A Teledermatology Pilot Programme for the Management of Skin Diseases in Primary Health Care Centres: Experiences from a Resource-Limited Country (Mali, West Africa)

Abstract

In sub-Saharan Africa, in particular in rural areas, patients have limited access to doctors with specialist skills in skin diseases. To address this issue, a teledermatology pilot programme focused on primary health centres was set up in Mali. This study was aimed at investigating the feasibility of this programme and its impact on the management of skin diseases. The programme was based on the store-and-forward model. Health care providers from 10 primary centres were trained to manage common skin diseases, to capture images of skin lesions, and to use an e-platform to post all cases beyond their expertise for dermatologists in order to obtain diagnosis and treatment recommendations. After training, the cases of 180 patients were posted by trained health workers on the platform. Ninety-six per cent of these patients were properly managed via the responses given by dermatologists. The mean time to receive the expert’s response was 32 h (range: 13 min to 20 days). Analysis of all diseases diagnosed via the platform revealed a wide range of skin disorders. Our initiative hugely improved the management of all skin diseases in the targeted health centres. In developing countries, Internet accessibility and connection quality represent the main challenges when conducting teledermatology programmes.

Control Strategies for Scabies

“…In lower-prevalence settings, or where MDA may be unrequired or infeasible, different strategies need to be developed and evaluated, including mass treatment of high-risk groups, or enhanced surveillance and intensified case management. Simplified, integrated clinical care pathways [ 56 , 57 ], and strategies such as teledermatology [ 58 , 59 , 60 ] may have an important role in providing high quality care to remote areas. Distinct strategies are also required for closed outbreaks in both developed and resource-limited settings.…”

Dermatological conditions encountered in The Independent State of Samoa and an exploration of possible strategies to manage dermatological health‐care needs in this resource‐poor setting

“…A pilot programme based on a store-and-forward model designed to work at a primary health-care level in a developing country (Mali, West Africa) validated the feasibility of a teledermatology programme in a resource-limited area. 8 Furthermore, the concept of teledermatopathology has also been explored in an African setting. 9 The authors are aware that this report is by no means exhaustive.…”

Implementation of Teledermatology: Theory and Practice

“…Pharmacy restrictions act as an additional barrier in underserved populations as evidenced in an urban area in the US [42] and in Belize [67•], as does limited access to labs and an underdeveloped infrastructure, which is often the experience in remote areas [89]. Another barrier, especially for remote areas, is inaccessibility to the Internet and poor connection quality, since mobile devices are being used more readily as a tool to provide access in these areas throughout the world [34,68].…”

“…In Queensland, Australia, 318 teledermatology referrals were noted in 2014, nearly doubling since 2012 [30]; and in the Netherlands, which has a more active program, 130,531 teledermatology consults were conducted between 2006 and 2015 [31]. In low-and moderate-income countries, particularly in remote areas, teledermatology has increased access, broadly defined as numbers of teledermatology encounters, as shown by studies in Afghanistan [32], 12 sub-Saharan African countries [33], and Mali [34]. Secure messaging as a vehicle for increasing teledermatology reach has been reported in Botswana [35] and Argentina [36], while a common commercial file sharing resource has been used in Egypt [37].…”