The Development of a Mobile Application to Support Peripheral Health Workers to Diagnose and Treat People with Skin Diseases in Resource-Poor Settings.

Liesbeth Mieras,Colette Van Hees,Alcino Ndeve,Erik Post,Anna Taal

doi:10.3390/tropicalmed3030102

Liesbeth Mieras, Colette Van Hees + Show 3 more

Open Access

https://doi.org/10.3390/tropicalmed3030102

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Abstract

The high prevalence of skin diseases in resource-poor settings, where health workers with sufficient knowledge of skin diseases are scarce, calls for innovative measures. Timely diagnosis and treatment of skin diseases, especially neglected tropical diseases (NTDs) that manifest with skin lesions, such as leprosy, is crucial to prevent disabilities as well as psychological and socioeconomic problems. Innovative technological methods like telemedicine and mobile health (mHealth) can help to bridge the gap between the burden of skin diseases and the lack of capable staff in resource-poor settings by bringing essential health services from central level closer to peripheral levels. Netherlands Leprosy Relief (NLR) has developed a mobile phone application called the ‘SkinApp’, which aims to support peripheral health workers to recognize the early signs and symptoms of skin diseases, including skin NTDs, and to start treatment promptly or refer for more advanced diagnostic testing or disease management when needed. Further research is needed to determine how greatly mHealth in general and the SkinApp in particular can contribute to improved health outcomes, efficiency, and cost-effectiveness.

Highlights

Diagnosis and treatment can prevent permanent disabilities, but skin neglected tropical diseases (NTDs) are usually not the most prevalent skin diseases, and are more likely to be missed by health workers with limited or no dermatology training
Agarwal et al conducted a systematic review entitled ‘Evidence on feasibility and effective use of mobile health (mHealth) strategies by frontline health workers in developing countries’ [17]. They found that mHealth strategies for peripheral health workers in low-resource countries are potentially an effective means to promote the shifting of essential health services to peripheral levels
What is not known about mHealth strategies is whether they contribute to improved health outcomes, efficiency, or cost-effectiveness

Summary

Epidemiology of Skin Diseases in Low- and Middle-Income Countries

It is known that skin diseases are highly prevalent, in resource-poor areas, where children are disproportionally affected—though there is a lack of systematically-collected data supporting this [1,2]. Neglected topical diseases (NTDs) that manifest in skin lesions like leprosy and lymphatic filariasis (see Table 1) are among the skin diseases that often cause disabilities such as permanent wounds, contractures, and advanced lymphedema. Diagnosis and treatment can prevent permanent disabilities, but skin NTDs are usually not the most prevalent skin diseases, and are more likely to be missed by health workers with limited or no dermatology training. Skin conditions are usually not fatal, but it is important to recognize those that may be, such as blistering diseases. They can be a sign of an underlying medical condition that might be life-threatening, such as HIV/AIDS. In view of the HIV/AIDS epidemic, the importance of dermatology cannot be underestimated, as 90% of HIV/AIDS patients develop a skin problem (see Table 1) during the course of their illness, and often initially present with a skin condition [4]

Psycological and Socioeconomic Burden

Capacity Gap

Technologies to Support Dermatology Services

Development of NLR SkinApp

Findings

Discussion and Conclusions