Adaptation and performance of a mobile application for early detection of cutaneous leishmaniasis

Abstract

Background Detection and management of neglected tropical diseases such as cutaneous leishmaniasis present unmet challenges stemming from their prevalence in remote, rural, resource constrained areas having limited access to health services. These challenges are frequently compounded by armed conflict or illicit extractive industries. The use of mobile health technologies has shown promise in such settings, yet data on outcomes in the field remain scarce. Methods We adapted a validated prediction rule for the presumptive diagnosis of CL to create a mobile application for use by community health volunteers. We used human-centered design practices and agile development for app iteration. We tested the application in three rural areas where cutaneous leishmaniasis is endemic and an urban setting where patients seek medical attention in the municipality of Tumaco, Colombia. The application was assessed for usability, sensitivity and inter-rater reliability (kappa) when used by community health volunteers (CHV), health workers and a general practitioner, study physician. Results The application was readily used and understood. Among 122 screened cases with cutaneous ulcers, sensitivity to detect parasitologically proven CL was >95%. The proportion of participants with parasitologically confirmed CL was high (88%), precluding evaluation of specificity, and driving a high level of crude agreement between the app and parasitological diagnosis. The chance-adjusted agreement (kappa) varied across the components of the risk score. Time to diagnosis was reduced significantly, from 8 to 4 weeks on average when CHV conducted active case detection using the application, compared to passive case detection by health facility-based personnel. Conclusions Translating a validated prediction rule to a mHealth technology has shown the potential to improve the capacity of community health workers and healthcare personnel to provide opportune care, and access to health services for underserved populations. These findings support the use of mHealth tools for NTD research and healthcare.

Tecnologias móveis para auxiliar no manejo terapêutico de leishmaniose tegumentar: uma revisão integrativa

“…Os estudos estrangeiros encontrados nesta pesquisa foram desenvolvidos na Colômbia (Rubiano et al, 2021;Navarro et al, 2018), na Turquia (Devrim et al, 2019), no Irã (Taheri et al, 2017) Esses achados são promissores para o acolhimento e manejo terapêutico de LT, uma vez que a certeza do diagnóstico só se obtém através de vários métodos, onde a chance de se encontrar o parasito é inversamente proporcional ao tempo de duração da lesão (Gontijo & Carvalho, 2003). Segundo a Organização Mundial da Saúde, Who (2016), em apenas 32 dos 88 países afetados pela doença a sua notificação é compulsória; sendo o Brasil um deles (Brasil, 2014).…”

“…e no Iêmen(Al-Kamel, 2017), onde também apresentaram resultados promissores sobre o tema Rubiano et al (2021). demonstrou um alto nível de concordância bruta entre o aplicativo móvel desenvolvido e o diagnóstico parasitológico de LT. Nesse estudo, o tempo para o diagnóstico foi reduzido significativamente, de 8 para 4 semanas em média, quando os agentes comunitários de saúde conduziram a detecção ativa de casos usando o aplicativo, em comparação com a detecção passiva de casos pelos profissionais da unidade de saúde.O Guaral/app foi desenvolvido para casos de LT na Colômbia e, diante disso,Navarro et al (2018) revisaram as principais etapas na criação de tais ferramentas de saúde móvel (mHealth).…”

Community Engagement in Cutaneous Leishmaniasis Research in Brazil, Ethiopia, and Sri Lanka: A Decolonial Approach for Global Health

“…Applied health researchers are concerned with CL at an individual, community, and population level. Improving health services, public health programs and national policies are at the forefront of this strand of research (13)(14)(15). The objective of social scientists working on CL, on the other hand, is to examine how the social and cultural milieu shapes the experiences of those affected by CL (16)(17)(18).…”

Sensitivity and Specificity of the Remote Evaluation of Therapeutic Response in Cutaneous Leishmaniasis Using Photographs from a Mobile Application

“…Smartphonebased mHealth tools have shown promising results for surveillance, diagnosis, and outcome assessment of infectious diseases in low-resource settings. 9,10 The provision of mHealth tools to community health volunteers (CHVs) and rural healthcare workers for the follow-up of patients with CL in their communities, and the remote evaluation of lesions photographs by medical experts, could help to overcome some of these challenges. Recently, a mobile application for therapy monitoring and assessment of therapeutic response in CL was developed, the Guaral1ST mobile app.…”