Low Cost Technology for Health:
Cell Phone Applications for Clinical Diagnostic Therapeutic and Public Health Use by Front-Line Health Workers in Developing Countries
Mobile phones are so useful that even people on very low incomes in developing countries are prepared to spend money acquiring and using them. Wherever mobile phone coverage exists a large proportion of the adult population have already bought mobile phones. This means that, even in remote and underserved rural areas, many health workers in developing countries own mobile phones and carry them with them during their working day.
All but the simplest mobile phones now have operating systems, and some have very sophisticated and powerful processors. It is possible to write applications that will run on a wide range of mobile phones.
Bringing these two trends together, we have developed a range of mobile phone applications and low-cost diagnostic devices that will run on mobile phones and make them into useful devices to support health workers in their day-to-day work. We have the almost unprecedented situation in health, of following an emerging new technology into remote areas rather than having to "push" it.
Our first working principle is that wherever possible we should avoid creating new capital or recurrent costs. This means making minimum use of the network capabilities of the phones (no calls, no SMS, no data transfer) and concentrating on using them as tiny computers.
Our second principle is to make the new applications and devices as simple as possible so that they require a minimum of training and can be used by as many health workers as possible - even into the waiting room for use by relatively untrained assistants. To achieve this end the applications must look and feel as much as possible like the normal functions of a mobile phone, and ideally require no more skill than looking up a missed call or adding a new contact. (After all, people have already taught themselves how to use mobile phones without any formal training.)
The third basic principle is to provide useful answers directly to the health worker in the clinic. There should be no reliance on distant experts or computer networks, which are less likely to be available exactly when they are needed (or at all).
Funding:
The team first came together around a generous grant from Microsoft Research. This seed funding has been multiplied by in-kind contributions from a number of different departments within the University and beyond, as well as very valuable contributions by undergraduate and postgraduate students.
The applications:
All the applications are intended for use by health workers at the health post/health centre/district hospital level in developing countries. So far all have been created using C# and the Microsoft .NET framework, and run on "smart phones" running Microsoft Windows Mobile 6.0. Some time soon, however, we plan to also support other languages such as Java. Visit this site again soon...
PLEASE NOTE THAT USING AND INTERPRETING THESE APPLICATIONS REQUIRES SOME SKILL. |
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Respiratory & pulse rate calculator
Traditionally health workers have been taught to count the respiratory rate or pulse rate by counting the number of breaths or heartbeats during a full minute. However this has often proved difficult for health workers who lack clocks or wristwatches, or who do not feel they have time to spend a whole minute measuring just one physical sign. This application uses the system clock inside the mobile phone to capture the time that the health worker begins and ends counting a chosen number of respiratory cycles or pulse beats, and uses that to calculate the number of breaths per minute or the heart rate. We recommend at least 10 breaths to count the respiratory rate, and at least 30 beats to count the heart rate.
Video demonstration 
Windows Mobile 6 Application Source code
Gestational dates calculator
In the antenatal clinic it is extremely important to know the date of the beginning of the pregnant woman's last normal menstrual 
period. From that we estimate the likely date the baby will be born, and at each antenatal visit we calculate the gestational age – how many weeks have passed since the last period. That allows the midwife to assess foetal growth, and to know when to suspect the presence of twins or a growth abnormality.
This application invites the midwife to record the calendar date of the onset of the pregnant woman's last normal menstrual period. It then calculates the gestational age today, and the estimated date of delivery.
Not all women in the developing world use a solar calendar to estimate when their babies are due. Instead they use the phases of the moon, counting one more month of pregnancy each time they see the new moon. In many cases these women can also quite accurately describe the phase of the moon when their last period started. The application gives the midwife the option of entering the current gestational age in terms of lunar cycles. From this it converts to the solar calendar and estimates the date of the last period, and the probable date of delivery.
Video demonstration Windows Mobile 6 Application Source code
Formulary/Drug dose calculator
This application records a subset of the information in the local formulary – the names, indications for use, dosing regimens and presentations of drugs available for health workers to prescribe to their patients. When the health worker selects a drug, an indication and a presentation (capsules, tablets, and pulls, etc), the application calculates the appropriate dose for that patient. The application reports the therapeutic aim (e.g. "20 to 40 mg/kg/day divided into four doses") and then tells the health worker exactly what to write on the prescription pad (e.g. "Amoxicillin tablets 500 mg, 2 four times per day for seven days").
When prescribing for children, the user is prompted to enter the child's weight. Where the exact weight is not known, it can be estimated from the child's age. (The application includes data from the 50th percentile of the relevant standard growth charts.)
Any relevant warnings, side-effects and contraindications are available for each drug.
View demonstration (Windows Mobile 6 Application to come) (Source code to come)
Drip rate calculator
Commonly a health worker wishes to give an intravenous infusion of a certain volume over a certain period of time. However, they need to work out how many drops per minute should actually fall within the giving set. Many health workers memorise the commonest combinations, but where uncommon volumes or times are involved a complex calculation is required. Then, when they come to the patient’s bedside, they need to count drops against a wrist watch or clock to set the correct drip rate.
This application allows the user to define the volume to be infused and the infusion period. It then calculates the corresponding number of drops per minute. The screen begins to flash at exactly that rate. By holding the mobile phone alongside the giving set, the health worker need only adjust the flow until one drop falls every time the screen flashes. There is no need for calculations or a wristwatch.
Where the volume to be infused is 500 ml or less the time period is measured in minutes, while for volumes above 500 ml the time period is measured in hours. The user can specify the number of drops in each millilitre (either 20 for a typical adult giving set or 30 for a typical paediatric giving set). The user also has the option of an audible sound for each flash of the screen.
Video demonstration Windows Mobile 6 Application Source code
Drug reminder alarm
This application makes use of the built-in digital camera that is present in mid-range and more sophisticated phones. It is meant to be used by pharmacists when they dispense complex drug regimens. The pharmacist lays out the correct number of tablets or capsules to be taken at a given time of day, takes a digital photograph, and then adds the photo and the time details to the application's task list. As many different photos can be added for as many different times each day as necessary.
The patient uses the phone as usual, but when one of the pre-set times arrives an alert appears on the screen. The patient can elect to "snooze", delaying the alert for 5, 10 or 15 minutes, or can select "Show alert". The application then displays the appropriate photo and the patient lays out the right tablets, capsules etc ready to take.
Video demonstration Windows Mobile 6 Application Source code
The diagnostic devices:
The Nossal Oximeter
An oximeter is a very useful device for measuring the oxygen saturation in the blood. It does so by shining light of two different wavelengths through the finger and measuring the absorption of the light by the tissue and blood in the fingertip. Unfortunately currently available commercial models are prohibitively expensive and are rarely found in health centres or district hospitals in developing countries.
We have developed a low-cost pulse oximeter for use in developing countries. One way we have kept the price down is by sending the data to the mobile phone for interpretation and display. The testing process is still ongoing, and the completed devices are not yet available for sale. But feel free to view the demonstration of the current prototype, and visit again soon for the production model...
Video demonstration
Low-cost ECG (Under development)
An electrocardiogram measures and displays the electrical activity of the heart. This device will allow a health worker to display an ECG trace from a patient on the screen of the mobile phone, with a choice of leads I, II, and III. A brief period of the ECG trace will be stored by the phone so that the health worker can back it up and view interesting complexes again at leisure.
This device is still under development – visit the site again soon...
Low-cost Phonocardiogram (Under development)
A phonocardiogram uses a small microphone applied to the patient's chest to record the sounds of the heart and display on the screen, together with the pulse rate. As the intensity of the heart sounds varies with respiration, it is also commonly possible to automatically calculate and display the respiratory rate.
This device is still under development – visit this site again soon...
The team:
Academic staff, University of Melbourne:
Jim Black (Nossal Institute for Global Health)
Rens Scheepers (Department of Information Systems)
Liz Sonenberg (Department of Information Systems)
Ahsan Khandoker(Department of Electrical and Electronic Engineering)
Marimuthu Palaniswami (Department of Electrical and Electronic Engineering)
Roger Rassool (School of Physics)
Universidade Eduardo Mondlane, Maputo, Mozambique:
Baltazar Chilundo (Departmento de Saúde da Comunidade)
Clinician:
Forbes McGain (Western Hospital, Footscray, Australia)
Electrical and Electronic Engineer:
Edgar Charry
C# Developer:
Nay Lin Soe
Mobile phone/networks expert:
Fernando Koch (Department of Information Systems)
Statistical adviser:
Julie Simpson (School of Population Health)
Postgraduate Students, University of Melbourne:
Bryn Sobott (School of Physics)
Chetan Singhal (Melbourne Business School)
Undergraduate Students:
Wei “Will” Dong (Department of Electrical and Electronic Engineering)
Happy Xia (Auckland University Electrical Engineering)
Brian Walker (Department of Electrical and Electronic Engineering)
Siti Nabihah Ahmad Suhud (Department of Electrical and Electronic Engineering)
Kiswahili Translation: Safina Yuma
| Questions? Comments? Would you like to help us (e.g. in translating the applications to your own language)? Contact Dr Jim Black via Jim DOT Black AT unimelb DOT edu DOT au. (Just replace the DOTs and AT with the usual symbols.) |