neal lesh computer science applications to improve health delivery in low-income countries
Post on 22-Dec-2015
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TRANSCRIPT
My Story
Mid-thirties computer researcher seeks more fulfilling career. Goes back to school then off to Africa. Discovers things are more simple and more complex than he originally imagined. Can't imagine doing anything else...
Thesis
It is increasingly possible to
apply computer innovation to
improve health care delivery in
low-income countries.
Who are you?
It is increasingly possible to
apply computer innovation to
improve health care delivery in
low-income countries.
What’s in this for you?
• Taste of global health• Confidence that information can help• Two examples
Patient record systems for AIDS treatmentMedical algorithms on handhelds
• Cautionary cartoon
Global Health Puzzle
Canada MexicoDeaths per 1000 per year (2003 est.) 7.61 4.97
Is Mexico healthier than Canada?
Risk Factorfor surviving the Titanic.
0
10
20
30
40
50
60
70
1st 2nd 3rd
class of service
% s
urvi
ved
Poverty as a
Simple Story$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
$
Infant mortality: 5 per 1,000 births
Maternal mortality: 8 per 100K births
Life expectancy: 78 years
Infant mortality: 95 per 1,000 births
Maternal mortality: 500-1000 per 100K
Life expectancy: 45 years
Simple Story$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$
$$$$
Simple Story
“We are the first generation that can end poverty.”
-Eveline Herfkens, UN Millennium Campaign
Complexity• Corruption, careerism, tax write-offs• 5-star poverty alleviation meetings• Unintended consequences, e.g., paying volunteers• Imperialism & foreign experts
“If you want to build a ship, don't drum up people to collect wood and don't assign them tasks and work, but rather teach them to long for the endless immensity of the sea.”– Antoine de Saint-Exupery
Information as Care
• Study: rigorous application of standard treatment protocols reduced in-hospital mortality in children’s malaria cases by 50%
• Clinician’s complaint: where are my lab results?!
• Patient Knowledge Example: five danger signs for seeking care during and after labor.
Roadmap
• Taste of global health• Confidence that information can help• Two examples
Patient record systems for AIDS treatmentMedical algorithms on handhelds
• Cautionary cartoon
Electronic Medical Record (EMR)
Patient MonitoringReports
Clinicians & Patients
Managers
EMR Staff
Paper forms
Program MonitoringReports
Funder & governmentreports
$
Re-allocate resources
Data Quality
• Mistyped IDs• Missing &
conflicting data• Backlog
Potential solution: point-of-care systems
Roadmap
• Taste of global health• Confidence that information can help• Two examples
Patient record systems for AIDS treatmentMedical algorithms on handhelds
• Cautionary cartoon
10
15
20
25
30
35
1999-00 2001-02
An
nu
al
mo
rta
lity
ra
te
Morogoro (IMCI) Rufiji (IMCI)
Ulanga Kilombero
Tanzania: underfive mortality was 13% lower in the two IMCI districts
Source: Schellenberg J et al
Full IMCIin HF
End ofstudy
13% difference95% CI: -7%, 30%
Significant impact on stunting
Deploying IMCI
• IMCI – Shown to reduce mortality and morbidity– Adopted by ~100 countries
• But uptake not as good as hoped– Training expensive– Correct use tapers off over time– Supervision challenging
Why Automate IMCI?
• Improve adherence• Improve
supervision• Easier to update• More sophisticated
protocols• Reduced training
Adherence ResultsInvestigation
Current practice adherence
e-IMCI adherence
p-value
Vomiting 66.7% (n=24) 85.7% (n=28) -
Chest indrawing 75% (n=20) 94.4% (n=18) -
Blood in stool 71.4% (n=7) 100% (n=3) -
Measles in the last 3 months
55.6% (n=9) 95.2% (n=21) < 0.05
Tender ear 0% (n=1) 100% (n=5) -
All 61% (n=299) 84.7% (n=359) < 0.01
What are we going to do today, Brain?
The same thing we do every day, Pinky….
Make a plan to TAKE OVER THE
WORLD!!!!!
Thank [email protected]