Smartphone Use for Cervical Cancer Screening in Low-Resource Countries: A Pilot Study Conducted in Madagascar.

Visual inspection of the cervix after application of 5% acetic acid (VIA) is a screening technique for cervical cancer used widely in low and middle-income countries (LMIC). To improve VIA screening performance, digital images after acid acetic application (D-VIA) are taken. The aim of this study was to evaluate the use of a smartphone for on- and off-site D-VIA diagnosis.Women aged 30-65 years, living in the city of Ambanja, Madagascar, were recruited through a cervical cancer screening campaign. Each performed a human papillomavirus (HPV) self-sample as a primary screen. Women testing positive for HPV were referred for VIA followed by D-VIA, cervical biopsy and endocervical curettage according to routine protocol. In addition, the same day, the D-VIA was emailed to a tertiary care center for immediate assessment. Results were scored as either D-VIA normal or D-VIA abnormal, requiring immediate therapy or referral to a tertiary center. Each of the three off-site physicians were blinded to the result reported by the one on-site physician and each gave their individual assessment followed by a consensus diagnosis. Statistical analyses were conducted using STATA software.Of the 332 women recruited, 137 (41.2%) were HPV-positive and recalled for VIA triage; compliance with this invitation was 69.3% (n = 95). Cervical intraepithelial neoplasia was detected in 17.7% and 21.7% of digital images by on-site and off-site physicians, respectively. The on-site physician had a sensitivity of 66.7% (95%CI: 30.0-90.3) and a specificity of 85.7% (95%CI: 76.7-91.6); the off-site physician consensus sensitivity was 66.7% (95%CI: 30.0-90.3) with a specificity of 82.3% (95%CI: 72.4-89.1).This pilot study supports the use of telemedicine for off-site diagnosis of cervical intraepithelial neoplasia, with diagnostic performance similar to those achieved on-site. Further studies need to determine if smartphones can improve cervical cancer screening efficiency in LMIC

Usability and feasibility of a mobile health system to provide comprehensive antenatal care in low-income countries: PANDA mHealth pilot study in Madagascar

Background Madagascar's maternal health mortality ratio in 2013 was 478 deaths per 100,000 live births. Most deaths are related to direct complications during pregnancy and childbirth and could be reduced by providing comprehensive antenatal care (ANC). Objective The objective of the study was to assess the usability and feasibility of a mobile health system (mHealth) to provide high-quality ANC, according to World Health Organization (WHO) recommendations. Methods PANDA (Pregnancy And Newborn Diagnostic Assessment) is an easy-to-use mHealth system that uses affordable communications technology to support diagnosis and health care worker decision-making regarding ANC. From January to March 2015, a cross-sectional pilot study was conducted in Ambanja District, Madagascar, in which ANC using PANDA was provided to 100 pregnant women. The collected data were transmitted to a database in the referral hospital to create individual electronic patient records. Accuracy and completeness of the data were closely controlled. The PANDA software was assessed and the number of abnormal results, treatments performed, and participants requiring referral to health care facilities were monitored. Results The PANDA system facilitated creation of individual electronic patient records that included socio-demographic and medical data for 100 participants. Duration of ANC visits averaged 29.6 min. Health care providers were able to collect all variables (100%) describing personal and medical data. No major technical problems were encountered and no data were lost. During 17 ANC visits (17%), an alert function was generated to highlight abnormal clinical results requiring therapy or referral to an affiliated hospital. Participants' acceptability of the system was very high. Conclusion This pilot study proved the usability and feasibility of the PANDA mHealth system to conduct complete and standardised ANC visits according to WHO guidelines, thus providing a promising solution to increase access to high-quality and standardised ANC for pregnant women in remote areas

Cross-sectional survey of knowledge of obstetric danger signs among women in rural Madagascar

Antenatal care (ANC) has the potential to identify and manage obstetric complications, educate women about risks during pregnancy and promote skilled birth attendance during childbirth. The aim of this study was to assess women's knowledge of obstetric danger signs and factors associated with this knowledge in Ambanja, Madagascar. It also sought to evaluate whether the participation in a mobile health (mHealth) project that aimed to provide comprehensive ANC to pregnant women in remote areas influenced women's knowledge of obstetric danger signs

Use of Smartphones as Adjuvant Tools for Cervical Cancer Screening in Low-Resource Settings

Our aim was to evaluate the feasibility and performance of smartphone digital images for the detection of cervical intraepithelial neoplasia of grade 2 or worse (CIN2+) as an adjunct to a conventional visual inspection approach with acetic acid (VIA) and Lugol's iodine (VILI), in comparison with detection by histopathologic examination

Additional file 1: of Cross-sectional survey of knowledge of obstetric danger signs among women in rural Madagascar

RENY_QuestionnaireFR (DOCX 118 kb

Additional file 1: of Cross-sectional survey of knowledge of obstetric danger signs among women in rural Madagascar

RENY_QuestionnaireFR (DOCX 118 kb

Sample sociodemographic characteristics and past obstetric and gynecological history (n = 95)^*

<p>Abbreviations: IQR = interquartile range; N. = number; sd = standard deviation; y = years.</p><p>*Some information from the 95 participants is missing</p><p>Sample sociodemographic characteristics and past obstetric and gynecological history (n = 95)^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134309#t001fn002" target="_blank">*</a>}</p

Sensitivity and specificity of VIA combined with VILI.

<p>Abbreviations: CI = Confidence interval; PPV = Positive Predictive Value; NPV = Negative Predictive Value.</p><p>Sensitivity and specificity of VIA combined with VILI.</p

Sample analysis results by pathological histology and their diagnosis and treatment on site.

<p>*CIN1, cervical intraepithelial neoplasia grade 1; CIN2, cervical intraepithelial neoplasia grade 2; CIN3, cervical intraepithelial neoplasia grade 3; CA INV, invasive carcinoma: Electroag. = Electrocoagulation; Hist. = Histology; Hysterect. = Hysterectomy</p><p>** Patient didn't show up for follow-up or refused treatment</p><p>*** Diagnosis N°1, diagnosed on photo by specialist N°1; Diagnosis N°2, diagnosed on photo by specialist N°2; Diagnosis N°3, diagnosed on photo by specialist N°3.</p><p>Sample analysis results by pathological histology and their diagnosis and treatment on site.</p

Knowledge, awareness and history of cervical cancer and screening (n = 95)

<p>Abbreviations: IQR = interquartile range; N. = number; sd = standard deviation; y = years.</p><p>Knowledge, awareness and history of cervical cancer and screening (n = 95)</p