Development and Initial Validation of a Frontline Health Worker mHealth Assessment Platform (MEDSINC®) for Children 2-60 Months of Age.

Barry A Finette,Kazi Asadur Rahman,Samuel V Scarpino,Barry Heath,Denis Muhoza,Edy Quizhpe,Marisol Bahamonde,Salvator Nibitanga,Eric Swedberg,John Canning,Megan Mclaughlin,Awa Seck,Hosneara Khondker,Michelle Grunauer,Enrique Teran,Rashed Shah,Ituki Chakma,Assiatta Kabore

doi:10.4269/ajtmh.18-0869

Abstract

.Approximately 3 million children younger than 5 years living in low- and middle-income countries (LMICs) die each year from treatable clinical conditions such as pneumonia, dehydration secondary to diarrhea, and malaria. A majority of these deaths could be prevented with early clinical assessments and appropriate therapeutic intervention. In this study, we describe the development and initial validation testing of a mobile health (mHealth) platform, MEDSINC®, designed for frontline health workers (FLWs) to perform clinical risk assessments of children aged 2–60 months. MEDSINC is a web browser–based clinical severity assessment, triage, treatment, and follow-up recommendation platform developed with physician-based Bayesian pattern recognition logic. Initial validation, usability, and acceptability testing were performed on 861 children aged between 2 and 60 months by 49 FLWs in Burkina Faso, Ecuador, and Bangladesh. MEDSINC-based clinical assessments by FLWs were independently and blindly correlated with clinical assessments by 22 local health-care professionals (LHPs). Results demonstrate that clinical assessments by FLWs using MEDSINC had a specificity correlation between 84% and 99% to LHPs, except for two outlier assessments (63% and 75%) at one study site, in which local survey prevalence data indicated that MEDSINC outperformed LHPs. In addition, MEDSINC triage recommendation distributions were highly correlated with those of LHPs, whereas usability and feasibility responses from LHP/FLW were collectively positive for ease of use, learning, and job performance. These results indicate that the MEDSINC platform could significantly increase pediatric health-care capacity in LMICs by improving FLWs’ ability to accurately assess health status and triage of children, facilitating early life-saving therapeutic interventions.

Highlights

In 2016, the World Health Organization (WHO) and United Nationals Children’s Fund (UNICEF) estimated that 99% of all deaths of children younger than 5 years, approximately 5.6 million, occurred in low- and middle-income countries (LMICs).[1]
With respect to the four clinical severity assessments, we observed between 82% and 97% correlation between frontline health workers (FLWs)-generated MEDSINC assessments and those generated by local health-care professionals (LHPs)
Quality point-of-care mobile health (mHealth) technology would provide a key tool for expanding health-care access, especially in LMICs, by assisting FLWs with identifying patients who are sick, leading to appropriate triage and facilitating early lifesaving therapeutic interventions

Summary

Introduction

In 2016, the World Health Organization (WHO) and United Nationals Children’s Fund (UNICEF) estimated that 99% of all deaths of children younger than 5 years, approximately 5.6 million, occurred in low- and middle-income countries (LMICs).[1]. A majority of these deaths could be prevented with early clinical risk assessments and appropriate basic therapeutic intervention.[2] access to quality health care in LMICs is significantly restricted because of a growing shortage of health-care professionals per population and limitations on health-care delivery infrastructure. The WHO recommends a minimum density threshold of 44.5 skilled health professionals/10,000 people to provide basic health coverage.[3] Presently, 83 countries fall below this threshold, and it is estimated that 40–50 million new health workers will need to be trained by 2030 to attain an effective range of primary care services to ensure quality health-care delivery.[3]

Methods

Results

Conclusion