computer science applications to improve health delivery in low-income countries
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Computer science applications to improve health delivery in low-income countries. Neal Lesh. My Story. - PowerPoint PPT PresentationTRANSCRIPT
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Neal Lesh
Computer science applications to improve health delivery in low-income countries.
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My Story
Mid-thirties computer researcher seeks more fulfilling career. Goes back to school then off to Africa. Discovers things are more simple and more complex than he originally imagined. Can't imagine doing anything else...
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Thesis
It is increasingly possible to
apply computer innovation to
improve health care delivery in
low-income countries.
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Who are you?
It is increasingly possible to
apply computer innovation to
improve health care delivery in
low-income countries.
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What’s in this for you?
• Taste of global health• Confidence that information can help• Two examples
Patient record systems for AIDS treatmentMedical algorithms on handhelds
• Cautionary cartoon
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Global Health Puzzle
Canada MexicoDeaths per 1000 per year (2003 est.) 7.61 4.97
Is Mexico healthier than Canada?
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Older populations are less healthy!
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Risk Factorfor surviving the Titanic.
0
10
20
30
40
50
60
70
1st 2nd 3rd
class of service
% s
urvi
ved
Poverty as a
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Global Health
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Simple Story$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
$
Infant mortality: 5 per 1,000 births
Maternal mortality: 8 per 100K births
Life expectancy: 78 years
Infant mortality: 95 per 1,000 births
Maternal mortality: 500-1000 per 100K
Life expectancy: 45 years
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Simple Story$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
$$$$
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Simple Story
“We are the first generation that can end poverty.”
-Eveline Herfkens, UN Millennium Campaign
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Complexity• Corruption, careerism, tax write-offs• 5-star poverty alleviation meetings• Unintended consequences, e.g., paying volunteers• Imperialism & foreign experts
“If you want to build a ship, don't drum up people to collect wood and don't assign them tasks and work, but rather teach them to long for the endless immensity of the sea.”– Antoine de Saint-Exupery
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Information as Care
• Study: rigorous application of standard treatment protocols reduced in-hospital mortality in children’s malaria cases by 50%
• Clinician’s complaint: where are my lab results?!
• Patient Knowledge Example: five danger signs for seeking care during and after labor.
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Roadmap
• Taste of global health• Confidence that information can help• Two examples
Patient record systems for AIDS treatmentMedical algorithms on handhelds
• Cautionary cartoon
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One year later
AIDS Treatment in Rural Rwanda
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One year later
Improving Health Systems
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One year later
Infrastructure
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Electronic Medical Record (EMR)
Patient MonitoringReports
Clinicians & Patients
Managers
EMR Staff
Paper forms
Program MonitoringReports
Funder & governmentreports
$
Re-allocate resources
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Patient Monitoring
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Unsuccessful Report
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Successful Report
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Unsuccessful Report
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OpenMRS
• Open source framework for medical record systems
• www.openmrs.org
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Data Quality
• Mistyped IDs• Missing &
conflicting data• Backlog
Potential solution: point-of-care systems
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Roadmap
• Taste of global health• Confidence that information can help• Two examples
Patient record systems for AIDS treatmentMedical algorithms on handhelds
• Cautionary cartoon
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Rural Dispensary in Tanzania
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Standardized Care (IMCI)
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Standardized Care (IMCI)
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Standardized Care (IMCI)
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10
15
20
25
30
35
1999-00 2001-02
An
nu
al
mo
rta
lity
ra
te
Morogoro (IMCI) Rufiji (IMCI)
Ulanga Kilombero
Tanzania: underfive mortality was 13% lower in the two IMCI districts
Source: Schellenberg J et al
Full IMCIin HF
End ofstudy
13% difference95% CI: -7%, 30%
Significant impact on stunting
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Deploying IMCI
• IMCI – Shown to reduce mortality and morbidity– Adopted by ~100 countries
• But uptake not as good as hoped– Training expensive– Correct use tapers off over time– Supervision challenging
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How Automate IMCI?
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Why Automate IMCI?
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Why Automate IMCI?
• Improve adherence• Improve
supervision• Easier to update• More sophisticated
protocols• Reduced training
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Field Work
Results to be published in CHI’08
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Viral Training
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Adherence ResultsInvestigation
Current practice adherence
e-IMCI adherence
p-value
Vomiting 66.7% (n=24) 85.7% (n=28) -
Chest indrawing 75% (n=20) 94.4% (n=18) -
Blood in stool 71.4% (n=7) 100% (n=3) -
Measles in the last 3 months
55.6% (n=9) 95.2% (n=21) < 0.05
Tender ear 0% (n=1) 100% (n=5) -
All 61% (n=299) 84.7% (n=359) < 0.01
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What are we going to do today, Brain?
The same thing we do every day, Pinky….
Make a plan to TAKE OVER THE
WORLD!!!!!
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Thank [email protected]