kills more people than AIDS and malaria combined and places tremendous strain on healthcare resources and costs. Currently, the epidemic of cardiometabolic disease worldwide is being diagnosed, treated and managed in separate silos. Healthcare systems rely on repetitive, duplicated tests and services, which inevitably leads to reduced patient outcomes and increased costs. To address this challenge, the Kardiogroup, a connected health company, has developed the first comprehensive cardiovascular risk reduction and treatment approach.


    The Kardio Ecosystem links connected health devices as a Technology Enabled Care (TEC) to validated Point of Care (POC) blood tests. It provides accurate and validated risk analyses, links to emergency care and access to treatment protocols informed by local and international guidelines.

     

    KardioPro, an mHeath app, is part of the ecosystem. It integrates with diagnostic tools, including a cardiolabs to measure patients’ blood pressure and Ankle-Brachial Index (ABI), a pulse oximeter, a professional wireless core body scale, and a glucometer.  Path Pro’s part of the configuration too. It provides the Alere Affinion Machine and the Abbott Istat POC pathology diagnostic equipment.

    Healthcare workers can use KardioPro to take measurements, connect to the KardioPro app from iPads or Androids, then visualise, track and share the results. It performs tests in 15 – 20 minutes, stores and organises results, simplifies patient monitoring and edits reports in PDF format so they can be shared by treatment teams. It also helps with the interaction of healthcare workers and patients to:

     

    •   Improve adherence

    •   Reassess treatments

    •   Reassure patients and explain to them the evolution of their health status

    •   Fix goals for patients

     

    The App:

    •   Is simple and easy to use

    •   Provides accurate risk analysis

    •   Has multi step reporting

    •   Provides treatment suggestions based on guidelines

    •   Delivers secure cloud based data capturing

     

    Tests performed by the app includes:

    1. HBA1C - Glycated Haemoglobin - This is used to test the 3 month average glucose of patients. It is used for screening for diabetes and used to monitor diabetic patients. 
    2.  Lipogram - This is a full cholesterol panel which is one of the important components in cardiovascular disease. It measures the different types of cholesterol in the body which is important in assessing cardiovascular risk in patients
    3. Crp - known as C-Reactive Protein - This is an inflammatory marker test can be used to determine if antibiotic therapy is required in patients who are ill.
    4. Urine ACR - known as Albumin to Creatinine Ratio - These are the two key markers to test for chronic kidney disease. 
    5. U&E - Urea and Electrolytes - This is an important and common type of biochemistry test. It is used to assess Renal Function in Diabetic patients and are important screening test for patients with hypertension.
     

    All health data generated by the device is secured and stored in an approved secure healthcare database. This is increasingly important with the rise in cyber-security threats.

    KardioPro is currently being used by 40 practitioners in South Africa. The solution has the potential to benefit resource poor communities across the continent. KardioPro is looking to expand internationally with interest to collaborate with international partners. 

  • Which apps protect against this silent killer?

    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.

  • mHealth has potential with NCDs

    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.

  • Sanofi joins WHO-backed diabetes mHealth programme

    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.

  • Can mHealth help with NCDs?

    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.”

  • MDGs make way for SDGs this year

    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.

  • mHealth supports mothers and children in Mali

    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.

  • La mSanté soutient le couple mére-enfant au Mali

    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.

  • Good eHealth for chronic conditions

    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.