Course Projects

Over half a million women die every year from pregnancy related complications in developing countries. In Zimbabwe, the maternal mortality rate is estimated to be 725 deaths for every 100,000 women, and there is a lot of potential and room to improve the access to and quality of prenatal care. For example, women in Zimbabwe present late for prenatal care (around 24 weeks) and only 68% of women achieve at least 4 prenatal visits, and get all the services recommended by the World Health organization, such as screening for HIV, syphilis, anemia and hypertensive disease, etc. Our project aims to use health information systems to complement the efforts of the municipal health care systems to improve the access and quality of prenatal care in Zimbabwe.

The long-term goal is to set up an open source electronic medical record at a public urban municipal clinic in a Zimbabwe. The EMR will be the patient data repository that will support key functionalities such as mobile communication technology for alerts and patient reminders, as well as data aggregation to meet reporting requirements into population databases currently being implemented in the country.  We also hope to enable health care providers to use  “tablet PCs” and smart phones–during patient care—that will interface with the EMR.  Last but not least, patients will be able to health information and visit reminders from the health care facility in the form of text messages. In addition, they will be able to send sms text messages to clinic with questions and concerns.

Goals:

• To complete a literature review of health information systems and maternal health in Zimbabwe and other developing countries.
• To get a better understanding of the available health information systems available and feasible for Zimbabwe.
• Develop a blue print on how to implement openMRS at an urban municipal clinic in Zimbabwe

Poor expenditure countries have been found to perform up to 40 times fewer surgeries than developed countries indicating a desperate need for better surgical services in low-resource settings. Barriers to surgical care in these areas include lack of trained personnel, and lack of vital technology. Recently, as global-surgery has gained attention, there has been a large influx of donated machinery to surgical centers all around the world in an attempt to alleviate overwhelmed medical centers. However, many of these donations have proven of little use as the machines are expensive to maintain, complicated to use, and medical personnel are not trained on how to use the new technology. An important goal of bettering surgical programs in low-resource settings is to therefore identify cheap, easy-to-use, dependable technology that can be used across multiple fields of medicine and surgery.

Recent advances in technology have allowed a connection between standard medical technology and cellular telephones. Ultrasound represents one example of a simple imaging technique used in developed countries across a wide array of surgical fields that has recently been transformed for use on cellphones. This technology is relatively cheap to maintain, easy to use, and dependable. The goal of this project is to explore and evaluate the potential role of emerging cellphone ultrasound technologies in bridging the health care gaps inherent to low resource settings, both domestic and international.

Goals:

• To understand some of the barriers in implementing advanced imaging technologies, (such as CT, MRI, mammography) in a low resource setting, including but not limited to problems of cost, logistics, skilled human resources and maintenance.
• To explore the benefits and limitations of using cellphone ultrasound technology to overcome some of the barriers to care encountered in low resource settings.

mHealth solutions for surgery in low and middle income countries including, but not limited to, post-operative decision support and data-collection for patients and community health workers.

The project has two agendas. The first is a public health analysis whilst the second is the design and testing of a technical prototype: The Public Health Agenda

• Analyzing the needs and requirements of post-operative decision support and data-collection for patients, community health workers, doctors and research teams
• Describe the role of a smart-phone based application system in this context
• Identify barriers and how these barriers could be addressed
• Intervention SWOT-analysis (Strengths and Weaknesses – Opportunities and Threats)
• Identify how data-entry can be made valuable for the person entering the data
• Defining the implementation and how to document the implementation process
• Define how to measure performance and impact

The Engineering Agenda

• Technical prototype of an information system. The Sana platform will be available.
• Development of a series of apps with post-operative forms
• Test outcome and compare to public health agenda

The student’s role is to first identify a surgical area of need in a LMIC that could benefit from an mHealth intervention. You may choose any country, however we would recommend Uganda, Liberia or Rwanda as the lead Project Manager Dr Lars Hagander will be stationed in these countries for a significant part of the course. There may also be opportunities to directly speak with surgeons and staff on the ground.

You will then need to provide a background history to your area of need and detail your proposed intervention. The next component will be to assess the potential barriers to implementation and means by which to overcome these, before detailing the implementation strategy. Most importantly, you will need to identify how you are going to assess the impact of your implementation. Data collection is challenging but absolutely vital at any level of health reform.

Can technology enable community health workers in high volume settings to fight the disease epidemics and human resource crisis? This project aims to understand, evaluate, and utilize an outpatient database from an ongoing e-health initiative in Malawi. The project will involve: a) understanding the information gaps by evaluating the front-end and the back-end of the outpatient data collected by primary care workers; b) designing a technical solution to improve the ongoing data collection effort; and c) visualizing current collected data to create better situational awareness.

Goals:

1. Understanding the challenges to healthcare in Malawi
2. Analyzing Malawi DB front-end: Basic project understanding and development/identification of the technical skills necessary to analyze and visualize the data.
3. Evaluating the back-end: Identifying gaps and problems with the data collection or DB and compiling a list of recommendations.
4. Visualizing the data gaps and prototype the proposed technical solution. Identify usability or user interface factors.

It is estimated that globally 588 million people have a hearing loss. Roughly 3 out of 1000 children are born with a significant permanent hearing loss and many others acquire hearing loss during childhood. Delayed and insufficient language development resulting from untreated hearing loss can negatively affect academic achievement, social skills and future employment. Fortunately most of these deficits can be avoided by the use of relatively inexpensive hearing aids or cochlear implants subsidized by governments. However, while standard clinical methods for detecting hearing loss (such as pure tone audiometry and otoacoustic emissions) are fast and relatively straightforward, they are limited in use because of the expensive equipment and large sound booths necessary to perform accurate and specific measurements.

In Brazil, there is a federal law (number 2794/01) that obligates every baby to have the hearing test done during the first week of birth. It is estimated that 5.7 millions of Brazilians have some degree of hearing loss. The situation for children is worse; 6% have hearing loss by age 4, and 6 in 1000 have hearing loss from birth.

For populations living in poor and/or distant rural areas, access to an audiology clinic is costly and difficult. The cost of the equipment in Brazil is high, since it is always imported. Although a federal law exists that mandates testing, not all government hospitals and clinics provide the hearing test and the poor populations cannot afford the test. This results, not surprisingly, in a high degree of complacency regarding any hearing problems an individual, or their children, may be experiencing. Thus, it is not uncommon for hearing problems to go untreated in rural and poor communities around the world, and in developing countries in particular, resulting in problems learning, safety risks, difficulties maintaining employment, and interpersonal challenges. A low-cost, portable method of detecting hearing loss will address current barriers in screening. Furthermore, because many governments subsidize hearing aids, the technician performing the screening can be a key player in providing awareness of hearing health and the availability of government subsidized rehabilitation, making a reluctant person (or their family) more likely to seek help from an audiologist.

Partnerst in Health
Maternal Newborn and Child Health (MNCH)

The Project:
Prepare selected MNCH best practices for re-use while contributing to the development of a platform and processes for use of standard interface terminologies.

1. Map selected MNCH best practices to the dictionary
2. Develop core dataset and link to WHO Indicators
3. Select and design delivery platform (paper, mobile, OpenMRS, etc.)
4. Design relevant reports, tools, processes to support delivery of the tool
5. Package for reuse

Information Pending

Sana is an mHealth telemedicine platform aimed at improving healthcare for the rural poor in resource-limited settings through technology innovation.

Our Mission is to:

• Broaden access to quality healthcare: bringing care to the rural and the poor
• Drive quality improvements: applying best-practices garnered by leading organizations and schools
• Build local capacity: training the next generation of global health informaticians, through sharing knowledge and venues such as this course

The Sana Clinical Repository is a tool to assist the adoption and sharing of clinical knowledge and best practices. This project will begin to bring together the developed tools and protocols from the various Sana projects and other reputable sources to build a database of knowledge that can be easily adapted and included with future Sana implementations or other technology solutions.

We will survey existing implementations across a range of global locations and disease protocols and extract the transferable design elements and design a schema to capture and share this knowledge.

Project Scope:

• Analyze and categorize global health priorities and existing standards and practices (WHO, IHI, Sana)
• Identify high level indicators for evaluation
• Develop an informatics schema to capture and translate specific protocols and quality metrics
• Architect technology specifications

Technical expertise is not required.