Tshiamo Mmotsa

Acfee Intern

  • Is eHealth’s cyber-security on the march?

    As Africa’s eHealth expands, its exposure to cyber-security risks increase. A cyber-security report from Acfee summarises these cyber-threats. They include:

    • Medical identify theft
    •  Ransomware
    • Denial of Service (DOS) attacks
    • Malware
    • Fraud.

    Reasons for cyber-crime differ from criminal to criminal. Some want money. Others, such as hacktivists, use it as a political campaign strategy. Examples of cyber-criminals’ goals for healthcare are:

    • Diverting funds or pharmaceutical stocks
    • Forging prescriptions
    • Stealing social security data to make fraudulent claims
    • Changing treatment regimens

    South Africa aims to implement comprehensive cyber-security measures driven by the South African Protection of Personal Information (POPI) Act. In the USA, the Health Insurance Portability and Accountability Act (HIPAA) provides the foundation. It fits another, the wider National Institute of Standards and Technology (NIST) initiative reported by eHNA to improve the US cyber-security framework. The Payment Card Industry Data Security Standard (PTI DSS) provides a generic standard that fits healthcare.

    Fortinet, a cyber-security company, has an integrated approach set out in its white paper Countering the Evolving Cybersecurity Challenge with Fortinet Security Fabric. It provides an integrated cyber-security architecture that includes Advanced Threat Protection (ATP), Application Programming Interfaces (API) and layered, segmented firewalls.

    Typically, cyber-security aims to add new devices and cyber-security measure to an over-burdened cyber-security service. This increasing network eventually becomes dysfunctional, failing to solve the problem. Fortinet says there’s a hazardous contradiction. Deploying new devices helps to decrease the time to discover some new cyber-threats. In parallel, cyber-threats are compromising organisations at a faster rate. Hence the need for a shift to a new cyber-security model.

    Africa’s eHealth hasn’t adopted a cyber-security framework like Fortinet’s. As cyber-security awareness increases, it seems like an essential option.

  • mHealth gives South African women access to legal abortions

    Illegal abortions are unsafe. WHO has a global survey showing there’s a death every eight minutes from preventable, unsafe abortions. Of the 21.6 million unsafe abortions globally, 18.5 million, more than 85%, are in developing countries like South Africa.

    Abortion in South Africa’s a reproductive right. Even after introducing the Choice on Termination of Pregnancy Act, 50% to 60% of abortions are illegal and unsafe. Research by Ipas says that 30% of South African women are unaware that abortion is legal.

    To give all South Africans access to immediate and locally relevant sexual health services, Safe2Choose has launched a new mHealth initiative. It includes evidence-based information and counselling to encourage having safe abortions. Safe2Choose's innovation arm, Fem, will run the campaign.

    The first will refer women to legal, safe abortion providers in their area privately and quickly. To use the services, users will have to:

    • SMS FEM to 30816
    • Answer standard questions on the platform, after which they will receive a referral SMS to a nearby legal and safe healthcare facility providing abortions
    • Authorise the system to map their geographic locations
    • If unable or unwilling to authorize geo-location, users will have access to a manual look-up option so they can select their preferred location and receive referrals.

    The pilot phase is currently underway in Gauteng. The campaign will gradually roll out to other provinces. In the first month, Fem referred some 300 pregnant women to safe and legal abortion facilities. The campaign was promoted on radio stations, flyers at local clinics and social media.    

  • Babyscripts allows doctors to track pregnant patients remotely

    Maternal mortality is a top priority for all health systems. In the US, seeking improvements has spawned several mHealth solutions that may benefit Africa too.

    An editorial by the Association of Reproductive Health Professional says that the US‘s 50th in the world for maternal mortality. Most countries reduced their maternal mortality between 1990 and 2008. There was a 34% decrease globally. But, in the US, maternal mortality doubled.

    To improve the pregnancy experience and maternal mortality in the US, Babyscripts was founded. The start-up focuses on maternal health and has developed an mHealth tool allowing obstetricians to monitor their pregnant patients' health and progress remotely. Obstetricians receive a Mommy Kit with a WiFi and Bluetooth-enabled blood pressure cuff and weight scale. These collect data, sending it back to doctors to monitor using the app. Women use this to replace some pre-natal appointments, saving time and money by not having to pay for a prenatal checkup. These are very valuable benefits for Africans.

    MedCity has a report saying the app's algorithms detect abnormal readings and notify providers to schedule any required visits with patients. Forbes has said the kit and app have already detected cases of pre-eclampsia earlier than conventional diagnoses. The team’s now working on a kit that includes a glucometer to help monitor patients at risk of gestational diabetes.

    This app is unique to existing apps such as Ovia Health App, Text 4 Baby, Due Date Plus and MomConnect. It's aimed at clinicians, while these other apps focus mainly on providing women with information regarding pregnancy and helping women to track their milestones. These don't share data with doctors.

    With Babyscripts receiving more funding, it’s now working with ten health systems. Six more will be added in the next month. The next project’s to track children's health remotely, moving the company into paediatrics. It seems like a very valuable addition to Africa’s health systems’ mHealth portfolios.

  • How can Africa monitor influenza during the upcoming season?

    In 2009, Sweden was one of the countries affected by A (H1N1) influenza, commonly called swine flu. Two minor peaks occurred during summer and winter. Starting among school children, the main epidemic occurred in late September and peaked in mid-November. It affected most parts of the country. An article in British Medical Journal (BMJ) says it leads to a debate on the level of the country’s preparedness.

    During this time, the epidemic was monitored using data from eHealth records and eSurveillance systems. A report supporting evidence-based strategies for eHealth system development in infectious diseases was published in the Journal of Medical Internet Research (JMIR). The study’s primary objective was to examine correlations between data from:

    1. Google Flu Trends (GFT), an Internet-based software system using aggregated data from Google to estimate influenza activity
    2. Computer support for tele-nursing centres
    3. Health service websites
    4. Influenza case rates during seasonal and pandemic outbreaks.

    Results indicated important correlations. These are between GFT, tele-nursing data and website visits. All influenza case data showed large effect sizes.

    With the influenza season due in May and June in Southern Africa, it’s essential to review other eHealth surveillance systems to help prepare countries for likely outbreaks. eHealth innovators can then design initiatives to ensure the region’s prepared to deal with influenza.

  • Weather surveillance and food security are vital for better health

    Rising sea temperatures and glacial retreats are two climate change measures reported by National Aeronautics and Space Administration (NASA). It’s clear that its effects are damaging in many ways. One negative impact’s food security, with its knock on adverse impact on nutrition. The  UN World Food Programme (WFP) has collected evidence that climate change aggravates the risks of undernutrition and hunger caused by extreme weather events such as floods, droughts and tropical cyclones. These can destroy crops, critical infrastructure such as hospitals, and key community assets. The results are deteriorated livelihoods and aggravated poverty. These exacerbate Africa’s health challenges.

    Climate change affects all dimensions of food security and nutrition such as food availability, food access, food utilisation and food stability. The World Bank has reported that more than 700 million people in the world are still living in extreme poverty, while the 2015 State of Food Insecurity in the World (SOFI) report states that 793 million people are undernourished. A BioMed Central report has also indicated that droughts as a result of climate change can cause food insecurity which may lead to psychological distress.

    To track changes in people's food security, the WFP’s Food Security Monitoring System (FSMS) monitors market prices, rainfall patterns and collects information on individual households, their income and food consumption. The FSMS data alerts the humanitarian community to adverse changes to ensure that help is provided when needed.

    FSMS uses the WFP Seasonal Monitor to examine satellite imagery of rainfall and vegetation. It analyses real-time satellite data streams and seasonal forecasts to identify potential changes that may result in food insecurity. 

    Highlights of the latest FSMS report for Southern Africa include:

    • Need for a good performance from the growing season from October 2016 to April 2017 for Southern Africa after suffering two consecutive droughts due to the lasting El Niño event that resulted in food insecurity
    • This season has suffered an irregular start, especially for countries like Zimbabwe, Mozambique and Zambia
    • Early rains are mostly used to restore the depleted soil moisture reserves, but its current limitation has caused depressed vegetation cover across most of the region and this has resulted in delays in crop and pasture develop
    • Positive, major cereal production areas in NE Southern Africa, Botswana, Namibia and Southern Angola have had a promising start
    • There are grounds for some optimism as the seasonal forecasts indicate more rainfall than average during January to March. 

    This data’s an essential component of health surveillance. It can be used to plan the health and healthcare initiatives needed to respond to adverse climate changes and avoid or minimise the effects. On its own, it’s crucial information. Combined with health surveillance and healthcare resource data, Africa’s health systems can plan effectively. An mhealth app can be created to educate community members on how to adapt to climate change can help reduce the effects of climate change.

  • mHealth can help Lesotho’s huge HIV challenge

    HIV’s still a global epidemic affecting most Low and Middle Income Countries (LMIC).  Some 4% of people in Africa are HIV+. At 12% of all deaths, HIV/AIDS is the biggest cause.

    Lesotho’s no exception, in fact it’s much worse. According to the UNAIDS Gap Report, 310,000 people in Lesotho are living with HIV, about 23% of the population. Only 42% of adults receive Anti-Retroviral Treatment (ART).  Most of Lesotho’s population live in rural areas, making healthcare access challenging.  

    One of the benefits of mHealth is meeting challenges of poor healthcare delivery, especially for HIV treatment. To address this challenge, The Guardian has reported that Lesotho’s Ministry of Health (MOH) has introduced an mHealth programme developed by Vodacom. It’s a combination of a smartphone app for healthcare providers and M-Pesa, a mobile money service for the patients. M-Pesa is a money transfer service for people to receive or send money using a mobile phone. It’s widely available throughout Sub-Saharan Africa. Since women and young children are most affected by the HIV epidemic, the programme focuses mainly on them.

    The programme allows healthcare providers to undertake on-site HIV testing through a mobile clinic in remote areas where travelling’s difficult so that community members can receive care. Healthcare providers can register HIV+ patients in the central database that’s used to provide patients with funds through M-Peas for transport costs. Health care providers can also use the database to plan, record and access treatment.

    If the mHealth programme’s delivered as planned, it should achieve three benefits set out by Ken Congdom of Health IT Outcomes:

    • Improved data accuracy
    • Improved data access
    • Improved patient care

    HIV is an immense healthcare crisis for the people of Lesotho. This programme aims to ensure that thousands of mothers and young children in some of the poorest communities in the world receive the care and support they need.  

  • Mamaope’s a biomedical jacket that diagnoses pneumonia

    Pneumonia accounts for 16% of all deaths of children under five, killing roughly 920,000 children globally each year. It’s a massive challenge for Uganda, where nearly 24,000 children die each year. A lack of access to laboratory testing and infrastructure in rural communities means that health workers often have to rely on simple clinical examinations to make their diagnoses. This often leads to misdiagnosis and preventable deaths.

    To tackle this problem, Olivia Koburongo Brian Turyabagye and a team of doctors from Uganda, created the MamaOpe (Mother's Hope) kit to help diagnose pneumonia. It comprises a mobile app and a biomedical wearable smart jacket, says an article in Daily Nation.  

    MamaOpe kit is simple and easy to use. Health workers simply slip the smart wearable onto a child so the sensors on the jacket can detect his or her breathing rate, temperature and the lungs’ sound patterns. The information’s then sent via Bluetooth to the mHealth app. An analysis determines the severity of the disease. Once the information’s captured and stored in the cloud, doctors can access it remotely, helping health workers make better decisions.

    Although the smart jacket’s still a prototype, early results are promising. Studies by the engineers indicate that it can detect and diagnose pneumonia three times faster than a health worker can. It reduces human error too.

    The team’s currently patenting the kit, which’s shortlisted for the 2017 Royal Academy of Engineering Africa Prize. Plans are underway to pilot the kit in Uganda's referral hospitals, then distribute it to remote health centres.