Soil transmitted helminths refers to a category of intestinal worms, which as the name implies, infect people who come in contact with STH contaminated soil. Worldwide, these are the most common infections, but primarily impact poor communities that lack good hygiene and sanitation systems. Infections are most common in sub-Saharan Africa, the Americas, China, and East Asia. According to the World Health Organization, worldwide incidents of infection are:

• A. lumbricoides over 1 billion people
• T. trichiura 795 million people
• Hookworms (Ancylostoma duodenale and Necator americanus) 740 million people

These worms cause a number of symptoms, including diarrhea, abdominal pain, malaise, and weakness.  These symptoms often prevent infected individuals from working and attending school. They may even stunt growth in children and cause cognitive growth retardation.  Hookworms also cause intestinal bleeding which may lead to anemia. Additionally, STHs are often co-infections with other diseases like tuberculosis, malaria, and HIV, leading to more serious consequences from these already debilitating infections.

Transmission

The worms live in an infected person’s intestine, and eggs are released into the environment in the form of feces. For some types of worms, infection takes place when the eggs are consumed by a person: when he puts his fingers in his mouth or consumes fruits or vegetables that haven’t been properly washed, cooked, or peeled. Hookworm is transmitted through the skin, typically when a person is walking barefoot in contaminated soil.

Prevention

No vaccine exists to prevent infection by STHs.  Kilifi Kids has coordinated and funded de-worming events, which provide medication to all kids, killing the intestinal worms in people who are infected with the worms.  However, the medication does not have a prophylactic affect, and the ultimate goal is to prevent people from getting infected in the first place. At this time, prevention must occur through behavior changes.  Several seemingly simple actions can help prevent infection, but in the current environment they may be difficult to implement due to lack of resources.  These actions will be examined in more detail in later blog posts.

• Wear shoes, especially in areas that are likely to be contaminated with feces.
• Use good sanitation practice when eating and preparing food: Wash hands and food in clean water, peel fruit and vegetables, or cook foods.
• Create designated places to go to the bathroom.  Ideally these will be permanent structures, but they should not be close enough to water sources to contaminate the water.
• Don’t use human feces as fertilizer.

According to the United Nations, in 2010, nearly 70 percent of people living in developing countries now have access to a mobile phone. It’s as if the developing world completely leap-frogged the developed world in this regard, which makes sense when you think about it: building cell phone towers is much cheaper than laying thousands of miles of land lines and fiber optic cables, and cell phones are certainly much cheaper than computers. The UN is so excited about the potential of mobile technology to improve the delivery of cost-effective humanitarian relief to some of the poorest communities, that its foundation has named mHealth as one of its top priorities, and has partnered with Vodafone to support the development of such programs across the developing world.

Kilifi Kids is wise to jump on the mHealth train to support its goal of improving the health and nutrition of 500,000 children across Kenya.  Here are some of the ways that mobile telephones can help improve the access and quality of health care in Kenya:

• By arming community health workers (CHW) with mobile phones, they can communicate health information more quickly from the remote villages to the doctors and nurses at the health clinics in the city center.
• With a focus on malnourished children, CHWs can monitor and record patients’ vital signs, symptoms, and other health indicators to more quickly diagnose medical conditions and mobilize the necessary actions for treatment.
• CHWs can request deliveries of needed medicines and food with a simple text message.
• Mobile phones allow CHWs to collect health data to inform the greater public health objectives
• Specialized mobile phone applications can educate residents about health information, both preventative and curative.

This is an exciting time to be involved in the burgeoning mHealth movement, and Kilifi Kids is right on the front lines, saving lives one cell phone at a time!

A study by the WHO tells us that a staggering number of developing countries (as many as 57) have a dangerous shortage of healthcare workforce.  This translates into a global deficit of 2.4 million doctors, nurses, and midwives.

This is where mHealth can make a difference. Mobile health can provide some of the following services:  (1) rendering health related information to the public, with a special attention to hard-to-reach segment of the population, (2) greater and better access to health care, (3) better ways of tracking and diagnosing diseases, (4) giving improved medical education and training for health workers, and (5) offering timelier health information to the public so that actions can be taken on time, just to name a few benefits.

Studies have demonstrated that mobile technology improves the efficiency of healthcare delivery and makes healthcare more effective. The mHealth field is dynamic and uses a range of applications that will continue to expand as technology progresses.

Some of key applications of mHealth are already being seen in developing countries, including:

• Education and awareness
• Remote data collection
• Remote monitoring
• Communication and training for healthcare workers
• Disease and epidemic outbreak tracking
• Diagnostic and treatment support

mHealth promises to have a dramatic impact on the delivery of healthcare around the world. A UN report states, “A 2007 pilot in South Africa showed that with SIMpill, 90% of patients complied with their medication regime, compared with the typical 22 to 60% compliance rate without the system.”  Improved compliance with treatment regimes, greater public awareness outcomes and improved disease management are only some of the major benefits already being delivered by mHealth. (See the full UN report at http://www.unfoundation.org/global-issues/technology/mhealth-report.html)

mHealth is only in its infancy but it shows enormous promise in saving lives and transforming the way care can be delivered and access improved, especially in areas like Kilifi, Kenya. For that reason, Kilifi Kids is actively involved in mHealth initiatives. Read more about what we’re doing!

Barely a year after a successful fundraising campaign by Kilifi Kids in partnership with Rotary International and lead by the Rotary clubs of Vinings and Kilifi, lots of progress is starting to be made. Phase I has already been rolled out, much to the delight of those impacted. “Whoa! At least my manual tabulations are now gone” exclaimed Janet Muema, the Ministry of Health Information Officer, after a successful roll out of FrontlineSMS forms for data collection and reporting by Health facilities of Kilifi.

In 2011 Kilifi Kids began to work with Medic Mobile, an organization based in the USA (with a wealth of experience in implementing mHealth projects in the globe.) They join the list of partners helping to implementi Phases II and III of Kilifi Kids’ mHealth project. The chief strategist, Isaac Hoolman, believes that mHealth is the way of the future for community health systems in rural Kenya and many other places around the globe. As part of the new partnership Jonathan Mativo, a ICT4D specialist from Kilifi, Kenya, joins the Medic Mobile team as a Field Project Manager based in Kenya. “Its great working on technology based systems that change and touch the lives of people” Mativo commented.

Bustling through the MOH corridors on a Thursday morning in the end of August, a group of health officials from more than 20 health facilities in the Kilifi District of Kenya, stream into a packed board room. Hurriedly walking into the board room, whispers and sighs of relief can be heard and it is easy to see from their jolly faces That the pervasive sentiment is, “Use of SMS’s is the in-thing. It has made our work easier”. After a long agenda the Health Information officer gets to the discussion of mHealth, and use of SMS, to report on the “hard-to-fill” IDSR form. These health facilities are responsible for tracking incidence of several diseases, including Malaria, Diarrhea, Measles, Typhoid and Cholera. Every Tuesday report the number of cases detected in the facility during the previous week. This process has a number of steps and is very time consuming. The report requires over 200 characters to describe what has occurred during the prior week as well as over the previous 6 months, which are first transmitted via SMS It’s then transferred manually into a black log book. Further analysis is done to aggregate the data and get the summaries which are then transmitted to the provincial headquarters. Every Tuesday evening the Information officer is reduced to a data clerk, and sometimes this task spills over to the following day.

Phase I of Kilifi Kids’ mHealth project introduced a common reporting format for use with SMS’s. Its use makes it easier for the information officer to copy and paste data for further analysis.

So this is the reason for all the excitement! 30th August 2011 marked the turning point. FrontlineSMS forms work for the main test phone and facilities are now able to submit information on one form which is sent via SMS to a central server based in the information office. “You mean it would have been this easy?” commented the Health Information Records Officer. In just minutes the test data sent from nearby phones, leaving the officers speechless.

I hurriedly rush to report the success and prepare to make rounds to the rest of the facilities and let them know the great news!

Project Details:

A SMS-based multiple choice and interactive quiz was administered to about 15,000 individuals living in rural parts of Mbarra who were also subscribers of the Celtel mobile phone network. As an incentive to participate in the project, free airtime was provided to those who took part. This was an advantage for participants since airtime can be transferred to others and used as a kind of currency. As the quizzes were given, the cell phone provider notified participants of correct answers via SMS whenever the participant gave a wrong answer. The quiz was focused on general information about HIV that should have been common knowledge; questions covered how HIV spreads, as well as the advantages of going for counseling and voluntary testing. When the quiz ended, participants were given a concluding SMS in order to persuade them to go to the local health center for counseling and testing. Everyone who visited the health center for HIV testing was asked whether it was the first time he/she was being tested for HIV. Those tested were asked to provide the clinic with their mobile numbers so that test results and follow up counseling could be provided. For those participating in TTC, HIV testing was done free of charge. The program launch was supported by the US pharmaceutical company Merck, and the Dutch Ministry of Foreign Affairs.

There were 2 goals of the quiz:
• The first was to determine how much knowledge the general public had about HIV. This was done by calculating the rate for correct answers. Once this was determined, the data was sent to UNICEF where it could be used for other health interventions and education programs.
• The second goal was to encourage counseling as well as testing.

Text messages have several advantages for projects such as this that aims to provide information to the public.
• They offer the participant anonymity
• Mobile phone use and ability to send and receive text messages is pervasive among much of the Ugandan population of the region of Mbarra.

 The main objective of the TTC was to improve health education, increase public knowledge, and increase health seeking behaviors with regards to HIV/AIDS among the population of the Mbarra region. The results of the project were impressive! The six-week period when the TTC project was taking places saw an increase in the number of patients getting tested for HIVe from 1000 to 1400. That’s about a 40% increase that is attributed to taking the quiz.

The major discovery of that project was, though the public were aware of the preventive measures of AIDS, they didn’t realize the importance to the AIDS testing. TTC passed this information on to bigger health centers that operated in that area, so they would be able to adjust their health education programs to improve their effectiveness. TCC planned a follow up project for January 2009. In this program, non-English speaking subscribers were able to read SMS messages in their local languages.

Video Links:

http://www.youtube.com/user/TexttoChange?blend=10&ob=5

• CHWs can be notified of health facility meeting times
• CHWs can be notified of vaccination days to mobilize communities
• Health facilities can provide feedback to CHW questions
• CHEWs (Community Health Extension Workers; our volunteers) can request follow-up sessions for HIV/TB/Antenatal cases
• CHWs can request emergency services of the District Hospital
• CHWs can provide referrals for malnutrition, malaria, pneumonia cases

Simultaneously, we plan to equip the District Hospital with a basic electronic health record system that can identify and monitor the health of patients that are cared for by the District Hospital and CHWs in the community.

Jonathan Mativo is leading the work on the ground and is a former President of Kilifi Rotary and new Project Manager for Medic Mobile.  He will be able to give us regular reports on the progress of our pilot and future work.  We’re excited for the full roll-out of this phase and will be sure to keep the information flowing.

Yet, the news from our in-depth report was not all positive and should give us pause.  A questionnaire administered to 496 pupils in classes 5 to 7 showed mix results on our educational progress.

The Good:  100 percent of children could (1) identify why worms and schistosome infections were harmful, (2) explain at least one way to avoid infection, and (3) provide at least one way to improve the health of their infected classmates.

The Not-so-Good:  Only 40 percent of the same children knew how one got infected with schistosomiasis.  Less than 20 percent knew the degree of how many other students were sick with parasites.  And, dismally, only 7.8 percent of the respondents knew all the ways of improving health for children infected with the diseases.

The answer to the question above is clear.  If we left our work now, the infection rates would most certainly return to pre-2008 levels in a matter of years.  More education is needed to eradicate these devastating diseases.  It is not just enough to supply a child with a pill once a year.  Education leads to better health and so it falls to us and others in the community to ensure that every child understands how to live healthier and avoid situations that put them in greater jeopardy of getting sick from water-borne diseases.

Kilifi Kids has funding to continue the program for the next three years and we have been strong advocates to other organizations and local government to get more involved in this fight.  We believe that this work has huge pay-offs for the community and will push forward.  We will also explore other avenues to combat the causes of infection (notably sanitation) and are always looking for help in this cause.  So, send an email, pick up the phone, and join us to make the next study produce just as impressive results as this last one. ]]> http://www.kilifikids.org/2011/10/18/56313-healthier-kids-more-work-to-do-part-3/feed/ 0 http://www.kilifikids.org/2011/09/29/un-proclaims-the-potential-of-mhealth-at-its-general-assembly-session/?utm_source=rss&utm_medium=rss&utm_campaign=un-proclaims-the-potential-of-mhealth-at-its-general-assembly-session http://www.kilifikids.org/2011/09/29/un-proclaims-the-potential-of-mhealth-at-its-general-assembly-session/#comments Thu, 29 Sep 2011 17:00:20 +0000 Laura Brogan http://www.kilifikids.org/?p=419 The United Nations is currently meeting for its 66th session of the General Assembly at UN headquarters in New York City. On Monday, September 19, the current President of the General Assembly, Nassir Abdulaziz Al-Nasser, called on world leaders to embrace mobile technologies in their efforts towards disease control and prevention.  Speaking at an awards ceremony during the Meeting on the Prevention and Control of Non-communicable Diseases, he proclaimed the potential of mHealth towards achieving the goals of the UN’s Millennium Development Goals (MDGs)—those of reducing hunger, poverty, maternal and child mortality, and the spread of preventable diseases by 2015. “Indeed, there is growing evidence that the use of these technologies can be a critical component of some aspects of health. I fully believe that information and communications technologies can enable countries to meet the 2015 deadline.”

“Only five years ago, who would have imagined that today a woman in sub-Saharan Africa could use a mobile phone to access health information on bringing her pregnancy safely to term, or that today a young person in the Middle East could use a mobile phone to help manage diabetes” remarked the President.

At the same two-day meeting, UN Secretary-General Ban Ki-moon called for the adoption of a multi-pronged campaign to address the known risk factors that contribute to the four main groups of non-communicable diseases (NCD) – cardiovascular diseases, cancers, respiratory diseases, and diabetes.  The campaign should address public health efforts to influence the behaviors that contribute to these often preventable diseases, such as smoking, alcohol use, and diet. “Non-communicable diseases are a threat to development….[they] hit the poor and vulnerable particularly hard, and drive them deeper into poverty,” Ki-moon added.

The Secretary-General cited statistics from the World Health Organization that NCDs cause 63% of all deaths, and will increase by 17% worldwide in the next decade—and by 24% in Africa. Al-Nasser commented, “the global community must work together to monitor, reduce exposure to risks, and strengthen health care for people with non-communicable diseases.”  Mobile health will play an important role in the UN’s efforts to prevent, diagnose, and manage the symptoms of these diseases globally, especially in the most vulnerable corners of the developing world.

We carried out an evaluation of the project by conducting questionnaires to school headteachers and pupils and examined stool and urine from 250 children from 10 schools who had participated in the deworming programme.

Urine filtration
Children were asked to urinate into a wide-mouthed plastic container. After stirring, urine was drawn into a plastic syringe, the volume measured, and the urine passed through a filter holder containing a Nucleopore TM filter of2.5mm diameter and 12μm pore size. Subsequently, the syringe was half-filled with air and this was passed through the filter to ensure the passage of all urine. The membrane was then removed with forceps and scanned at low magnification(x4) with a microscope.

Visual Examination
Macrohaematuria was used to measure heavy infection/high morbidity. Presence of blood in urine is a good indicator of pathological conditions in the bladder. This can also assess the potential of anaemia in the children in endemic area. Any child with urine-which was red (or pink) in colour was regarded as positive.

Interview and questionnaires
A simple standard questionnaire was administered to a sample of 500 respondents in 10 primary schools. The study population was drawn from the 58 Primary schools with an enrollment of 56,313 pupils in Ganze and Vitengeni Divisions in Kilifi district. We used both purposive and random sampling to identify the study area, schools and the respondents. The criteria for selection of the 10 schools and 500 respondents were done through the zoning of schools to ensure equitable representation. We also considered acceptability and accessibility. Ballot papers were prepared for random sampling of the schools while school registers were used to identify respondents from which sampling was done. A qualitative questionnaire was administered to all respondents including teachers by the Public health officers from the Ministry of Public Health and Sanitation.

It thus gives us confidence that we’re measuring our performance accurately and in turn truly helping the community in our work.  If you have any feedback on ways we could improve or enhance our evaluation process for future work, we would love to hear from you! You can leave your comments on this post, or find us on Twitter at @kilifikids.