BackgroundGiven the shortage of skilled healthcare providers in Nigeria, frontline community health extension workers (CHEWs) are commonly tasked with providing maternal and child health services at primary health centers. In 2012, we introduced a mobile case management and decision support application in twenty primary health centers in northern Nigeria, and conducted a pre-test/post-test study to assess whether the introduction of the app had an effect on the quality of antenatal care services provided by this lower-level cadre.MethodsUsing the CommCare mobile platform, the app dynamically guides CHEWs through antenatal care protocols and collects client data in real time. Thirteen health education audio clips are also embedded in the app for improving and standardizing client counseling. To detect changes in quality, we developed an evidence-based quality score consisting of 25 indicators, and conducted a total of 266 client exit interviews. We analyzed baseline and endline data to assess changes in the overall quality score as well as changes in the provision of key elements of antenatal care.ResultsOverall, the quality score increased from 13.3 at baseline to 17.2 at endline (p<0.0001), out of a total possible score of 25, with the most significant improvements related to health counseling, technical services provided, and quality of health education.ConclusionThese study results suggest that the introduction of a low-cost mobile case management and decision support application can spur behavior change and improve the quality of services provided by a lower level cadre of healthcare workers. Future research should employ a more rigorous experimental design to explore potential longer-term effects on client health outcomes.

Automated digital contact tracing is effective and efficient, and one of the non-pharmaceutical complementary approaches to mitigate and manage the epidemics like Coronavirus disease 2019 (COVID-19). Despite the advantages of digital contact tracing, it is not widely used in the western world, including the US and Europe, due to strict privacy regulations and patient rights. We categorized the current approaches for contact tracing, namely: mobile service-provider-application, mobile network operators' call detail, citizen-application, and IoT-based. Current measures for infection control and tracing do not include animals and moving objects like cars despite evidence that these moving objects can be infection carriers. In this paper, we designed and presented a novel privacy anonymous IoT model. We presented an RFID proofof-concept for this model. Our model leverages blockchain's trust-oriented decentralization for on-chain data logging and retrieval. Our model solution will allow moving objects to receive or send notifications when they are close to a flagged, probable, or confirmed diseased case, or flagged place or object. We implemented and presented three prototype blockchain smart contracts for our model. We then simulated contract deployments and execution of functions. We presented the cost differentials. Our simulation results show less than one-second deployment and call time for smart contracts, though, in real life, it can be up to 25 seconds on Ethereum public blockchain. Our simulation results also show that it costs an average of $1.95 to deploy our prototype smart contracts, and an average of $0.34 to call our functions. Our model will make it easy to identify clusters of infection contacts and help deliver a notification for mass isolation while preserving individual privacy. Furthermore, it can be used to understand better human connectivity, model similar other infection spread network, and develop public policies to control the spread of COVID-19 while preparing for future epidemics.

Background The coronavirus disease (COVID-19) pandemic is the biggest global economic and health challenge of the century. Its effect and impact are still evolving, with deaths estimated to reach 40 million if unchecked. One effective and complementary strategy to slow the spread and reduce the impact is to trace the primary and secondary contacts of confirmed COVID-19 cases using contact tracing technology. Objective The objective of this paper is to survey strategies for digital contact tracing for the COVID-19 pandemic and to present how using mobile positioning data conforms with Nigeria’s data privacy regulations. Methods We conducted an exploratory review of current measures for COVID-19 contact tracing implemented around the world. We then analyzed how countries are using mobile positioning data technology to reduce the spread of COVID-19. We made recommendations on how Nigeria can adopt this approach while adhering to the guidelines provided by the National Data Protection Regulation (NDPR). Results Despite the potential of digital contact tracing, it always conflicts with patient data privacy regulations. We found that Nigeria’s response complies with the NDPR, and that it is possible to leverage call detail records to complement current strategies within the NDPR. Conclusions Our study shows that mobile position data contact tracing is important for epidemic control as long as it conforms to relevant data privacy regulations. Implementation guidelines will limit data misuse.

Blockchain, a form of distributed ledger technology has attracted the interests of stakeholders across several sectors including healthcare. Its' potential in the multi-stakeholder operated sector like health has been responsible for several investments, studies, and implementations. Electronic Health Records (EHR) systems traditionally used for the exchange of health information amongst healthcare stakeholders have been criticised for centralising power, failures and attack-points with exchange data custodians. EHRs have struggled in the face of multi-stakeholder and system requirements while adhering to security, privacy, ethical and other regulatory constraints. Blockchain is promising amongst others to address the many EHR challenges, primarily trustless and secure exchange of health information amongst stakeholders. Many blockchain-in-healthcare frameworks have been proposed; some prototyped and/or implemented. This study leveraged the PRISMA framework to systematically search and evaluate the different models proposed; prototyped and/or implemented. The bibliometric and functional distribution of all 143 articles from this study were presented. This study evaluated 61 articles that discussed either prototypes or pilot or implementations. The technical and architectural analysis of these 61 articles for privacy, security, cost, and performance were detailed. Blockchain was found to solve the trust, security and privacy constraints of traditional EHRs often at significant performance, storage and cost trade-offs. INDEX TERMS Bioinformatics, blockchain, DLT, distributed ledger technology, distributed computing, distributed databases, health information management, health information exchange, hospitals, pharmaceutical technology, telemedicine, digital health, eHealth, mHealth.

Background Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media–only internet bundle, with the cost ranging from 1000 leones (US $0.11) to 1500 leones (US $0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US $0.11) and 5000 leones (US $0.52). Conclusions mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale.