Use of Telemedicine to Diagnose Tinea in Kenyan Schoolchildren

Smith, Sarah E.; Ludwig, John Travis; Chinchilli, Vernon M.; Mehta, Khanjan; Stoute, José A.

doi:10.1089/tmj.2012.0085

Cited by 11 publications

(8 citation statements)

References 7 publications

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“…Recognizing that Geneticists may not be available in resource-limited settings experiencing generalized HIV-epidemics argues for organizations such as WHO to create or support the creation of expert regional panels to promote proper classification of malformations, encourage case management and build the capacity of antiretroviral birth surveillance programs. Even in resource-limited settings, technology is progressing at a rate to support electronic (eHealth) and mobile health (mHealth) applications, providing for technologically viable mechanisms for medical experts to provide guidance or evaluation remotely [12–14]. …”

Section: Discussionmentioning

confidence: 99%

Detecting congenital malformations - Lessons learned from the Mpepu study, Botswana

et al. 2017

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IntroductionA large and increasing number of HIV-infected women are conceiving on antiretroviral treatment (ART). While most antiretrovirals are considered safe in pregnancy, monitoring for rare pregnancy and infant adverse outcomes is warranted.MethodsWe conducted a retrospective secondary analysis nested within a clinical trial of infant cotrimoxazole vs. placebo prophylaxis in Botswana (the Mpepu Study). Infants were examined at birth, and at least every 3 months through 18 months of age. Abnormal physical findings and diagnostic testing revealing malformations were documented. Post hoc, a geneticist classified all reported malformations based on available documentation. Structural malformations with surgical, medical or cosmetic importance were classified as major malformations. We present a descriptive analysis of identified malformations.ResultsBetween 2011 and 2014, 2,933 HIV-infected women who enrolled in the Mpepu study delivered 2,971 live-born infants. Study staff conducted 2,944 (99%) newborn exams. One thousand eighty-eight (38%) women were taking ART at conception; 1,147 (40%) started ART during pregnancy; 442 (15%) received zidovudine monotherapy; and 223 (7%) received no antiretroviral during pregnancy. Of 33 reported anomalies, 25 (76%) met congenital malformations criteria, 10 (30%) were classified as major malformations, 4 (40%) of which were identified after the birth exam.DiscussionOur results highlight the importance of staff training on identification of congenital malformations, programmatic monitoring beyond the birth examination and the value of geneticist involvement in the malformations classification process in resource-limited settings. These elements will be important to fully define antiretroviral drug safety in pregnancy.SignificanceSurveillance systems for monitoring the safety of antiretroviral use during pregnancy among HIV-infected women in resource-limited setting are lacking. The World Health Organization’s published programmatic recommendations for such surveillance systems represents the gold standard. We employed data from a clinical trial in Botswana, a country with a generalized HIV epidemic and high antiretroviral uptake by HIV-infected women, to highlight practical opportunities to strengthen congenital malformation surveillance systems in these settings where over 1 million HIV infected pregnant women reside.Trial registrationClinical Trials.gov NCT01229761

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Section: Discussionmentioning

confidence: 99%

Detecting congenital malformations - Lessons learned from the Mpepu study, Botswana

et al. 2017

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“…Telemedicine services can potentially remedy some of the healthcare challenges in developing countries, especially in Africa, where distance, cost of equipment, time, limited human resources and lack of e-Health strategy remain major barriers that contribute to the poor quality of healthcare. 3 , 12 , 13 …”

Section: Introductionmentioning

confidence: 99%

Barriers and opportunities to implementation of sustainable e-Health programmes in Uganda: A literature review

Kiberu

Mars

Scott

2017

Afr. j. prim. health care fam. med.

109

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BackgroundMost developing countries, including Uganda, have embraced the use of e-Health and m-Health applications as a means to improve primary healthcare delivery and public health for their populace. In Uganda, the growth in the information and communications technology industry has benefited the rural communities and also created opportunities for new innovations, and their application into healthcare has reported positive results, especially in the areas of disease control and prevention through disease surveillance. However, most are mere proof-of-concepts, only demonstrated in use within a small context and lack sustainability. This study reviews the literature to understand e-Health’s current implementation status within Uganda and documents the barriers and opportunities to sustainable e-Health intervention programmes in Uganda.MethodsA structured literature review of e-Health in Uganda was undertaken between May and December 2015 and was complemented with hand searching and a document review of grey literature in the form of policy documents and reports obtained online or from the Ministry of Health’s Resource Centre.ResultsThe searches identified a total of 293 resources of which 48 articles met the inclusion criteria of being in English and describing e-Health implementation in Uganda. These were included in the study and were examined in detail.ConclusionUganda has trialled several e-Health and m-Health solutions to address healthcare challenges. Most were donor funded, operated in silos and lacked sustainability. Various barriers have been identified. Evidence has shown that e-Health implementations in Uganda have lacked prior planning stages that the literature notes as essential, for example strategy and need readiness assessment. Future research should address these shortcomings prior to introduction of e-Health innovations.

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“…Fungal infections, most notably ringworm, seemed to be the most common visibly obvious skin problem. In a separately conducted rigorous study, we have clinically validated that a webcam can be used by physicians to diagnose ringworm (tinea) remotely [19]. In the next phase, the dermascope will be integrated into the Mashavu telemedicine system and a comprehensive clinical study will be conducted.…”

Section: Discussionmentioning

confidence: 99%

“…During another pilot in South Africa, medical diagnosis was possible in 99% of the cases and an improvement in patient treatment was made in 55% of consultations [18]. Finally, teledermatology was shown as an effective means to diagnose tinea in Kenyan schoolchildren [19]. Collectively, these studies validate that when operators are trained in taking appropriate photos of skin abnormalities and additional medical history is provided, teledermatology can be effectively and efficiently used to diagnose skin conditions.…”

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confidence: 89%

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Affordable dermascope for resource-poor settings

Johnstone

Bacik

Burke

et al. 2013

2013 IEEE Global Humanitarian Technology Conference (GHTC)

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Skin diseases in developing countries receive little attention when compared with well-known killers such as HIV/AIDS, pneumonia and tuberculosis. In communities with few doctors and even fewer dermatological specialists (if any), Community Health Workers (CHWs) are charged with meeting the needs of these at-risk populations. However, skin diseases can be difficult to assess by CHWs and often signify larger underlying problems. Teledermatology is being increasingly employed as a means of remotely assessing and diagnosing skin ailments. Typical commercially-available dermascopes cannot withstand the harsh conditions of developing countries and there is a need for inexpensive and ruggedized dermascopes for resource-constrained settings. This paper presents the design and field-testing results for a dermascope intended for use in rural Kenya as a part of an operational telemedicine system. Though the design faced challenges with ambient light, material availability, and camera mobility, the final prototype produced images deemed acceptable for diagnosis by Kenyan clinicians.

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Use of Telemedicine to Diagnose Tinea in Kenyan Schoolchildren

Abstract: These results suggest that telemedicine can be used to diagnose simple skin conditions in a low resource setting with reasonable sensitivity and specificity.

Cited by 11 publications

References 7 publications

Detecting congenital malformations - Lessons learned from the Mpepu study, Botswana

Detecting congenital malformations - Lessons learned from the Mpepu study, Botswana

Barriers and opportunities to implementation of sustainable e-Health programmes in Uganda: A literature review

Affordable dermascope for resource-poor settings

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