A user-centred evaluation of a mobile phone-based interactive voice response system to support infectious disease surveillance and access to healthcare for sick children in Ghana: users’ experiences, challenges and opportunities for large-scale application. Part of a concept and pilot study for mobile phone-based Electronic Health Information and Surveillance System (eHISS) for Africa

Brinkel J. A user-centred evaluation of a mobile phone-based interactive voice response system to support infectious disease surveillance and access to healthcare for sick children in Ghana: users’ experiences, challenges and opportunities for large-scale application. Part of a concept and pilot study for mobile phone-based Electronic Health Information and Surveillance System (eHISS) for Africa. Bielefeld: Universität Bielefeld; 2020.Digital Health offers tremendous potential to change the face of health systems in all countries. Although the application of digital technologies in the health sector has become central to global health thinking, various implementation barriers still exist. One of the most significant is the process of user acceptance and adoption of new interventions, which still remains a neglected research area in sub-Saharan Africa. The synopsis is a synthesis of the findings of a three-year research study embedded within a larger research consortium that developed and piloted a mobile phone-based Electronic Health Information and Surveillance System for sub-Saharan Africa (eHISS) in Ghana. The system aimed to support sick children to assess the disease severity, to advice appropriate treatment and to collect data on the occurrence of symptom clusters. The thesis evaluated the usability and acceptance among users of the mobile health (mHealth) system (caregivers of children) by soliciting their views on their experiences while using the system. The doctoral thesis followed a human-centred design (HCD) circle and consisted of the following research activities; (i) the assessment of the state of research, (ii) the innovative field test of a prototype of the eHISS system and an assessment of users’ needs to drive the design, (iii) the evaluation of the clinical decision algorithm as backbone of the electronic system and (iv) the evaluation of experiences with the system after a six-month pilot phase of the system. A manuscript was developed from each research activity for publication, thus making a total of four papers that form the empirical basis of this thesis. Results showed that users are generally open to mHealth and interested in new technologies, and comprehensive knowledge on critical factors favouring and disfavouring the integration of the system in the daily life of participants, and suggestions on how the system could be improved has been gained. The thesis thus confirmed and highlighted the key role of user experiences in the design process of new mHealth approaches, and provided insights on how to develop and evaluate mobile health approaches from the user perspective. Based on the results of the user evaluation, two possible directions for the future of eHISS have been developed. We further conclude that programs and initiatives must be guided by robust strategies to overcome existing barriers for implementation. Like all digital health interventions, the presented eHISS system is not a silver bullet and has significant limitations, but taking the requirements discussed in the thesis into consideration we believe that systems developed based on the eHISS experiences in future can make a real impact on health service delivery and disease response

Fighting Antimicrobial Resistance:Development and Implementation of the Ghanaian National Action Plan (2017-2021)

In recent years, Ghana has been recognised as a leading player in addressing antimicrobial resistance (AMR) in Africa. However, based on our literature review, we could not ascertain whether the core elements of the national action plan (NAP) were implemented in practice. In this paper, we present a qualitative analysis of the development of AMR-related policies in Ghana, including the NAP. We conducted 13 semi-structured expert interviews to obtain at a more thorough understanding of the implementation process for the AMR NAP and to highlight its accomplishments and shortcomings. The results show that AMR policies, as embodied in the NAP, have led to an extended network of cooperation between stakeholders in many political fields. Broadly, limited allocation of financial resources from the government and from international cooperation have been deplored. Furthermore, the opportunity for using the NAP in mainstreaming the response to the threat of AMR has not been seized. To the general public, this remained hidden behind a number of other relevant health topics such as infection prevention, veterinary services and pharmaceutical regulation. As a One Health (OH) challenge, developing countries could integrate AMR NAPs into other health and environmental programmes to improve its implementation in practice

Feasibility of Electronic Health Information and Surveillance System (eHISS) for disease symptom monitoring: A case of rural Ghana.

The current surge of mobile phone use in many African countries creates the opportunity to provide caregivers with limited access to the health care system with vital health recommendations. At the same time such communication system can be utilised to collect tempero-spatial data on disease symptoms

A Systematic Review of Arsenic Exposure and Its Social and Mental Health Effects with Special Reference to Bangladesh

Underground water in many regions of the world is contaminated with high concentrations of arsenic and the resulting toxicity has created a major environmental and public health problem in the affected regions. Chronic arsenic exposure can cause many diseases, including various physical and psychological harms. Although the physical problems caused by arsenic toxicity are well reported in literature, unfortunately the consequences of arsenic exposure on mental health are not adequately studied. Therefore we conducted a review of the available literature focusing on the social consequences and detrimental effects of arsenic toxicity on mental health. Chronic arsenic exposures have serious implications for its victims (i.e. arsenicosis patients) and their families including social instability, social discrimination, refusal of victims by community and families, and marriage-related problems. Some studies conducted in arsenic affected areas revealed that arsenic exposures are associated with various neurologic problems. Chronic arsenic exposure can lead to mental retardation and developmental disabilities such as physical, cognitive, psychological, sensory and speech impairments. As health is defined by the World Health Organization as “a state of complete physical, mental and social wellbeing”, the social dimensions have a large impact on individual’s mental health. Furthermore studies in China und Bangladesh have shown that mental health problems (e.g. depression) are more common among the people affected by arsenic contamination. Our study indicates various neurological, mental and social consequences among arsenic affected victims. Further studies are recommended in arsenic-affected areas to understand the underlying mechanisms of poor mental health caused by arsenic exposure

Mobile Phone-Based mHealth Approaches for Public Health Surveillance in Sub-Saharan Africa: A Systematic Review

Whereas mobile phone-based surveillance has the potential to provide real-time validated data for disease clustering and prompt respond and investigation, little evidence is available on current practice in sub-Sahara Africa. The objective of this review was to examine mobile phone-based mHealth interventions for Public Health surveillance in the region. We conducted electronic search in MEDLINE, EMBASE, IEE Xplore, African Index Medicus (AIM), BioMed Central, PubMed Central (PMC), the Public Library of Science (PLoS) and IRIS for publications used in the review. In all, a total of nine studies were included which focused on infectious disease surveillance of malaria (n = 3), tuberculosis (n = 1) and influenza-like illnesses (n = 1) as well as on non-infectious disease surveillance of child malnutrition (n = 2), maternal health (n = 1) and routine surveillance of various diseases and symptoms (n = 1). Our review revealed that mobile phone-based surveillance projects in the sub-Saharan African countries are on small scale, fragmented and not well documented. We conclude by advocating for a strong drive for more research in the applied field as well as a better reporting of lessons learned in order to create an epistemic community to help build a more evidence-based field of practice in mHealth surveillance in the region

Mobile Phone-Based mHealth Approaches for Public Health Surveillance in Sub-Saharan Africa: A Systematic Review

Brinkel J, Krämer A, Krumkamp R, May J, Fobil J. Mobile Phone-Based mHealth Approaches for Public Health Surveillance in Sub-Saharan Africa: A Systematic Review. International Journal of Environmental Research and Public Health. 2014;11(11):11559-11582.Whereas mobile phone-based surveillance has the potential to provide real-time validated data for disease clustering and prompt respond and investigation, little evidence is available on current practice in sub-Sahara Africa. The objective of this review was to examine mobile phone-based mHealth interventions for Public Health surveillance in the region. We conducted electronic search in MEDLINE, EMBASE, IEE Xplore, African Index Medicus (AIM), BioMed Central, PubMed Central (PMC), the Public Library of Science (PLoS) and IRIS for publications used in the review. In all, a total of nine studies were included which focused on infectious disease surveillance of malaria (n = 3), tuberculosis (n = 1) and influenza-like illnesses (n = 1) as well as on non-infectious disease surveillance of child malnutrition (n = 2), maternal health (n = 1) and routine surveillance of various diseases and symptoms (n = 1). Our review revealed that mobile phone-based surveillance projects in the sub-Saharan African countries are on small scale, fragmented and not well documented. We conclude by advocating for a strong drive for more research in the applied field as well as a better reporting of lessons learned in order to create an epistemic community to help build a more evidence-based field of practice in mHealth surveillance in the region

Digital Technologies to Enhance Infectious Disease Surveillance in Tanzania: A Scoping Review

Mobile phones and computer-based applications can speed up disease outbreak detection and control. Hence, it is not surprising that stakeholders in the health sector are becoming more interested in funding these technologies in Tanzania, Africa, where outbreaks occur frequently. The objective of this situational review is, therefore, to summarize available literature on the application of mobile phones and computer-based technologies for infectious disease surveillance in Tanzania and to inform on existing gaps. Four databases were searched—Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase), PubMed, and Scopus—yielding a total of 145 publications. In addition, 26 publications were obtained from the Google search engine. Inclusion and exclusion criteria were met by 35 papers: they described mobile phone-based and computer-based systems designed for infectious disease surveillance in Tanzania, were published in English between 2012 and 2022, and had full texts that could be read online. The publications discussed 13 technologies, of which 8 were for community-based surveillance, 2 were for facility-based surveillance, and 3 combined both forms of surveillance. Most of them were designed for reporting purposes and lacked interoperability features. While undoubtedly useful, the stand-alone character limits their impact on public health surveillance

An investigation of users’ attitudes, requirements and willingness to use mobile phone-based interactive voice response systems for seeking healthcare in Ghana: a qualitative study

Brinkel J, Dako-Gyeke P, Krämer A, May J, Fobil JN. An investigation of users’ attitudes, requirements and willingness to use mobile phone-based interactive voice response systems for seeking healthcare in Ghana: a qualitative study. Public Health. 2017;144:125-133