Abstract
BackgroundMobile health (mHealth) technologies hold incredible promise to improve healthcare delivery in resource-limited settings. Network reliability across large catchment areas can be a major challenge. We performed an analysis of network failure frequency as part of a study of real-time adherence monitoring in rural Uganda. We hypothesized that the addition of short messaging service (SMS+GPRS) to the standard cellular network modality (GPRS) would reduce network disruptions and improve transmission of data.MethodsParticipants were enrolled in a study of real-time adherence monitoring in southwest Uganda. In June 2011, we began using Wisepill devices that transmit data each time the pill bottle is opened. We defined network failures as medication interruptions of >48 hours duration that were transmitted when network connectivity was re-established. During the course of the study, we upgraded devices from GPRS to GPRS+SMS compatibility. We compared network failure rates between GPRS and GPRS+SMS periods and created geospatial maps to graphically demonstrate patterns of connectivity.ResultsOne hundred fifty-seven participants met inclusion criteria of seven days of SMS and seven days of SMS+GPRS observation time. Seventy-three percent were female, median age was 40 years (IQR 33–46), 39% reported >1-hour travel time to clinic and 17% had home electricity. One hundred one had GPS coordinates recorded and were included in the geospatial maps. The median number of network failures per person-month for the GPRS and GPRS+SMS modalities were 1.5 (IQR 1.0–2.2) and 0.3 (IQR 0–0.9) respectively, (mean difference 1.2, 95%CI 1.0–1.3, p-value<0.0001). Improvements in network connectivity were notable throughout the region. Study costs increased by approximately $1USD per person-month.ConclusionsAddition of SMS to standard GPRS cellular network connectivity can significantly reduce network connection failures for mobile health applications in remote areas. Projects depending on mobile health data in resource-limited settings should consider this upgrade to optimize mHealth applications.
Highlights
Cellular phone access in sub-Saharan Africa increased from approximately 5 to 70% during 2000 to 2008, to reach over 380 million users [1,2]
The devices transmit a standard general packet radio service (GPRS) cell phone message via the cellular phone network to a server hosted in South Africa each time the pill bottle is opened [5]
Statistical Methods Uganda AIDS Rural Treatment Outcomes Study (UARTO) participants were included in network connectivity analysis if they had received a Wisepill device and had a minimum of seven days of GPRS and seven days of GPRS+SMS observation time
Summary
Cellular phone access in sub-Saharan Africa increased from approximately 5 to 70% during 2000 to 2008, to reach over 380 million users [1,2]. The widespread ownership of cellular phones and corresponding wireless network infrastructure enable public health programs to leverage mobile health (mHealth) technologies, with a goal of improving health care monitoring and delivery in resource-limited settings via real-time communication across large catchment areas. There has been an international effort to coordinate the design, testing, and implementation of novel health devices in low and middle-income countries [3,4]. Successes from these technologies have included drug adherence monitoring [5,6], strengthening of patient provider communication [7,8], and improved healthcare quality control [9]. We hypothesized that the addition of short messaging service (SMS+GPRS) to the standard cellular network modality (GPRS) would reduce network disruptions and improve transmission of data
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