The Future of mHealth: Mobile Phones Improve Care in Developing World

By Janet Maragioglio

The Future of mHealth is a series that explores opportunities and challenges of mHealth, which aims to put widespread access to healthcare within the reach of those who need it most.

People in developing nations depend on mobile phones to access health services and prevent disease, as mobile technology creates a platform for improving healthcare in remote, underserved areas.

According to the United Nations International Telecommunications Union, nearly 70 percent of people in the developing world have a mobile subscription, and Cisco reports worldwide 48 million people without electricity and landline Internet access have a mobile phone, showing that of mobile use outpaces basic infrastructure in many rural and developing areas.

These numbers represent an opportunity for the mHealth field, because devices can reach people who might otherwise go without care and services, impacting the health of entire populations and furthering public health initiatives in remote, underserved areas.

Halting the Spread of Contagious Disease

In developed countries, mobile health innovations manage and prevent chronic conditions, such as diabetes and heart disease.

In developing nations, however, the need is much different. In countries without access to clean water, sanitary conditions and basic preventive care, communicable diseases still run rampant.

Cell phones fight cholera in Haiti, for example. Late last year, community health workers began using specially programmed Nokia cell phones to track information about cholera infections in Haiti's Central plateau. The disease affects thousands of Haitians in isolated mountain communities, and worsens during the fall rainy season.

Diseases such as cholera are on the rise, as well, since the 2010 earthquake in Haiti, which created a large homeless, migratory population and eased the disease's spread.

By tracking and reporting new cholera cases quickly using mobile technology, health workers can isolate the disease to prevent spreading and get treatment to people who need it.

Cholera can kill within 24 hours of infection. Before the mobile program, health workers often walked six or more hours to submit weekly disease reports from outlying areas, losing critical days of response time.

In Kenya, text messages improved recovery rates in malaria treatment programs by 25 percent. Researchers sent SMS reminders to Kenyan health workers' mobile phones twice a day for six months, focusing on inspiring and informing community workers to help them stick with ongoing malaria treatment efforts.

The program helps the workers remember to administer malaria medications regularly and to keep their spirits up in a tough job, underscoring the potential of mobile devices' to bring both practical solutions and hope to areas that need it most.

Financing Healthcare in Developing Areas

Mobile banking is on the rise in the developing world, presenting another opportunity for mobile health to grow because it represents a way for poor families to pay for healthcare without carrying large amounts of cash or relying on sparse banking services.

In African nations with limited banking services and computer access, people use cell phones to send money to family and friends, pay bills and track their savings.

Kenya's M-Pesa system is the world's largest mobile banking platform, according to a PBS NewsHour report, with more than 13 million active customers. The mobile finance system allows people to store and transfer mobile credits on their phones and withdraw cash from local vendors.

The same technology could soon further mobile health initiatives as well, allowing people to save credits toward future health needs, for example, or distributing mobile payment incentives to villagers who immunize their children.

The Pesinet agency uses cell phones to provide a form of "health insurance" for families in Mali, which has one of the world's highest child mortality rates.

Under Pesinet's program, community health workers test children weekly for signs of illness, then enter the data from the weekly checkups into a custom-designed mobile app. Workers send data to an online database, where doctors analyze it and send out alerts to health workers and children's' families to arrange treatment if necessary.

Families pay a small monthly fee to enroll in the program, which entitles them to free weekly examinations and covers half the cost of any medications needed.

As mobile devices proliferate worldwide, they create a route to healthcare access in areas where traditional medical services are in short supply, forming a base for communication, treatment and funding to improve public health.

--- Originally published on http://www.mobiledia.com/news/127632.html

India Records its First Polio-Free Year in History

(HN, January 12, 2012) As recently as 2009 India had more polio cases than any other country in the world. 

UNICEF has now reported that India has recorded its first polio free year; the longest period of time without a single case of polio in India's polio history.

While this is good news for India, the threat of the spread of polio into India is not gone. Nigeria, Pakistan and Afghanistan are are all classified by the World Health Organization as polio endemic countries - India shares a border with Pakistan and Afghanistan. 

UNICEF Executive Director, Greeta Rao Gupta said of the good news from India, "This is not a moment to relax or stop the effort or reduce the amount of effort - it needs the same amount of resources and commitment to keep it going and truely eradicate polio." 

Contracting polio and symptoms

Poliomyelitis (polio) is a highly infectious disease caused by a virus that invades the nervous system. It invades the nervous system, and can cause total paralysis in a matter of hours. The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs.

Polio is a disease that is most often spread through contact with the stool (bowel movement) of an infected person. Polio germs can also be spread through food and water. The disease mainly affects children under 5 years old, but unvaccinated people of any age are at risk.

Up to 95% of persons infected with polio will have no symptoms. About four to eight percent of infected persons have minor symptoms such as fever, fatigue, nausea, headache, flu-like symptoms, stiffness in the neck and back, and pain in the limbs which often resolves completely. Fewer than one percent of polio cases result in permanent paralysis of the limbs (usually the legs). Of those paralyzed, 5-10% die when the paralysis strikes the respiratory muscles.

There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life. 

- HUMNEWS Staff and UNICEF Television 

Polio Must Be Defeated "Once and For All" (PERSPECTIVE)

By Angelique Kidjo

Parts of Africa continue to struggle to eliminate polio, a devastating disease that threatens our children with lifelong paralysis and even death.

Nigeria, which borders my home country of Benin, is one of the last places in the world where the wild poliovirus has never been stopped. Recently, polio also reemerged in several countries across West Africa, including Côte d’Ivoire, Mali, Guinea and Niger.

I have participated in immunization campaigns across Africa and have witnessed firsthand the lifesaving power of vaccines. This is why it is so heartbreaking for me to see African children continue to be paralyzed from polio, when an effective and affordable vaccine is available.

But there are signs of hope that defeating polio in Africa is within reach. In September, health workers spread out across several West African countries to vaccinate tens of millions of children. In Côte d’Ivoire, where post-election violence prohibited polio vaccinators from reaching children, improved security has enabled vaccinators to reach previously inaccessible areas. 

There is now an incredible opportunity for countries across Africa to be part of a historic achievement. In 1988, when Rotary and its partners launched the global effort to end polio, the disease affected 350,000 people worldwide every year. Today, with the coordinated and dedicated effort of supporters around the world, polio cases have plummeted by 99%, with fewer than 1,400 polio cases last year. Polio will be only the second human disease in history, after smallpox, to be eliminated from the face of the Earth.

But the fight is not yet over. Polio knows no borders; and the disease continues to spread from countries like Chad and Nigeria into neighboring countries, proving that as long as there is polio anywhere, children everywhere remain at risk.

Polio eradication work has already yielded other significant benefits across Africa when combined with other key health interventions, such as the mass distribution of measles vaccines and Vitamin A. It’s important that we build on that to do even more to strengthen routine immunization and create strong health systems. By delivering on the promise of a polio-free world, we will infuse public health in Africa with a new energy, attract more resources and good people, and create the political will necessary to tackle the many other health priorities facing our families.

For these reasons, it is critical that we remain vigilant and strengthen our efforts to protect our children against polio. While recent commitments from national leaders are promising, we are at a crossroads – we can sit idly by, or we can make sure that the eradication initiative receives the effort, attention and resources needed to ensure that no child ever again has to suffer from this crippling disease.

We cannot do this alone. An unprecedented global alliance, including Rotary International, UNICEF, WHO and the Bill & Melinda Gates Foundation, along with many national governments, remains committed to the global eradication of polio. Now is the time for all current and potential donors to ramp up their support to help us reach our goal.

We all must do our part. Parents, please make sure your children receive the polio vaccine during the upcoming immunization campaigns. Urge your friends, neighbors and family members to do the same.

We as Africans must seize this opportunity to defeat polio once and for all. We are truly “this close” to a polio-free world.  Together, we can end polio now.

Angelique Kidjo is a UNICEF Ambassador and participant in Rotary International’s “This Close to ending polio” awareness campaign. This commentary first appeared on StarAfrica.com

Gates Foundation & FC Barcelona Team Up on World Polio Day 2011 (VIDEO)

(HN, October 24, 2011) - Today is World Polio Day - a communicable disease which is about 99% eradicated but still endemic in four countries - Nigeria, Pakistan, India and Afghanistan.

This year, the Bill and Melinda Gates Foundation has teamed up with FC Barcelona to launch a campaign to eradicate polio entirely. Microsoft founder and Gates Foundation chief, Bill Gates, appears in a video (see below), alongside members of the FCB family. "We are on the threshold of eradicating the second disease in history," says the Foundation.

The Global Polio Eradication Initiative (GPEI) said  that "polio will not be eradicated unless it receives a higher priority - in many of the polio-affected ccountries, and across the world".

Recently, polio was found to have crossed borders in to China, which prompted a massive immunization campaign.

Polio Outbreak Hits China (NEWS BRIEF)

(HN, September 21, 2011) An outbreak of polio has been confirmed in China for the first time since 1999. So far the outbreak has left one person dead and nine others hospitalized, according to the World Health Organization (WHO). Among the ten cases confirmed, six are children under three years old and four are young adults.  

Polio is a contagious viral illness that in its most severe form causes paralysis, difficulty breathing and sometimes death, broke out in the prefectures of Hotan and Bazhou in China’s western Xinjiang province.

The WHO said evidence indicates the virus is genetically linked to polio cases currently circulating in Pakistan, which borders Xinjiang. Pakistan has been affected by the nationwide transmission of the same WPV1 strain. The WHO has warned that the virus could spread beyond the current affected area.

According to China's Center for Disease Control and Prevention, the Ministry of Health has dispatched a group of public health experts to the affected region to help treat the virus.

It said the local government had launched a mass vaccination campaign starting in early September. WHO confirmed initial vaccination campaigns carried out by mid-September had reached over 3.5 million children -- children being particularly vulnerable to polio.

Pakistan

According to the World Health Organization (WHO) in 2011, supplementary immunization activities (SIA’s) in Pakistan have been inadequate in key high-risk areas. In security- compromised parts of the Federally Administered Tribal Areas (FATA), upwards of 200,000 children have been regularly missed during SIAs conducted during the last two years. In addition to reaching children in insecure areas, significant operational challenges continue to be a problem affecting the quality of SIAs in accessible areas and in other key transmission areas of the country.

At the same time undetected circulation cannot be ruled out due to persistent sub-national surveillance gaps. Given these factors the spread of Wild poliovirus type 1 (WPV1) internationally, the WHO rates as ‘high’ the risk of further international spread of WPV from Pakistan.

To urgently address the widespread transmission of wild poliovirus affecting the country, the Government of Pakistan has this year launched a National Polio Emergency Action Plan. However, the impact of the Plan is not yet being seen at the critical programme implementation level.

To rapidly build up population immunity levels  staggered sub -national immunization days are planned from September 19-21, to be closely followed by further activities in high-risk union councils in 54 districts of the country.

The WHO says, the  key to success will be to overcome remaining operational challenges in fully-accessible areas and implemented special outreach strategies with full community participation to increase access to populations in security-compromised areas. To achieve this, full and consistent engagement and accountability at provincial, district and union-council level is urgently needed.

India and Saudi Arabia

With the detection of polio in China, after a gap of ten years, the Health Ministry in India has put on high alert various border states in the country, asking them to put up polio booths. The states of Punjab, Himachal Pradesh, Rajasthan, Gujarat, Uttar, and Bihar have been asked to administer polio drops to all children entering India from any of the neighboring countries.

Punjab, which has an open border with Pakistan, has already set up polio vaccination booths at the Wagah border and the Attari railway station, for administering polio drops to all children entering India from Pakistan, Punjab’s Health Secretary Satish Chandra told the Press Trust of India (PTI) .

Polio drops would be administered to will be administered to all children up to five years of age who enter the country via train, road or on foot from the Wagah check post, even if they have been vaccinated in the past, he said, adding that this would continue for the next few months.

Punjab, has been polio free since 2009 and India has so far reported only one case of polio in West Bengal’s Howrah district in January this year according the India Health Ministry.

With Hajj and Umrah season already started, the Kingdom of Saudi Arabia has issued vaccination requirements for travelers (all ages) for Umrah and Hajj.

Travelers of all ages from polio endemic countries are required to show proof of vaccination with Oral Polio Vaccine (OPV) six weeks prior to travel to the Kingdom of Saudi Arabia, and will receive a further dose of OPV upon their arrival.

Contracting Polio – Symptoms

While Polio has been eradicated in most of the world there are still cases of polio in Afghanistan, Nigeria, India and Pakistan – four countries that are classified by the World Health Organization (WHO) as polio-endemic. Polio, also known as poliomyelitis, is usually transmitted through contaminated food and water and is a highly infectious disease caused by a virus that invades the nervous system.

The virus enters the body through the mouth and multiplies in the intestine. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs.

Polio is a disease that is most often spread through contact with the stool (bowel movement) of an infected person. The disease mainly affects children under 5 years old, but unvaccinated people of any age are at risk.

Up to 95% of persons infected with polio will have no symptoms. About four to eight percent of infected persons have minor symptoms such as fever, fatigue, nausea, headache, flu-like symptoms, stiffness in the neck and back, and pain in the limbs which often resolves completely. Fewer than one percent of polio cases result in permanent paralysis of the limbs (usually the legs). Of those paralyzed, 5-10% die when the paralysis strikes the respiratory muscles.

There is no cure for polio, it can only be prevented. Polio vaccine, given multiple times, can protect a child for life. 

 - HUMNews Staff, WHO