• Cancer
  • Whatsapp helps to demystify cancer in Tanzania

    Cancer rates are soaring in Africa and people are taking note. The answer to why the disease is spreading so rapidly on the continent is not straightforward. Doctors and health workers attribute the spike to poor health education, environmental changes, high HIV rates, improved diagnostics and the fact that people are simply living longer.

    WHO has recently warned that Non-Communicable Diseases (NCD) are likely to kill more people in Africa than infectious disease. It set these out as a forecast by 2030. Cancer’s a major contributor.

    The Ocean Road Cancer Institute (ORCI), Tanzania’s major cancer centre, has estimated that the country’s heading for 30,000 new cancer cases a year. The diseases’s a huge public health concern.

    Combating the increase in misleading cancer information is part of Tanzania’s contributing. An article in allAfrica says it includes false cancer cures claims and alarming stories on social media linking some foods and human behaviour with cancer. Experts are trying to demystify the disease by curbing this damaging information.  

    Radiotherapists in Tanzania say WhatsApp, the cross-platform instant messaging service for smartphones, can help to tackle the problem. In February, radiotherapists formed Saratani.info a set of WhatsApp groups to disseminate cancer awareness. Currently, there are five groups. Each one has 251 members, so 1,255 people have so far joined. Each group has five educators, including radiotherapists, doctors and nurses.

    Mr Franklin Mtei, Saratani.info’s founder, and managing director of the Tanzanian Cancer Society (Tacaso), formed in 2014, leads the team of educators.  They’re expected to become future cancer ambassadors. Other group members included people from the general public, the private sector, public officials, students, entrepreneurs, professionals and non-professionals.

    The groups were formed by adding the WhatsApp users that the radiologists already had in their own phone books. Other people were invited through Facebook. People can join and leave any of the groups voluntarily through their Facebook Page.

    A co-founder of Tacaso, Mr Ally Idris, a radiotherapist, says people's perception about cancer in Tanzania has been wrong for many years. Society’s information gap is huge. Many people believe that cancer is contagious, while others think that treatment by radiations causes more cancer.

    The founders want their initiative to provide services beyond the WhatsApp groups. They plan to expand across Tanzania, targeting vulnerable people who lack information about cancer, its causes, prevention and how to access treatment. It’s an initiative that could benefit all Africa.

  • Protecting our children from HPV

    One in every eight women in South Africa die from complications of  cervical cancer. Each year, 5,743 new cases of cervical cancer are reported. Almost half of these, 3,027 cases are fatal.

    About 80% of cervical cancers are caused by the Human Papilloma Virus (HPV). It infects the genital area and causes anything from a small genital wart to cervical and other cancers. Vaccination can prevent the virus infection developing on the cervix. 

    In 2014, the South African National Departments of Health (NdoH) and Basic Education launched a national vaccination campaign to prevent cervical cancer by vaccinating girls aged over nine against HPV. The vaccination was aimed at 500 000 girls from 17 000 public and special schools to provide them with protection before they can be exposed to HPV infection. 

    In co-ordination with the government’s Integrated School Health Programme (IHSP), school health nurses visit schools twice a year to vaccinate the girls. None of them are vaccinated without parental consent.

    As the vaccination campaign grew, collecting data became more complex and challenging. NDoH approached the Health Information Systems Program South Africa (HISP-SA) to lead implementation of a mobile data capturing application. It supports data capture during the campaigns. 

    The app’s part of the NDoH's routine health information system, DHIS2, sometimes referred to as webDHIS. It was customised for the campaign by HISP-SA’s Lusanda Ntoni and piloted in three provinces. Then, it was developed further using findings from field visits, and implemented during the 2016 campaign. 

    A Standard Operating Procedure (SOP) document helps vaccinators and data capturers to transfer HPV data from registers into the tracker capture app. There’s also a guideline for programme managers and information officers on accessing dashboards with information from the campaign on  webDHIS. These were updated as the app was implemented. 

    To date, the app’s been implemented in all nine provinces in South Africa, a task co-ordinated by HISP SA’s HPV project manager, Margaret Modise. It’s simplified HPV dashboards for monitoring and reporting and shows how a simple mHealth initiative can enhance the productivity of vaccination campaigns. Will this way of capturing data lead to more large-scale campaigns in South Africa?   

  • There’s lots of projects to improve breast cancer diagnoses

     WHO has a report showing breast cancer as the most common cancer in women, both in developed and under developed countries. The breast cancer mortality rate was estimated at 508,000 in 2011. Although breast cancer is thought to be a disease of the developed world, almost 50% of breast cancer cases and 58% of deaths occur in less developed countries. Incidence rates vary greatly worldwide, from 19.3 per 100,000 women in Eastern Africa to 89.7 per 100,000 in Western Europe. In most developing regions, incidence rates are below 40 per 100,000. Africa has the lowest e rates,  but here, breast cancer incidence rates are increasing.

    An article in FierceBiotech says Philips,  the  Dutch technology company, is partnering with PathAI, a company that develops artificial intelligence (AI) for pathology, to develop solutions that improve the precision and accuracy of routine breast cancer diagnosis. A report by Tissue Pathology says the two companies are developing deep-learning algorithms that will detect and diagnose several diseases, with the first being breast cancer. The outcome’ll be an app that automatically identifies cancerous lesions in breast tissue.

    Tumour analysis is essential to diagnosis, but conducting it manually is time consuming and laborious for pathologists. The app will ease the burden on pathologists.

    Philips’ Illumeo platform uses adaptive intelligence to help radiologists work more efficiently. Its IntelliSite Pathology Solution is an automated digital pathology system that includes a slide scanner, image management system and software tools. Last June, the company bought PathXL, a Northern Ireland company focusing on image analysis and digital pathology.

    There’s plenty of similar research underway. Samsung is another company that’s applying AI to diagnose breast cancer from medical imaging. It uses deep-learning algorithms too to detect breast cancer lesions in ultrasound images.

    Breast Cancer News has reported that researchers from Houston Methodist Hospital have developed software to predict breast cancer risk from patient charts and mammograms. Harvard Health Publications has reported that a Harvard-MIT team has used AI to diagnose breast cancer from slides of lymph node cells.

    These developments are a step into the future of disease diagnosis. How far behind do developing nations lag in implementing these innovations?



  • Kenya’s cancer screening app ETiCCS’s now available

    Cervical cancer is the second most common cause of death for women worldwide. In Kenya, it’s the leading cause of death for women of reproductive age.  Kenyan Network of Cancer Organizations says there are approximately 39,000 new cases of cancer each year in Kenya, leading to more than 27,000 deaths. The star has a report estimating increases in cervical cancers cases from 3,000 to 4,200 by 2025. It’s largely due to lack of access to healthcare resources and treatments.

    To address this gap and improve the quality of life among women in Africa, and particularly Kenya, the SAP’s Design and Co-Innovation Center together with Heidelberg University Hospital has optimised a cervical cancer screening test that combines practical medical research with cloud technology from SAP. The digitised screening test, called Emerging Technologies in Cervical Cancer Screening (ETiCCS) strives to support the fight against cancer in developing countries.

    An article in IT online reports that ETiCCS was piloted during a one-year study, which tested 800 women at the Moi Teaching and Referral Hospital in Eldoret, Kenya. The program is ongoing and SAP East Africa plans to include the countrywide self-sampling and IoT scenarios, deep learning, pattern recognition, remote diagnostics support and validation into the program. SAP East Africa will collaborate with technology including SAP HANA Cloud Platform, as development continues SAP HANA Cloud allows seamless communication between healthcare providers including those in remote areas and environments with unstable Internet connectivity.

    The technology will allow the healthcare screening services to:

    1. Keep medical records safely stored in the cloud providing instant access to results. Enabling labs to accelerate the screening process and empower medical staff through improved quality control embedded in the screening process
    2.  Enforce compliance with data privacy and security requirements, meaning labs can make informed diagnoses regardless of location or region
    3. Enable healthcare professionals to uncover critical patient insights and adapt the solution to other screening processes and field research.

    The ETiCCS program has already enabled hundreds of women in Kenya access to screening for cervical cancer.

  • AI’s good at diagnosing skin cancer

    Conventionally, skin cancer’s primarily diagnosed visually. It starts with a clinical screenings, then, if needed, followed by dermoscopic analyses, a biopsies and histopathological examinations. A team mainly from Stanford University, California, has reported in Nature that mHealth can provide an alternative. It’s a technological step up for Africa’s mHealth.

    Classifying skin lesions using images is challenging, owing to fine-grained variabilities in their appearance. Convolutional Neural Networks (CNN) offer potential for dealing with fine-grained object categories. The team demonstrates skin lesion classifications using a single CNN, trained end-to-end directly from images using only pixels and disease labels as inputs. Trained CNN used a dataset of 129,450 clinical images and 2,000 skin lesions.

    Its performance was tested against 21 dermatologists using proven clinical images from biopsies in two use cases:

    1. Keratinocyte carcinomas versus benign seborrheic keratosis, identifying the most common cancers
    2. Malignant melanomas versus benign nevi, identifying deadliest skin cancer.

    CNN achieved performance in both use cases that matched all tested experts. It shows that the algorithms in Artificial Intelligence (AI) can classify skin cancer as well as dermatologists. Equipped with CNN, mHealth can potentially extend dermatologists’ reach beyond their clinics. An impact is lower-cost universal access to vital diagnostic services.

    As healthcare researcher teams extend AI across other conditions, it offers Africa’s mHealth initiatives a much wider role and impact. It seems that mHealth can have much more to offer.

  • IHE wants comments on endoscopy

    Four aspects of endoscopy can be seen as the instrument, the technique, a diagnostic tool and minimally invasive surgery. It’s a very valuable medical technology. Looking inside people is a clever way to avoid cutting them open.

    Endoscope’s aren’t a modern idea. Primed Canada says its inventor identified by most medical historians is Philip Bozzini. In 1805, he used a tube, lichtleiter, a light guiding instrument, he created, to examine urinary tracts. Antoine Jean Desormeaux, a French surgeon renamed it the endoscope. It’s claimed that in 1868, Adolph Kussmaul was the first person to use an endoscope to see the inside of a stomach of a living person. In 1878, two doctors, Max Nitze and Josef Leiter, invented an endoscope to inspect the urinary tract and bladder.

    None of these men concerned themselves with the informatics or eHealth standards and interoperability of their innovations. Integrating the Healthcare Enterprise (IHE) does. It’s released for consultation two supplements:

    Endoscopy Image Archiving (EIA)

    Endoscopy Ordering Workflow (EWF).

    The IHE Endoscopy Technical Committee wanted comments on these by 18 January 2017. They will now complete the supplements as part of the planned IHE Endoscopy Technical Framework.

  • eHealth can help Africa's cancer care

    Cancers are on the march, but disproportionately affect developing countries. India’s using Medic Mobile. It’s part of the British Council's Global Innovation Initiative and partnerships with University of Edinburgh, Weill Cornell Medical College, New York and Christian Medical College Vellore, India.

    Medic Mobile says more than 60% of world's new annual cancer cases occur in Africa, Asia and Central and South America. They account for 70% of the world's cancer deaths. Cancer’s become a serious public health issue in India. It has only eleven health workers for every 10,000 citizens, and rural and urban populations experience vastly different healthcare.

    World Health Rankings for all cancers in 2014 show India’s death rate as about 70 per 100,000. Africa’s average’s about 87. Ten African countries have a death rate lower than India’s. Gabon’s the lowest at about 51. Gambia, Namibia and Niger are all below 60 too. Zimbabwe’s the highest at about 210 per 100,000. It’s an outlier. Burundi’s second highest at about 130. If India sees cancers as a public health priority, Africa’s facing challenges too. 

    Cancers in rural parts of India are rarely diagnosed due to lack of public awareness and healthcare. The delays in diagnoses pose treatment challenges. Leveraging low-cost, low-technology mHealth can improve healthcare access, reduce costs, and strengthen health systems to meet cancer care challenges in remote communities. A study’s analysing the impact that the mHealth tools have on cancer outcomes in low-resource settings as health workers and nurses us it to screen high-risk people, refer some of them to facilities for care and follow them up for treatment.

    Three sites are Padhar, Vellore and Mungeli. Only Vellore's Rural Unit for Health and Social Affairs (RUHSA) currently has a paper-based early cancer detection system. Padhar and Mungeli have no early cancer screening or detection system and only provide cancer care in facilities. The lack of early detection at these two sites means that many late-stage oral and cervical cancer patients have low chances of successful treatment. The project will train health workers, nurses, dental assistants and project coordinators to use mHealth to screen, record, and refer patients.

    Health workers are being trained to identify oral cancer lesions and refer the patients with precancerous lesions to the hospital. The health workers will use mHealth to create a profile for each new patient and generate a unique patient ID. Cervical cancer screening requires a Visual Inspection with Acetic acid (VIA), so nurses will screen women for cervical cancer by visiting community centres in the villages. Women who test VIA positive are counselled by nurses to visit the hospital’s gynaecology department where they’ll have a second VIA test, and a biopsy if needed, then appropriate medical treatment. Nurses will use mHealth to report on the second test results and treatment confirmation.

    This’s a simple, effective mHealth model that Africa’s health systems can adopt. A small start leading to a steady roll out with adjustments from learning has much to commend it.

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    Image from Kera News

  • Top healthcare solutions in the Innovation Prize for Africa

    The African Innovation Foundation (AIF) has announced the top ten nominees for its landmark programme, the Innovation Prize for Africa (IPA). Now celebrating its fifth year under the theme Made in Africa, IPA offers a grand share prize of $150 000 to spur growth and prosperity in Africa through home-grown solutions, an article in IT-Online says.

    The IPA has seen considerable growth in applications and increasing interest from both innovators and innovation enablers over the years. IPA 2016 attracted a record of over 3,600 innovators and received 985 successful submissions from 46 African countries. African ingenuity this year showcases new breakthroughs in public health, including malaria, HIV/AIDS and cancer, smart solutions for farmers and dynamic energy initiatives. 

    AIF will host the IPA 2016: Made in Africa awards ceremony on 22 and 23 June 2016 in Gaborone, Botswana. Collaborating partners include the Ministry of Infrastructure, Science and Technology (MIST), and the Botswana Innovation Hub (BIH). 

    The healthcare solutions in the top 10 IPA 2016 nominees include:

    Urine Test for Malaria (UMT)

    Dr Eddy Agbo from Nigeria developed the UMT, a rapid non-blood diagnostic medical device that can diagnose malaria in less than 25 minutes. Africa has the highest number of malaria cases worldwide. The inability to quickly diagnose and commence malaria treatment can lead to various complications including kidney failure, build-up of lung fluid, aplastic anaemia and even death. UMT uses a dip-stick to get accurate results within half an hour. The technology detects malaria parasite proteins in urine of patients with fever due to malaria. UMT’is simple and affordable, and a potential game changer in managing malaria across Africa. 

    Api-Palu

    Valentin Agon from Benin also developed a solution to curb the spread of malaria. Api-Palu is an anti-malaria drug treatment developed out of natural plant extract. It is significantly cheaper than available anti-malarial drugs, and has great inhibitory effects on 3D7 strains of plasmodium falciparum the causative agent of malaria. According to the WHO, Sub-Saharan Africa is home to 88% of malaria cases and 90% of malaria deaths reported globally with some African governments spending up to 40% of their public health budgets on malaria treatment. Api-Palu manifests as a fast rate of malaria parasite clearance from the blood following short term treatment, with relatively lower doses. It is available in tablets, capsules or syrup. The drug has been approved in Benin, Burkina Faso, Tchad, and Central Africa Republic because of its therapeutic and non-toxic effects.

    Exatype

    Dr Imogen Wright, South Africa, solution addresses a different healthcare issue facing many African countries, HIV/AIDS. Exatype’s a software solution that enables healthcare workers to determine HIV positive patients’ responsiveness to Antiretroviral Drugs (ARV) drug treatment. According to WHO, 71% of people living with HIV/AIDS reside in Africa. 

    A growing number of people on ARVs are resistant to drug regimens, leading to treatment failure, further exacerbating the continent’s HIV/AIDS burden. Exatype processes the highly complex data produced by the advanced next generation of DNA sequencing of HIV DNA in patients’ blood. A simple report detects drugs resistant to patients, then highlights the need to avoid these to ensure successful treatment. Exatype has the potential to contribute towards effectively managing HIV/AIDS in Africa, and also holds promise in helping detect drug resistance for other disease burdens such as Tuberculosis (TB) and malaria.

    Aceso

    Dr Kit Vaughan, also from South Africa, created an imaging technology, capable of performing full-field digital mammography and automated breast ultrasound at the same time, dramatically improving breast cancer detection. Annually, there are more than half a million cancer deaths in Africa and these numbers are expected to double in the next three decades. If diagnosed early enough, the chances of treating the cancer successfully increases dramatically. However, because 40% of women have dense tissue, their cancers cannot be seen on X-ray. Furthermore, a false negative finding can have devastating consequences. Aceso is a single device that can acquire dual-modality images, full-field digital mammography and automated breast ultrasound at the same time. This world first system’s protected by international patents and has been successfully tested in two separate clinical trials with 120 women.

    Having four healthcare solutions emerging from the top ten Innovative solutions across the different sectors is very encouraging. All four address critical healthcare issues facing African health systems and have the potential to have a real impact and save lives across the continent.

  • Molecular scissors cut through a leukaemia barrier

    Layla was a healthy baby. Her story's that at after 14 weeks, she was diagnosed with Infant Acute Lymphoblastic Leukaemia (ALL) and admitted to the world-famous Great Ormond Street Hospital (GOSH). She had one of the most aggressive forms of the disease the GOSH’s doctors had seen. Chemotherapy was started without delay, then a bone marrow transplant (BMT) to replace her damaged blood cells. It didn’t work. A second round of treatment wasn’t an option. Neither was an experimental treatment at another hospital. Layla was a year old then.

    Profs Waseem Qasim and Paul Veys described Layla’s story at the Royal Society of Medicine’s 12th Innovation Summit in April. They were able to offer a very recent and experimental treatment only trialled in mice. Prof Qasim was developing the molecular scissores, and only one vial was available for Prof Veys to use. There were no guarantees. Layla’s parents agreed. GOSH’s ethics committee promptly agreed it was right to try it.

    Treatment used molecular scissors to edit genes and create designer immune cells programmed to seek and kill drug-resistant leukaemia. Leyla was given a small 1ml infusion of genetically engineered cells, Universal Chimeric Antigene Receptor T-cells (UCART19).

    It took a couple of minutes, followed by a five minute flush. She was bouncing around her cot during the process. Leyla’s now cancer-free, and doing well. The breakthrough from GOSH and UCL Institute of Child Health’s (ICH) pioneering research teams supported by the National Institute for Health Research (NIHR) Great Ormond Street Biomedical Research Centre.

    The doctors expected an immune response within a fortnight, usually a rash or a fever. A rash emerged after two weeks. It worsened, then, faded. A second child has now had successful molecular scissor treatment, and didn’t have a rash.

    When doctors were confident that Leyla’s leukaemia cells had been removed, she was given a bone marrow transplant to replace her entire blood and immune system which had been wiped out by the treatment. She returns to GOSH regularly to check that her bone marrow cells are healthy and blood counts continue to normalise.

    Molecular scissors works by adding new genes to healthy donor T-cells, arming them against leukaemia. Molecular tools, TALEN, act like accurate scissors to cut specific genes to make the T-cells behave in two ways. First, cells become invisible to a powerful leukaemia drug that usually kill them. Next, they’re reprogrammed to target and fight leukaemia cells.

  • Smartphones improve cervical cancer screening in Madagascar

    mHealth keeps expanding its potential. A study in Ambanja, a city in Madagascar, published in PLOS One, found that using smartphones for on-site diagnosis offer the same information as off-site diagnosis, and it takes much less time. 

    The team, mostly from Geneva University Hospitals, sought to test the use of smartphones to improve the screening technique of visual inspection of the cervix after applying 5% acetic acid (VIA). It’s a technique used widely in Low and Middle-Income Countries (LMIC). Women were recruited from a screening campaign, 332 in total. Each one completed a human papillomavirus (HPV) self-sample as a primary screen. PV is a group of viruses that affect skin and moist membranes lining bodies, so they can affect the cervix.

    Women testing positive for HPV went on to VIA followed by D-VIA, a cervical biopsy and endocervical curettage, a procedure where the mucous membrane of the cervical canal is scraped with a curette, a spoon-shaped instrument. The D-VIA was emailed to a tertiary care centre for immediate assessment. Results were either D-VIA normal or D-VIA abnormal, requiring immediate therapy or referral to a tertiary centre.

    About 41%, 137 women, were HPV-positive and recalled for VIA triage. About 69%, 95 women, complied. Cervical intraepithelial neoplasia, an indication of premalignant transformation and abnormal growth, was detected in digital images by 18% on-site and 22% off-site physicians. After adjusting for sensitivity, the team concluded that using smartphone images for off-site diagnosis of cervical intraepithelial neoplasia achieves a similar diagnostic performance to on-site diagnosis.

    While smartphone images can improve cervical cancer screening, the study didn’t extend to testing the efficiency of using smartphones in LMICs. While these results are awaited, it’s encouraging to confirm another valuable role for mHealth in Africa.