• Public Health
  • Predictive analytics needed for better infectious disease tracking

    When outbreaks of new diseases emerge, public health’s impact inevitably follows events. Eventually, it catches up. The US Government Accountability Office (GAO) report in May 2017, Emerging Infectious Diseases Actions Needed To Address the Challenges of Responding to Zika Virus Disease Outbreaks, found that the Zika virus case counts from the national disease surveillance system underestimate the total number infections because: 

    Infected people may not seek medical care because they have only mild or no symptoms, or other reasons,May not be diagnosed because of limitations in Zika virus diagnostic testingIncomplete surveillance reporting.                                                                                                                                   

    Better, prompt and accurate information’s still needed. Three Congress representatives have written to the GAO boss, the Comptroller General, suggesting a subsequent study into predictive models and systematically integrating modelling into outbreak responses. They think the US can respond more effectively bt learning if:

    Federal agencies use predictive modelling to inform planning for emerging infectious diseases?How federal agencies use models to inform regulatory decisions about infectious disease outbreaks?Do medical product sponsors use predictive modelling?What funding’s available for infectious disease predictive modelling?What challenges do predictive modellers face?If and how, federal agencies validate models’ predictions? 

    With predictive modelling and analytics expanding their potential, these seem like a good set of questions that all countries should ask. Answers can inform eHealth strategies and strengthen the role and impact of public health professionals.

  • Egyptians’ OHI profiles identified

    As African’s have increasing opportunities to use the Internet to find Online Health Information (OHI), it’s extremely valuable to know about how they use it so health systems can expand and improve the service. A study by a team from the UK’s Birmingham University and Egypt’s Suez Canal University, reported in the Journal of Medical Internet Research (JMIR) has identified the characteristics of adult Egyptian OHI users.

    Internet World Stats has estimated that about a third of Egyptians seek OHI. Most users looked for information about more than one health topic. The team’s sample of 490 of these had an OHI topics’ profile of:

    Most people, 83%, rated OHI quality as good or excellent. The other 17% thought it was fair, so no-one said it was poor.

    Over half, 53%, were searching for information about their own health. Under a third, 30% were seeking information for someone else.

    The main personal characteristics associated with frequent OHI searching by Egyptian adults were:

    Younger ageFemalesHigher educationGood general health.

    People with one or more chronic health problem was more likely to search for OHI more frequently than people without any chronic health conditions. This may indicate a vital role for OHI.

    The study’s results can only be generalised to Egyptian OHI seekers. It would be good to see equivalent studies from all African countries. Until then, Africa’s health systems can continue to rely on the Internet as an important tool for health information dissemination and to support healthcare delivery. It can build on the findings that OHI has made the Internet a major and growing source of health information for Egyptian Internet users.

  • 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?   

  • How can patients’ data follow them around health systems?

    Most patients are mobile. Their healthcare’s provided by different types of health professionals and other workers and organisations. In Africa, many people change towns and migrate from remote communities, so they access their healthcare in different districts and regions. It’s hard for their information to keep up, even between local clinics and hospitals.

    A major eHealth goal is to provide access to patients’ information wherever they turn up for their healthcare. A report from Health IT Analytics sets out a way to achieve it. Best Practices for Building an IT Infrastructure to Support Digital Transformation. It sets out five main steps:

    Create an eHealth footprint focused on connectivityUnlock data to move information securely across different systemsEliminate data silos to enable secure data sharingEngage patients electronically in a way that’s convenient and meaningful for themUse analytics to optimise health data’s value. 

    It needs a significant parallel investment in the data itself. These eHealth programmes can be pursued in the context of the five goals. For Africa’s health systems, this may easier to construct than developed countries because of the current, limited legacy systems. It might be easier, but it’s not easy.

    The report sets out a hierarchy of eight steps moving from an integration foundation up toe ecosystem engagement:

    AnalyticsMobile app developmentIdentity federationApplication Programming Interface (API) managementExtensible Markup Language (XML) and Service-Oriented Architecture (SOA) servicesAPI integrationB2B Electronic Data Interchange (EDI) integrationManaged file transfer

    This perspective sets an eHealth horizon beyond information systems. It needs rigorous eHealth leadership. It needs considerable resources and eHealth capacity too. For Africa’s eHealth, the eight steps offer a long term direction. It’s still a direction that’s needed, and building blocks can be put in place in the short term.

  • Africa’s relative poverty is increasing

    Poverty and poor health worldwide are inextricably linked, and it’s both a cause and a consequence of poor health, which traps communities in poverty. The Health Poverty Action (HPA) initiative’s clear about it, and says links between poverty and poor health are:

    Economic and political structures that sustain poverty and discrimination need to be transformed for poverty and poor health to be tackledMarginalised groups and vulnerable individuals are often worst affected, and deprived of the information, money or access to health services that would help them prevent and treat diseaseVery poor and vulnerable people may have to make harsh choices, knowingly putting their health at risk because they can’t see their children go hungryCultural and social barriers faced by marginalised groups, including indigenous communities, can mean they use health services less, with serious consequences for their health, perpetuating their disproportionate levels of povertyCosts of doctors’ fees, courses of drugs and transport to reach health centres can be devastating for poor people and their relatives who care for them or help them reach and pay for treatmentIn the worst cases, the burden of illness may mean that families have to sell their properties, take their children out of school to earn money, sometimes  by beggingCaring burdens are often taken on by female relatives who may have to give up their education, or take on waged work to help meet households’ costsMissing education has long-term implications for women’s opportunities and their healthOvercrowded and poor living conditions can contribute to the spread of airborne diseases such as tuberculosis and respiratory infections such as pneumoniaReliance on open fires or traditional stoves can lead to deadly indoor air pollutionA lack of food, clean water and sanitation can be fatal.

    The Economist has reviewed data from the World Bank.  The good news is that the number of people living in absolute poverty, defined as having less, than US$,90 a day at 2011 purchasing parity, has dropped from over 1.8 billion in 1990 to under 0.8 billion in 2013, down by about 55%. Within this considerable achievement, Sub Saharan Africa’s (SSA) relatively worse off.

    In 1990, about 15% of its population were in absolute poverty. In 2013, it was approaching 50%. Two reasons are first, absolute poverty in South Asia and East Asia and the Pacific has dropped enormously. Second, Africa’s population has expanded by about 2.5% a year, more than twice Asia’s growth rate. SSA’s absolute poverty rate has dropped from 54% to 41%, but the relatively high population growth means that more people in SSA are now living in absolute poverty.

    For many years, SSA’s been attributed with a relatively high burden of disease. Now that other global regions are pulling away from absolute poverty, it has an increasing relative absolute poverty burden. The HPA commentary indicates a heightening challenge. It’s clear where Africa’s eHealth’s focus should be.

  • VFAN is expanding into more countries

    After its success in Rwanda, Vision for a Nation (VFAN) is planning to take its approach to other countries. It could be good news for some African countries.

    It’s already helped more than a million people in Rwanda to access eye care services. In four years, VFAN’s provided:

    Over 1.2 million eye screenings, more than 10% of the population560,000 prescriptions144,000 referrals for specialist treatment109,000 pairs of glasses.

    VFAN’s programme has supported Rwanda’s Ministry of Health to build an affordable, successful nationwide eye care service locally available to 10.5 million people. It’s fully integrated into the public health system.

    Tom Rosewall, VFAN’s CEO says “Rwanda is the first emerging country in the world to provide all of its people with local access to affordable eye care.” The service in Rwanda’s sustainable. eHNA reported earlier that Rwanda’s Ministry of Health will assume full responsibility for new eye care services from January 2018. VFAN now plans to take its initiative to other countries around the world. Other parts of Africa are good places to start.

  • There’s not enough eHealth for healthy living

    An important theme in Acfee’s goal of healthy Africans is eHealth that supports healthy lifestyles and discourages unhealthy behaviours. Few eHealth initiatives are available for this public health strategy. In an article in KQED Science, Stephen Downs, chief technology and strategy officer the Robert Wood Johnson Foundation (RWJF), attributes the paucity to two main causes. One’s the growing proliferation of chronic diseases, especially diabetes, cancer and heart ailments. The other’s a huge growth in wearables that monitor the consequences of sedentary lifestyles, such as mHealth apps that count steps to show that people don’t naturally incorporate the time and space to walk.

    Down’s solution is for innovators to stop treating symptoms and start remedying the problem’s roots. This needs much more than eHealth. It needs unhealthy systems to be re-engineered to remedy the effects of unhealthy environments by engineers and designers in all industries and for them to identify their products’ effects people’s health.

    An example is the Changing Places group at the Massachusetts Institute of Technology (MIT) Media Lab. It’s attempting to create solutions that change human behaviour fundamentally. One initiative’s designing ways to feed people healthier diets through urban farms that make use of city spaces. If it succeeds it could benefit millions of Africans living in Africa’s huge cities. A project is the MIT CityFARM that aims to eliminate the large water volumes used by agriculture and avoid unnecessary fertilizers and pesticides.

    Another’s the Blue Apron delivery services. It provides boxes of fresh food to doorsteps, with all the ingredients and spices needed to cook meals at home. It replaces fast food with faster food and better nutrition.

    ColaLife’s an equivalent and expanding initiative in Africa. eHNA’s previously posted about its activities and successes.

    With eHealth’s existing, huge emphasis in healthcare, it seems it’ll be sometime before eHealth for health will start to catch up. Links needed with other activities make it a complex endeavour. Africa’s health systems could take a leading role.

  • How quickly can Africa’s public health fill the social media space?

    Social media seems to dominate some people’s every waking minute. It may have a big role in some people’s sleep too. A report in the Journal of Public Health Policy, Social media, knowledge translation, and action on the social determinants of health and health equity: A survey of public health practices, sees this as “Opportunities for public health to increase its influence and impact on the social determinants of health and health equity.”

    It found that public health agencies use social media for knowledge translation, relationship building, and specific public health roles to advance health equity. Its penetration leaves plenty of room for expansion into activities such as navigating, creating and evaluating content to support action on Social Determinants of Health (SDH), health equity, enhance research evidence and mobilising knowledge, informing, educating, and empowering people about health issues, assessing public perception, increasing rapid access to public health messaging during emergencies and other times, mobilising community partnerships and action, and collecting surveillance data. There’s a wide range of uses to aim at.

    Facebook and Twitter are the main media channels identified by the survey. On a scale of daily, weekly, monthly, infrequently and never across several public health SDH and health equity activities, never had the highest score, between 32% and 44%. Infrequently was second, between 29% and 33%.

    These give a range of rates for regular social media use of between 14% and 38%. Expanding from this low base is an opportunity because about 75% respondents said online engagement afforded opportunities for networking and relationship building. Nearly 70% said it’s good for collaboration. Over half are motivated by the chance to share their work on SDH and health equity.

    The challenge’s converting the motivation into capacity utilisation. How quickly can Africa’s public health utilise social media’s spare capacity?

  • IHE release new quality, research and public health white paper

    Access to secondary data and using it effectively’s essential for initiatives to improve health and healthcare quality, research, implementation, surveillance and M&E. The Quality, Research and Public Health  (QRPH) Technical Committee of Integrating the Healthcare Enterprise (IHE) has published a new white paper, Using IHE Profiles for Healthcare - Secondary Data Access. It’s the fourth in a series of white papers. The other three are:

    Knowledge Representation in Chronic Care Management: Example of Diabetes Care ManagementNewborn Screening (NBS)Performance Measure Data Element Structured for EHR Extraction.

    The new white paper describes how to allow secondary data communities to have standard, reliable and secure data access from another health community, especially clinical. It also provides guidance on respecting patients’ privacy and access to data if a secondary data community isn’t allowed to know patients’ identifiers used by the other community.

    Before using the white paper, it’s important to have a working knowledge of five IHE standards:

    Cross-Enterprise Document Sharing (XDS)Patient Identifier Cross-Referencing (PIX)Cross-Community Access (XCA)Patient Demographic Query (PDQ)Cross-Community Document Reliable Interchange (XCDR)Query for Existing Data (QED).

    Other relevant standards are:

    Redaction Services (RSP)Data Element Exchange (DEX)Clinical Research Process Content (CRPC)Retrieve Protocol for Execution (RPE)Aggregate Data Exchange (ADX).

    There are two use cases:

    Epidemiology, with data available from research to the clinical communityCase Report Forms (CRF) retrieval for clinical purposes, with data available in both directions between research and clinical communities.

    IHE has a standing invitation to public health professionals to join its collaborative efforts between the public health and HIT vendor communities. It guides the development of IHE Integration Profiles for Interoperability (IOp) among and between EHR and Public Health Systems (PHS). The profiles facilitate the linkages, standardisation and integration of health data between clinical care and public health to create robust, overarching Health Information Exchanges (HIE). These are becoming increasingly important for Africa’s eHealth.

  • mHealth improves public healthcare in South Africa

    42 million South Africans rely on an under-resourced public health care sector. Inadequate access to health care perpetuate the inequalities that exist. The country faces infectious diseases which kill thousands of people every year namely HIV/AIDs and TB, as well as non-communicable diseases, such as diabetes and cardiovascular diseases, high levels of violence and injury, as well as a relatively high maternal and child mortality rate. These factors make for a dire healthcare situation in the county.

    IT-ONLINE says that healthcare in South Africa is increasingly hospital-centred, disease focused and specialized. This model has led to significant advances in medicine, has helped to improved access to health care and proven profitable, but excludes large segments of the population as it cannot provide universal access.

    The Department of Family Medicine at the University of Pretoria has created a community-orientated primary care (COPC) model for the country. “COPC is a geographically-based, collaborative approach to health that begins with individuals, and families in their homes,” explains research lead Professor Jannie Hugo.

    “COPC is an established concept, but our solution is novel in that it blends academic rigour, public health focus, clinical care and technological innovation and a transformative platform for improved society-wide health outcomes,” says Prof Hugo. The value of the model rests in its comprehensive care that integrates the home, clinics, GPs and hospitals to improve individuals’ ability to manage their health consistently. The system has the potential to revolutionise health care in South Africa.

    AitaHealth is a smartphone app which supports the newest COPC model used by community healthcare workers. Modules in the app collect patient information, guides responses and plans treatment and future visits. “The app guides community health workers through the process, and the information entered guides action, such as treatment or testing,” explains Prof Hugo.

    The backend of the app has a web-enabled platform so all information and interventions captured is available to managers to plan service and delivery. It also allows managers to  support their teams in the field in real-time. AitaHealth is linked to a patient record system using Synaxon to provide continuity of information and care by connecting people in their homes to professionals in clinics and hospitals.

    Continuous learning is another key feature of the app  and is critical in healthcare, and COPC in particular. “To equip healthcare workers and professionals with the knowledge and skills required to carry out the complex tasks of COPC, is necessary for success and sustainable development,” says Prof Hugo.

    Continuous work integrated learning is built into the implementation plan and is supported by curricula, face-to-face training and specifically developed learning materials. Through workplace learning, health workers transition to higher qualifications and professional development to empower and upskill community members.

    The collection of information also provides robust data on the real health situation and services in communities. This kind of information means teams can tailor health care to individuals in specific areas, and can be used in basic and applied research.

    As a result of this work, the National Research Fund is funding 14 masters and 12 doctorate students who are working on various aspects of learning in community health to improve the model, quality of care and the general level of capability in health, including health research.

    The project is already supporting the health of communities around Tshwane and is replicable and scalable. Because the approach is sustainable and affordable community-based health care system, millions more can benefit from this new approach.