Improving access to diagnostics for schistosomiasis case management in oyo state, Nigeria:Barriers and opportunities

Schistosomiasis is one of the Neglected Tropical Diseases that affects over 200 million people worldwide, of which 29million people in Nigeria. The principal strategy for schistosomiasis in Nigeria is a control and elimination program which comprises a school-based Mass Drug Administration (MDA)with limitations of high re-infection rates and the exclusion of high-risk populations. TheWorld Health Organization (WHO) recommends guided case management of schistosomiasis (diagnostic tests or symptom-based detection plus treatment) at the Primary Health Care (PHC) level to ensure more comprehensive morbidity control. However, these require experienced personnel with sufficient knowledge of symptoms and functioning laboratory equipment. Little is known aboutwhere, bywhom and how diagnosis is performed at health facilities within the case management of schistosomiasis in Nigeria. Furthermore, there is a paucity of information on patients' health-seeking behaviour from the onset of disease symptoms until a cure is obtained. In this study, we describe both perspectives in Oyo state, Nigeria and address the barriers using adapted health-seeking stages and access framework. The opportunities for improving case management were identified, such as a prevalence study of high-risk groups, community education and screening, enhancing diagnostic capacity at the PHC through point-of-care diagnostics and strengthening the capability of health workers.</p

Educating for a systems design approach to complex societal problems

Design education has devoted little attention to the topic of societal systems transformation in the context of sustainable development. This paper reports on a master‘s-level course that aims to build the capacity for design engineering students to adopt a Systems Design Approach comprised of the integration of Product-Service System (PSS) and Systems Thinking, in order to develop sustainable energy systems concepts. We identify key factors for skilful performance when designing solutions for complex societal problems. The findings suggest that design approaches grounded in systems thinking are promising for dealing with the increasing complexity of the societal problems which future generations of design professionals are expected to solve. An Open Learning E-Package (OLEP) was offered to support Higher Education Institutions (HEIs) to introduce Product-Services Systems and Distributed Renewable Energy (DRE) models into their design curricula. We argue that capacity building for a systems design approach to complex societal problems, such as those faced in low-income energy markets, can support future generations of design engineers to take an active role in the development and widespread implementation of sustainable energy systems

Comparing Performance of Biomass Gasifier Stoves:Influence of a Multi-Context Approach

Millions of people worldwide die prematurely or suffer from severe health ailments due to cooking equipment that causes unhealthy doses of (household) air pollution. Many attempts to address this have fallen short because technology was not improved sufficiently or the way it was introduced constituted an ill fit with the broader "cooking eco-system". In terms of technology, (biomass) gasifier stoves look promising on all three sustainability dimensions (people, planet, profit) but have not been adopted on a substantial scale across cultures and regions either. We therefore used a design approach that takes multiple contexts (target groups) into account and compared the performance of a gasifier stove that was developed following this multi-context approach with four previous gasifier versions. With the comparative assessment using criteria well beyond mere technological performance we found that it performed better than these versions as well as than what could be expected based on historical learning, while providing additional systemic advantages. These results encourage verification of the value of the multi-context approach in more settings while providing clues for refinement of the assessment method

An automated slide scanning system for membrane filter imaging in diagnosis of urogenital schistosomiasis

Traditionally, automated slide scanning involves capturing a rectangular grid of field-of-view (FoV) images which can be stitched together to create whole slide images, while the autofocusing algorithm captures a focal stack of images to determine the best in-focus image. However, these methods can be time-consuming due to the need for X-, Y- and Z-axis movements of the digital microscope while capturing multiple FoV images. In this paper, we propose a solution to minimise these redundancies by presenting an optimal procedure for automated slide scanning of circular membrane filters on a glass slide. We achieve this by following an optimal path in the sample plane, ensuring that only FoVs overlapping the filter membrane are captured. To capture the best in-focus FoV image, we utilise a hill-climbing approach that tracks the peak of the mean of Gaussian gradient of the captured FoVs images along the Z-axis. We implemented this procedure to optimise the efficiency of the Schistoscope, an automated digital microscope developed to diagnose urogenital schistosomiasis by imaging Schistosoma haematobium eggs on 13 or 25 mm membrane filters. Our improved method reduces the automated slide scanning time by 63.18% and 72.52% for the respective filter sizes. This advancement greatly supports the practicality of the Schistoscope in large-scale schistosomiasis monitoring and evaluation programs in endemic regions. This will save time, resources and also accelerate generation of data that is critical in achieving the targets for schistosomiasis elimination

Developing inclusive digital health diagnostic for schistosomiasis: a need for guidance via target product profiles

IntroductionThe INSPIRED project aims to develop inclusive Digital Optical Diagnostic Devices (DODDs) for schistosomiasis, to support disease management by enabling rapid diagnostic results, to improve efficient data management to guide decision-making and to provide healthcare workers with critical health information to facilitate follow-up action. Due to the non-availability of Target Product Profiles (TPPs) for guiding the development of digital diagnostics for schistosomiasis, we explored existing diagnostic TPPs.MethodsUsing a curated open access database (Notion database), we studied a selection of TPPs for diagnosing infectious diseases, focusing on specifications related to digital health products for Neglected Tropical Diseases (NTDs).ResultsEighteen TPPs originating from 12 documents, covering 13 specific diseases, were selected and their characteristics were labeled and entered into the database. Further exploration of the database revealed several gaps, including a lack of stakeholder input, sustainability, and TPP availability. Other significant gaps related to digital health platform interconnectivity and data stewardship specifically in relation to digital diagnostics, including DODDs.DiscussionThese findings reflect two possible scenarios: (1) there is currently no need for digital diagnostic devices for schistosomiasis and, by extension for other NTDs; or (2) those needs are not yet covered by TPPs. Therefore, we recommend that digital health diagnostics are included in the use cases for schistosomiasis control and elimination, at least in the ideal/desirable scenario, as this will guide research and incentivize investment in digital health diagnostics for schistosomiasis

Leveraging Tensions in Systemic Design

Complex systems do not lend themselves to simplification. Systemic designers have no choice but to embrace complexity, and in doing so, embrace opposing concepts and the resulting paradoxes. It is at the interplay of these ideas that they find the most fruitful regions of exploration. Within the field of systemic design, we find tensions between the positions that different practitioners and scholars take and the methods, practices and ideas they promote. Rather than viewing these differences as problems that need resolving, we see those tensions and differences in perspectives and ideas as opportunities to develop the field. Examples of tensions are: - Humanizing systems versus technical systems solutions - The do-ers/ entrepreneurs versus the thinkers/ philosophers in systemic design - Bottom-up system innovation versus top-down system innovation - The need for predictability and structure versus the need for surprise and emergence - Western ways of systems thinking versus indigenous, Eastern and other ways of systems thinking The goal of this workshop is to explore the tensions that exist in the field of systemic design and the ways they can be leveraged to develop the field

Two-stage automated diagnosis framework for urogenital schistosomiasis in microscopy images from low-resource settings

Purpose Automated diagnosis of urogenital schistosomiasis using digital microscopy images of urine slides is an essential step toward the elimination of schistosomiasis as a disease of public health concern in Sub-Saharan African countries. We create a robust image dataset of urine samples obtained from field settings and develop a two-stage diagnosis framework for urogenital schistosomiasis. Approach Urine samples obtained from field settings were captured using the Schistoscope device, and S. haematobium eggs present in the images were manually annotated by experts to create the SH dataset. Next, we develop a two-stage diagnosis framework, which consists of semantic segmentation of S. haematobium eggs using the DeepLabv3-MobileNetV3 deep convolutional neural network and a refined segmentation step using ellipse fitting approach to approximate the eggs with an automatically determined number of ellipses. We defined two linear inequality constraints as a function of the overlap coefficient and area of a fitted ellipses. False positive diagnosis resulting from over-segmentation was further minimized using these constraints. We evaluated the performance of our framework on 7605 images from 65 independent urine samples collected from field settings in Nigeria, by deploying our algorithm on an Edge AI system consisting of Raspberry Pi + Coral USB accelerator. Result The SH dataset contains 12,051 images from 103 independent urine samples and the developed urogenital schistosomiasis diagnosis framework achieved clinical sensitivity, specificity, and precision of 93.8%, 93.9%, and 93.8%, respectively, using results from an experienced microscopist as reference. Conclusion Our detection framework is a promising tool for the diagnosis of urogenital schistosomiasis as our results meet the World Health Organization target product profile requirements for monitoring and evaluation of schistosomiasis control programs

System Design For Sustainable Energy For All. A new knowledge base and know-how developed within the LeNSes European and African project

This paper presents the results of the Learning Network on Sustainable Energy Systems (LeNSes) an African-European multi-polar network for curriculum development on Design for Sustainability (DfS) focused on Distributed Renewable Energy (DRE) and Sustainable Product-Service Systems (S.PSS), i.e. System Design for Sustainable Energy for All (SD4SEA). The project has been funded by the European Union (EU) 2013-2016, Edulink Programme and involves four African and three European universities offering design-specific programmes of study. The results are articulated in knowledge-base and know-how outcomes. Regarding knowledge level the paper highlights the design role within the framework of the S.PSS applied to DRE and how they can be used to develop and implement sustainable energy solutions for all in the African, or more in general low and middle-income context. The discussion is supported by the presentation of projects shaped in the courses regarding sustainable energy product service systems involving for example cooking, mobility, lighting, and healthcare. The United Nations’ Global Action Agenda [1] highlights indeed action areas for the achievement of long-term sustainable development as Modern Cooking Appliances & Fuels, Distributed Electricity Solutions, Grid Infrastructure & Supply Efficiency, Large Scale Renewable Power, Industrial & Agricultural Processes, Transportation, Buildings & Appliances. From the know-how (design methods and support tools) point of view they consist in a new modular and adaptable package of learning resources focused on System Design for Sustainable Energy for All (SD4SEA); in pilot courses at African Higher Educational Institutions (HEIs) targeted at undergraduate and graduate students, practitioners and companies; and in an open web platform for distributed production and transfer of learning resources (lectures, tools, case studies, student projects…) in this area