The Journal of ERW and Mine Action Issue 16.3 (2012)

Mine Risk Education | Africa | Disability Rights | Notes from the Field | Research and Developmen

Preparedness for e-health in developing countries: the case of Ghana

As Ghana embarks on a national e-Health initiative there is the need to explore its preparedness in terms of socioeconomic and development, technology infrastructure and operational preparedness, and skills and human resources. This paper reports on a literature review as part of a research program, which aims to inform the development of an effective roadmap for the successful implementation of the national e-Health initiative in Ghana. The literature was searched for factors of e-Health adoption in developing countries; and realization of the anticipated benefits through IEEE, Medline, Google scholar and Google search engines. Sixteen (16) articles were reviewed were from 176 related articles that were found. The literature review found the two highest priority objectives in in e-Health Africa: providing health education for health professionals (identified in 7 of the 16 projects reported on in the literature) and improvement of primary health care services 9 of the 16 projects). Six (6) or 39% each of the 16 projects reported a lack of skills and Human Resources Socioeconomic issues, and Technology infrastructure problems reported in 22% or the remaining four (4) projects. The paper concluded that the effects of these challenges could lead to Ghana like many other developing countries struggling to adopt e-Health, its inability to realize the potential benefits of e-Health and its ability to institutionalize and sustain e-Health

Challenges and opportunities of a paperless baseline survey in Sri Lanka

BACKGROUND: Personal digital assistants (PDAs) have been shown to reduce costs associated with survey implementation and digitisation, and to improve data quality when compared to traditional paper based data collection. Few studies, however, have shared their experiences of the use of these devices in rural settings in Asia. This paper reports on our experiences of using a PDA device for data collection in Sri Lanka as part of a large cluster randomised control trial. FINDINGS: We found that PDAs were useful for collecting data for a baseline survey of a large randomised control trial (54,000 households). We found that the PDA device and survey format was easy to use by inexperienced field staff, even though the survey was programmed in English. The device enabled the rapid digitisation of survey data, providing a good basis for continuous data quality assurance, supervision of staff and survey implementation. An unexpected advantage was the improved community opinion of the research project as a result of the device, because the use of the technology gave data collectors an elevated status amongst the community. In addition the global positioning system (GPS) functionality of the device allowed precise mapping of households, and hence distinct settlements to be identified as randomisation clusters. Future users should be mindful that to save costs the piloting should be completed before programming. In addition consideration of a local after-care service is important to avoid costs and time delays associated with sending devices back to overseas providers. DISCUSSION: Since the start of this study, PDA devices have rapidly developed and are increasingly used. The use of PDA or similar devices for research is not without its problems; however we believe that the universal lessons learnt as part of this study are even more important for the effective utilisation of these rapidly developing technologies in resource poor settings

Performance measurement of district level hospitals in low income countries: participatory development of an instrument to assess inputs, processes, and outputs for evidence-based management and quality improvement

Thesis (Dr.P.H.)--Boston UniversityBACKGROUND: The potential of hospital performance measurement (HPM) to contribute to improved quality of care and patient outcomes is underrepresented in the health system strengthening literature and no standardized HPM instrument exists for hospitals in developing countries. The problem centered Participatory Action Research (PAR) approach is particularly suited to addressing complex organizational problems in low resource settings and is gaining acceptance as an applied research method in healthcare settings. METHODS: This quasi-experimental study using the PAR approach was carried out in 4 hospitals in Cameroon. Quantitative (415 surveys) and qualitative (129 interviews and 77 observations) methods examined how participating in the design of a HPM instrument influences health personnel's knowledge, attitude, interest, and intention to continue use of performance measurement for quality improvement. Changes in scores for the above outcomes from before and after implementation of the performance indicators were compared to scores from a non-participating control hospital at the same time points. RESULTS: Personnel designed and pilot tested performance measurement indicators in all hospital services. Hospitals that actively participated in instrument design showed a statistically significant increase in HPM knowledge and attitude, and were more likely to report intention to continue using HPM as compared to the non-participating hospital. Hospital personnel participating in the design process were more aware of the workload barriers to implementing HPM but nonetheless were more motivated to continue the HPM effort. In addition, the PAR approach fostered ownership, increased skills, raised awareness of performance gaps, and led to a contextually appropriate tool. CONCLUSIONS: The results of this study demonstrate the feasibility of designing and implementing an HPM instrument in a low-resource health care system and highlight the positive benefits of the PAR approach. Further research is needed to determine the effect of regular HPM on quality of care and its sustainability over time in resource constrained settings

eHealth for family planning in Botswana: acceptability and feasibility

BACKGROUND: As many as 50% of pregnancies in Botswana are unintended, but only half of women in the country are currently using contraception. This thesis explores the barriers and facilitators for provision, choice and use of contraception in Botswana, and the feasibility and potential for an eHealth intervention in the field of family planning to address them. METHODS: I conducted a narrative review of factors influencing contraceptive choice, uptake and use in Botswana, and qualitative, semi-structured interviews with Batswana women (n=22), healthcare providers and key policy stakeholders in family planning (n=14), and Botswanabased eHealth experts (n=11). FINDINGS: Many Batswana women lack accurate, in-depth family planning knowledge, and experience extreme clinical and social barriers in accessing contraception. Socio-cultural barriers are more influential than physical access or availability, with partner control and patriarchal attitudes towards sex and gender the most prominent reason for women’s non-use of contraception, exacerbated by urban-rural disparity and education level. Botswana’s HIV epidemic has heavily dominated sexual health services and policy, leading to conflict between national approaches towards HIV and family planning. Key challenges for eHealth innovation in Botswana are related to inconsistent Wi-Fi infrastructure, a lack of national policy, and a reliance on external partners leading to unsustainable design and implementation of interventions. Suggestions for an eHealth intervention in family planning include using a range of media platforms to address varied levels of technological knowledge and access, and ensuring content is culturally appropriate and useful to intended users. CONCLUSION: There is a need, and desire, for more detailed, balanced, up-to-date family planning information for women, their partners, and the providers who counsel them. An eHealth intervention that adheres to the realities of technology and infrastructure limitations, and is Botswana-led in terms of content, design, and implementation, could be highly effective in addressing this gap

Machine Intelligence in Africa: a survey

In the last 5 years, the availability of large audio datasets in African countries has opened unlimited opportunities to build machine intelligence (MI) technologies that are closer to the people and speak, learn, understand, and do businesses in local languages, including for those who cannot read and write. Unfortunately, these audio datasets are not fully exploited by current MI tools, leaving several Africans out of MI business opportunities. Additionally, many state-of-the-art MI models are not culture-aware, and the ethics of their adoption indexes are questionable. The lack thereof is a major drawback in many applications in Africa. This paper summarizes recent developments in machine intelligence in Africa from a multi-layer multiscale and culture-aware ethics perspective, showcasing MI use cases in 54 African countries through 400 articles on MI research, industry, government actions, as well as uses in art, music, the informal economy, and small businesses in Africa. The survey also opens discussions on the reliability of MI rankings and indexes in the African continent as well as algorithmic definitions of unclear terms used in MI.Comment: Accepted and to be presented at DSAI 202

EVALUATING THE USE OF MOBILE PHONE TECHNOLOGY TO ENHANCE POSTNATAL CARE IN SOUTH AFRICA

EVALUATING THE USE OF MOBILE PHONE TECHNOLOGY TO ENHANCE POSTNATAL CARE IN SOUTH AFRICA Kemunto Mokaya*, Elsie Etsane**, Jannie Hugo**, Jenny D. Makin**, Anne-Marie Bergh**, Robert C. Pattinson** and Brian W. Forsyth* *Department of Pediatrics, Yale University School of Medicine, New Haven, CT **Maternal and Infant Health Care Strategies Research Unit, University of Pretoria, Pretoria, South Africa. Maternal and child care in South Africa is sub-optimal, contributing to the maternal mortality and high infant mortality rates in the country. About a third of these deaths are due to modifiable factors, some of which are related to poor communication between healthcare providers and patients. A potential intervention that could reduce some of these modifiable factors is the incorporation of mobile phone technology. The goal of this study was to determine the feasibility and effectiveness of incorporating mobile phone technology in postnatal care. The specific objectives were: to determine patterns and preferences of cell phone use among mothers; to determine healthcare staff attitudes towards the use of mobile phone technology in postnatal care; to determine whether a mobile phone intervention using SMS and phone call reminders will increase rates of attendance in postnatal clinics; to determine the cost-effectiveness of these reminders; and to determine the patients satisfaction with their reminders. The study was divided into 3 sub-projects. (i) In sub-project A, cross-sectional questionnaires were used to determine patterns and preferences of mobile phone use among mothers. (ii) In sub-project B, cross-sectional questionnaires were used to determine staff attitudes regarding use of mobile phones to enhance communication. (iii) In sub-project C, a randomized controlled trial (RCT) was carried out to determine the impact of a mobile phone intervention on rates of postnatal clinic attendance. (i) 375 mothers participated in sub-project A. Of these, 98% had access to a mobile phone, and 83% owned personal mobile phones. 86% of the mothers had positive attitudes towards the use of mobile phones for patient: provider communication. (ii) 135 healthcare workers participated in sub-project B. Of these, 75% reported willingness to use a mobile phone to communicate with patients. (iii) In the RCT involving 415 mothers, the use of phone call/SMS reminder significantly increased rates of patient attendance at their 3-day appointment from 45% in controls to 72% and 81% in mothers who received phone calls and SMS reminders, respectively (p \u3c0.001). SMS reminders were more cost-effective than phone calls. 94% of mothers who got reminders were satisfied with them. Mobile phone technology can effectively be used to enhance communication between healthcare providers and patients in South Africa due to its high reach and acceptability among patients and healthcare staff. Additionally, mobile phone technology is simple to use and cost-effective. Mobile phone technology may effectively be used not only for appointment reminders, but also in other areas such as health education/awareness, chronic disease management, and HIV medication monitoring and compliance

DETERMINING THE DRIVERS OF QUALITY OF LIFE IN HIV PATINTS TREATED WITH ANTIRETROVIRAL THERAPY IN SUBSAHARAN AFRICA

During the last decade, HIV in sub-Saharan Africa has shifted from a fatal disease to a chronic condition thanks to the expansion of antiretroviral therapy (ART). As a result, the focus of care has transitioned from survival to quality of life (QoL), and the latter has become a significant outcome measure during patient follow up. Yet, the determinants of QoL among HIV patients in western and central Africa are not well known. The objective of this dissertation was to determine the main factors associated with QoL among ART-treated HIV adult patients in western and central Africa to ensure healthcare providers and stakeholders use the most relevant, up-to-date evidence when designing and implementing interventions that help patients effectively stay in care and remain asymptomatic. We first performed a systematic review to synthesize known determinants of QoL in sub- Saharan Africa. Leveraging the findings of the systematic review, we conducted a crosssectional survey at Espoir Vie Togo (EVT), a patient-oriented community health clinic in Lomé, Togo, to measure QoL and determine which factors previously identified in the systematic review were associated with physical and mental domains of QoL in this population. We also interviewed EVT patients to better understand their life experiences and potentially uncover novel factors associated with QoL. The systematic review included 41 observational studies conducted in 14 countries and we found that QoL was most frequently influenced by sociodemographic factors such as age, education, gender, employment, social or family support, as reported in nine or more studies; by clinical factors including mental health and CD4 count; and treatment-related factors such as treatment duration. At EVT, the mean (SD) physical health summary (PHS) and mental health summary (MHS) scores of 147 ART-treated patients were 80.7 (13.9) and 66.7 (11.1), respectively, on a 0-100 scale. Younger age, male gender, food security, the absence of side effects and self-evaluated “excellent” or “very good” health status were associated with higher PHS scores. Male gender, a higher level of education, food security, family or social support and self-evaluated “excellent”, “very good” and “good” health status were associated with higher MHS scores. Finally, in qualitative interviews with 12 ART-treated EVT patients, patients described good QoL as being in good health and being physically and mentally functional. Family, social and community support, the presence of a supporting individual, being on ART and food security were factors influencing QoL. In this cohort, participants experienced difficulties accepting their positive status, and often faced perceived or enacted stigma. The QoL of people living with HIV in western and central Africa is driven by multiple sociodemographic, clinical and treatment-related factors that have been summarized in this dissertation. These findings provide stakeholders with valuable evidence to optimize patient care and management. Future research will focus on pediatric populations and compare treatment satisfaction between patients receiving care in non-governmental organizations and in public healthcare facilities

Comprehensive care: pastoral care of people living with HIV/AIDS in the Pilgrim Wesleyan Church in Zambia

https://place.asburyseminary.edu/ecommonsatsdissertations/1802/thumbnail.jp