Reducing Under-five Childhood Mortality using IMCI/e-IMCI: Implementation Approaches in Nigeria

To address the global issue of healthcare disparity and access to care, particularly in children under-five years of age, Integrated Management of Childhood Illness (IMCI) was put in place by WHO and UNICEF. To address poor adherence to IMCI that affects Under-five Mortality Rates (U5MRs), e-IMCI was introduced 1. With its three components: improvement of case management skills of health-care staff, overall health systems, and family and community health practices, IMCI/e-IMCI targets under-five children’s health with a holistic approach 2. While IMCI/e-IMCI helps to provide quality care, save cost and potentially time, inadequate healthcare providers’ training remains a primary challenge to the quality of implementation at the global level especially in lower-middle income countries like Nigeria. This paper presents the barriers to IMCI/e-IMCI from the policy makers, health workers and patient standpoint in Nigeria. Also, the paper elaborates on various implementation approaches to address these barriers in the context of the Nigerian health care system.Master of Public Healt

Mobile Health Technology in Developing Countries: The Case of Tanzania

Mobile technology is one of the fastest growing industries. In rural parts of the world, mobile phones are more accessible than sanitation facilities and electricity. Mobile phones can be used to transmit health information, promote health awareness, track the spread of diseases, and ultimately decrease the prevalence of diseases. In particular, this study focuses on how mobile health technology, m-health, can reduce the spread of HIV/AIDS and malaria in Tanzania

Disease surveillance and patient care in remote regions: an exploratory study of collaboration among healthcare professionals in Amazonia

The development and deployment of information technology, particularly mobile tools, to support collaboration between different groups of healthcare professionals has been viewed as a promising way to improve disease surveillance and patient care in remote regions. The effects of global climate change combined with rapid changes to land cover and use in Amazonia are believed to be contributing to the spread of vector-borne emerging and neglected diseases. This makes empowering and providing support for local healthcare providers all the more important. We investigate the use of information technology in this context to support professionals whose activities range from diagnosing diseases and monitoring their spread to developing policies to deal with outbreaks. An analysis of stakeholders, their roles and requirements, is presented which encompasses results of fieldwork and of a process of design and prototyping complemented by questionnaires and targeted interviews. Findings are analysed with respect to the tasks of diagnosis, training of local healthcare professionals, and gathering, sharing and visualisation of data for purposes of epidemiological research and disease surveillance. Methodological issues regarding the elicitation of cooperation and collaboration requirements are discussed and implications are drawn with respect to the use of technology in tackling emerging and neglected diseases

Μελέτη και καταγραφή των μεθόδων ιατρικής συμμόρφωσης και στατιστική ανάλυση του επιπέδου συμμόρφωσης των ασθενών μέσω mobile εφαρμογών

149 σ.Η παρούσα διπλωματική έχει ως στόχο να παρουσιάσει αρχικά την έννοια της "κινητής" υγείας (mobile health), καθώς και βασικές έννοιες και τεχνολογίες που συνδέονται με αυτήν. Θα αναλυθεί η σχέση της με τη βελτίωση της ποιότητας της υγείας και ειδικότερα με τη φαρμακευτική συμμόρφωση των ασθενών μέσω εφαρμογών (mobile applications) που έχουν αναπτυχθεί για έξυπνα τηλέφωνα (smartphones). Θα γίνει μια εκτενής αναφορά σε προγράμματα mHealth που έχουν πραγματοποιηθεί σε χώρες του αναπτυσσόμενου κόσμου, εστιάζοντας στα τεχνολογικά μέσα με τα οποία υλοποιήθηκαν όπως επίσης και στο σκοπό για τον οποίο έγιναν και στα αποτελέσματα που επέφερε η εφαρμογή τους. Πέρα από αυτές τις αναφορές, θα δοθεί ιδιαίτερη βαρύτητα στην έννοια της φαρμακευτικής συμμόρφωσης και τις παραμέτρους που σχετίζονται με αυτήν. Θα πραγματοποιηθεί μελέτη των σχετικών εφαρμογών για κινητά και λεπτομερής στατιστική ανάλυση των χαρακτηριστικών και των αποτελεσμάτων τους. Θα αξιολογηθούν οι εφαρμογές αυτές ως προς το επίπεδο συμμόρφωσης που κρίνεται ότι προσφέρουν ώστε να αναδυθούν οι καλύτερες και επικρατέστερες εφαρμογές και θα συγκριθούν μεταξύ τους ενδελεχώς προκειμένου να καταγραφούν τα πλεονεκτήματα και οι ελλείψεις που έχουν.The present thesis aims at first to present the meaning of mobile health, as well as the principles and the technologies which are related with it. We analyze mobile health's relation with the enhancement of the quality health level and especially with the patients' medication adherence through mobile applications for smartphones. We make an extensive report to mHealth projects which have been made in developing countries and we focus on the technological means which were used for it, as well as on the purpose for which the projects were made and on their outcome. Apart from these reports, we pay great attention to the meaning of medication adherence and its related parametres. We study relative mobile applications and we make a detailed statistical analysis of their characteristics and results. We rate these apps according to their offered compliance level, in order to present the best and most well-known apps. We compare the apps with each other in order to record their advantages and their lack of functionality which they probably have.Πέτρου Μαρί

Global challenges with scale-up of the integrated management of childhood illness strategy: results of a multi-country survey

<p>Abstract</p> <p>Background</p> <p>The Integrated Management of Childhood Illness Strategy (IMCI), developed by WHO/UNICEF, aims to contribute to reducing childhood morbidity and mortality (MDG4) in resource-limited settings. Since 1996 more than 100 countries have adopted IMCI. IMCI case management training (ICMT) is one of three IMCI components and training is usually residential over 11 consecutive days. Follow-up after ICMT is an essential part of training. We describe the barriers to rapid acceleration of ICMT and review country perspectives on how to address these barriers.</p> <p>Methods</p> <p>A multi-country exploratory cross-sectional questionnaire survey of in-service ICMT approaches, using quantitative and qualitative methods, was conducted in 2006-7: 27 countries were purposively selected from all six WHO regions. Data for this paper are from three questionnaires (QA, QB and QC), distributed to selected national focal IMCI persons/programme officers, course directors/facilitators and IMCI trainees respectively. QC only gathered data on experiences with IMCI follow-up.</p> <p>Results</p> <p>33 QA, 163 QB and 272 QC were received. The commonest challenges to ICMT scale-up relate to funding (high cost and long duration of the residential ICMT), poor literacy of health workers, differing opinions about the role of IMCI in improving child health, lack of political support, frequent changes in staff or rules at Ministries of Health and lack of skilled facilitators. Countries addressed these challenges in several ways including increased advocacy, developing strategic linkages with other priorities, intensifying pre-service training, re-distribution of funds and shortening course duration. The commonest challenges to <it>follow-up </it>after ICMT were lack of funding (93.1% of respondents), inadequate funds for travelling or planning (75.9% and 44.8% respectively), lack of gas for travelling (41.4%), inadequately trained or few supervisors (41.4%) and inadequate job aids for follow-up (27.6%). Countries addressed these by piggy backing IMCI follow-up with routine supervisory visits.</p> <p>Conclusions</p> <p>Financial challenges to ICMT scale-up and follow-up after training are common. As IMCI is accepted globally as one of the key strategies to meet MDG4 several steps need to be taken to facilitate rapid acceleration of ICMT, including reviewing core competencies followed by competency-driven shortened training duration or 'on the job' training, 'distance learning' or training using mobile phones. Linkages with other 'better-funded' programmes e.g. HIV or malaria need to be improved. Routine Primary Health Care (PHC) supervision needs to include follow-up after ICMT.</p

Using Electronic Technology to Improve Clinical Care -- Results from a Before-after Cluster Trial to Evaluate Assessment and Classification of Sick Children According to Integrated Management of Childhood Illness (IMCI) Protocol in Tanzania.

Poor adherence to the Integrated Management of Childhood Illness (IMCI) protocol reduces the potential impact on under-five morbidity and mortality. Electronic technology could improve adherence; however there are few studies demonstrating the benefits of such technology in a resource-poor settings. This study estimates the impact of electronic technology on adherence to the IMCI protocols as compared to the current paper-based protocols in Tanzania. In four districts in Tanzania, 18 clinics were randomly selected for inclusion. At each site, observers documented critical parts of the clinical assessment of children aged 2 months to 5 years. The first set of observations occurred during examination of children using paper-based IMCI (pIMCI) and the next set of observations occurred during examination using the electronic IMCI (eIMCI). Children were re-examined by an IMCI expert and the diagnoses were compared. A total of 1221 children (671 paper, 550 electronic) were observed. For all ten critical IMCI items included in both systems, adherence to the protocol was greater for eIMCI than for pIMCI. The proportion assessed under pIMCI ranged from 61% to 98% compared to 92% to 100% under eIMCI (p < 0.05 for each of the ten assessment items). Use of electronic systems improved the completeness of assessment of children with acute illness in Tanzania. With the before-after nature of the design, potential for temporal confounding is the primary limitation. However, the data collection for both phases occurred over a short period (one month) and so temporal confounding was expected to be minimal. The results suggest that the use of electronic IMCI protocols can improve the completeness and consistency of clinical assessments and future studies will examine the long-term health and health systems impact of eIMCI

Evaluating mobile solutions of integrated Community Case Management (iCCM): Making the final connection

No Abstrac

Human computer interaction for international development: past present and future

Recent years have seen a burgeoning interest in research into the use of information and communication technologies (ICTs) in the context of developing regions, particularly into how such ICTs might be appropriately designed to meet the unique user and infrastructural requirements that we encounter in these cross-cultural environments. This emerging field, known to some as HCI4D, is the product of a diverse set of origins. As such, it can often be difficult to navigate prior work, and/or to piece together a broad picture of what the field looks like as a whole. In this paper, we aim to contextualize HCI4D—to give it some historical background, to review its existing literature spanning a number of research traditions, to discuss some of its key issues arising from the work done so far, and to suggest some major research objectives for the future