Lay-Operator mHealth Network: Real-Time Syndromic Surveillance and Intervention

 描述(由申请人提供)：该项目探索基于智能手机/平板电脑的网络的开发、实施和评估，该网络由乡村、定制培训的非专业mHealth工作人员组成，他们定期使用易于操作的网络集成软件报告一种单一说明性慢性病：点头综合征的推定和医学诊断病例。长期目标是开发一个可持续、廉价、受监测、实时的“基于人口的医疗电子地理”和基于病例的电子病历系统，利用该系统查明疾病热点，并酌情开展快速诊断和治疗，加强社区教育、流行病学研究和长期保健规划。第二个长期目标是创建一支为未来与健康相关的职业所吸引的驻村非专业mHealth操作员队伍(从而提高医疗保健能力)。研究将在冲突后乌干达北部的一个农村地区进行，那里营养不良和传染病破坏了贫困村民的健康。研究重点专门放在点头综合症(NS)上，这是一种容易识别的、慢性的、非传染性的儿童疾病，病因不明，其特征是行为变化，包括由进食和其他感官刺激引发的点头、身体和精神发育迟缓、抽搐，如果不治疗，还会早期死亡。我们的初步研究发现，从照顾者和医学诊断首次发现异常行为(缺席、点头和/或抽搐)之间的时间延迟非常长(平均约4年，我们的目标是将延迟10倍)。虽然治疗不是这项研究建议的一部分，但我们已经表明，在适合目的的设施中进行适当的药物、营养、身体和教育干预可以显著促进受影响儿童的生长和发育，显著减少他们的癫痫发作频率，并改善认知状态和学习能力。我们将测试驻村非专业mHealth工作人员是否能够准确地发现新的NS病例，加快他们的医疗诊断以激活治疗，并帮助乌干达开始建立一个地区性电子医疗记录系统，该系统已在邻国肯尼亚开发、试点和采用。18-25岁的mHealth工作人员将居住在他们调查的村庄，并每周传递与NS有关的信息。电子平板电脑还将用于收集、输入健康历史，并将其下载到ZadiTM，这是一种DHIS2集成中央管理医疗信息系统，已被邻国肯尼亚采用。将整合从mHealth工作人员和通过ZidiTM收到的有关NS病例的数据，用于绘制整个集水区的疾病地图，并与政府卫生当局共享。将评估该计划对mHealth工作人员、医学生和社区卫生人员的影响，以评估非专业运营商mHealth网络是否具有更广泛的实用性。

 DESCRIPTION (provided by applicant): This project explores the development, implementation, and evaluation of a smartphone-/ tablet -based network of village-based, custom-trained, layperson mHealth workers who use simple-to-operate, network-integrated software regularly to report presumptive and medically diagnosed cases of a single illustrative chronic disease: Nodding Syndrome . The long-term goal is to develop a sustainable, inexpensive, monitored, real-time `population-based medical e-geography' and case-based electronic medical record system with which to identify disease hotspots and to mount, as appropriate, rapid diagnosis and treatment , enhanced community education, epidemiological research and long-term health planning. Creation of a cadre of village-based lay mHealth operators who are attracted to a future health-related career (thereby increasing healthcare capacity) is a second long-term goal. Research will be carried out in a rural region of post-conflict northern Uganda where poor nutrition and infectious disease ravage the health of impoverished villagers. Research focus is placed exclusively on Nodding Syndrome (NS), an easily recognizable, chronic, non-communicable childhood disorder of unknown etiology characterized by behavioral changes, including head nodding triggered by eating and other sensory stimuli, retardation of physical and mental development, convulsions and, if untreated, early death.Our pilot study has revealed inordinately long delays (~4 years on average, which we aim to reduce >10-fold) between the time when abnormal behavior (absences, head nodding, and/or convulsions) is first noted by caregivers and medical diagnosis. While treatment is not part of this research proposal, we have shown that appropriate pharmaceutical, nutritional, physical, and educational intervention in a fit-for-purpose facility can dramatically advance the growth and development of affected children, markedly reduce their seizure frequency, and improve cognitive status and learning capacity. We will test whether village-based lay mHealth workers can accurately detect new NS cases, speed their medical diagnosis to activate treatment, and help populate the beginnings of a regional electronic medical record system in Uganda that has been developed, piloted and adopted in neighboring Kenya. Aged 18-25 years, the mHealth workers will reside in the villages they survey and weekly transmit information relating to NS. Electronic tablets will be also be used to collect, enter and download health history into ZidiTM, a DHIS2 integrated central management healthcare information system that has been adopted by the neighboring country of Kenya. Data on NS cases received from mHealth workers and via ZidiTM will be integrated, used to map the disease across the catchment area, and shared with government health authorities. The impact of this program on mHealth workers, medical students, and community health personnel will be evaluated to assess whether a lay-operator mHealth network has utility on a broader scale.