Mapping the role of digital health technologies in the case detection, management, and treatment outcomes of neglected tropical diseases: a scoping review

Telemedicine in the Clinical Care of Neglected Tropical Diseases: A Scoping Review

BACKGROUND

The Neglected Tropical Diseases (NTDs) represent a global public health problem. Telemedicine uses telecommunications to deliver remote healthcare services when patients and providers are separated by distance. Using digital health technologies to offer medical care remotely to NTDs can be an important strategy for reducing inequalities in access but is challenging in low-and middle-income settings. The objective of the current review was to identify and summarize international evidence on the use of telemedicine for clinical care of patients with NTDs around the world based on a scoping review protocol.

METHODOLOGY/PRINCIPAL FINDINGS

A total of 422 articles were extracted from the databases MEDLINE/PubMed, Web of Science and Scopus, and after removing 129 duplicates, 285 studies were excluded because they did not meet the eligibility criteria. A total of 8 articles were included for data extraction, half of them published after 2021 (n=4). Four studies were focused on dermatological diseases, like leprosy and leishmaniasis, and the other diseases found were dengue (n=2), trachoma (n=1) and cysticercosis (n=1). Most telemedicine interventions in NTDs involved Primary Health Care teams (n=5). Studies that evaluated the accuracy of remote diagnosis demonstrated good effectiveness for leprosy, trachoma and complications of neurocysticercosis. There was a reduction in the need for specialized in-person medical consultations with telemedicine for the care of dengue fever and some dermatological NTDs; and an improvement in the quality of clinical monitoring of cutaneous leishmaniasis using mobile health was demonstrated.

CONCLUSIONS/SIGNIFICANCE

Although we observed a small recent increase in academic research on the theme, there is a gap in recommendations for the clinical management of NTDs through telemedicine in the literature. The feasibility and potential for telemedicine-based NTDs diagnosis and treatment have been demonstrated in only a few settings/countries, revealing that this resource is still largely underutilized.

Digital approaches in post-COVID healthcare: a systematic review of technological innovations in disease management

Post-COVID conditions (PCC) emerged during the pandemic, prompting a rise in the use of Digital Health Technologies (DHTs) to manage lockdowns and hospital overcrowding. Real-time tracking and information analyses were crucial to strengthening the global research response. This study aims to map the use of modern digital approaches in estimating the prevalence, predicting, diagnosing, treating, monitoring, and prognosis of PCC. This review was conducted by searching PubMed and Scopus databases for keywords and synonyms related to DHTs, Smart Healthcare Systems, and PCC based on the World Health Organization definition. Articles published from 1 January 2020 to 21 May 2024 were screened for eligibility based on predefined inclusion criteria, and the PRISMA framework was used to report the findings from the retained studies. Our search identified 377 studies, but we retained 23 studies that used DHTs, artificial intelligence (AI), and infodemiology to diagnose, estimate prevalence, predict, treat, and monitor PCC. Notably, a few interventions used infodemics to identify the clinical presentations of the disease, while most utilized Electronic Health Records and AI tools to estimate diagnosis and prevalence. However, we found that AI tools were scarcely used for monitoring symptoms, and studies involving SHS were non-existent in low- and middle-income countries (LMICs). These findings show several DHTs used in healthcare, but there is an urgent need for further research in SHS for complex health conditions, particularly in LMICs. Enhancing DHTs and integrating AI and infodemiology provide promising avenues for managing epidemics and related complications, such as PCC.

Evaluating the World Health Organization's SkinNTDs App as a Training Tool for Skin Neglected Tropical Diseases in Ghana and Kenya: Cross-Sectional Study

BACKGROUND

Neglected tropical diseases (NTDs) affect over 1.5 billion people worldwide, primarily impoverished populations in low- and middle-income countries. Skin NTDs, a significant subgroup, manifest primarily as skin lesions and require extensive diagnosis and treatment resources, including trained personnel and financial backing. The World Health Organization has introduced the SkinNTDs app, a mobile health tool designed to train and be used as a decision support tool for frontline health care workers. As most digital health guidelines prioritize the thorough evaluation of mobile health interventions, it is essential to conduct a rigorous and validated assessment of this app.

OBJECTIVE

This study aims to assess the usability and user experience of World Health Organization SkinNTDs app (version 3) as a capacity-building tool and decision-support tool for frontline health care workers.

METHODS

A cross-sectional study was conducted in Ghana and Kenya. Frontline health care workers dealing with skin NTDs were recruited through snowball sampling. They used the SkinNTDs app for at least 5 days before completing a web-based survey containing demographic variables and the user version of the Mobile Application Rating Scale (uMARS), a validated scale for assessing health apps. A smaller group of participants took part in semistructured interviews and one focus group. Quantitative data were analyzed using SPSS with a 95% CI and P≤.05 for statistical significance and qualitative data using ATLAS.ti to identify attributes, cluster themes, and code various dimensions that were explored.

RESULTS

Overall, 60 participants participated in the quantitative phase and 17 in the qualitative phase. The SkinNTDs app scored highly on the uMARS questionnaire, with an app quality mean score of 4.02 (SD 0.47) of 5, a subjective quality score of 3.82 (SD 0.61) of 5, and a perceived impact of 4.47 (SD 0.56) of 5. There was no significant association between the app quality mean score and any of the categorical variables examined, according to Pearson correlation analysis; app quality mean score vs age (P=.37), sex (P=.70), type of health worker (P=.35), country (P=.94), work context (P=.17), frequency of dealing with skin NTDs (P=.09), and dermatology experience (P=.63). Qualitative results echoed the quantitative outcomes, highlighting the ease of use, the offline functionality, and the potential utility for frontline health care workers in remote and resource-constrained settings. Areas for improvement were identified, such as enhancing the signs and symptoms section.

CONCLUSIONS

The SkinNTDs app demonstrates notable usability and user-friendliness. The results indicate that the app could play a crucial role in improving capacity building of frontline health care workers dealing with skin NTDs. It could be improved in the future by including new features such as epidemiological context and direct contact with experts. The possibility of using the app as a diagnostic tool should be considered.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/39393.

Validation of artificial intelligence-based digital microscopy for automated detection of Schistosoma haematobium eggs in urine in Gabon

INTRODUCTION

Schistosomiasis is a significant public health concern, especially in Sub-Saharan Africa. Conventional microscopy is the standard diagnostic method in resource-limited settings, but with limitations, such as the need for expert microscopists. An automated digital microscope with artificial intelligence (Schistoscope), offers a potential solution. This field study aimed to validate the diagnostic performance of the Schistoscope for detecting and quantifying Schistosoma haematobium eggs in urine compared to conventional microscopy and to a composite reference standard (CRS) consisting of real-time PCR and the up-converting particle (UCP) lateral flow (LF) test for the detection of schistosome circulating anodic antigen (CAA).

METHODS

Based on a non-inferiority concept, the Schistoscope was evaluated in two parts: study A, consisting of 339 freshly collected urine samples and study B, consisting of 798 fresh urine samples that were also banked as slides for analysis with the Schistoscope. In both studies, the Schistoscope, conventional microscopy, real-time PCR and UCP-LF CAA were performed and samples with all the diagnostic test results were included in the analysis. All diagnostic procedures were performed in a laboratory located in a rural area of Gabon, endemic for S. haematobium.

RESULTS

In study A and B, the Schistoscope demonstrated a sensitivity of 83.1% and 96.3% compared to conventional microscopy, and 62.9% and 78.0% compared to the CRS. The sensitivity of conventional microscopy in study A and B compared to the CRS was 61.9% and 75.2%, respectively, comparable to the Schistoscope. The specificity of the Schistoscope in study A (78.8%) was significantly lower than that of conventional microscopy (96.4%) based on the CRS but comparable in study B (90.9% and 98.0%, respectively).

CONCLUSION

Overall, the performance of the Schistoscope was non-inferior to conventional microscopy with a comparable sensitivity, although the specificity varied. The Schistoscope shows promising diagnostic accuracy, particularly for samples with moderate to higher infection intensities as well as for banked sample slides, highlighting the potential for retrospective analysis in resource-limited settings.

TRIAL REGISTRATION

NCT04505046 ClinicalTrials.gov.

The effectiveness of digital health versus standard care on exclusive breastfeeding duration among postpartum mothers in LMIC: Systematic review and meta-analysis

Objective

This study aims to evaluate the effectiveness of digital health interventions compared to standard care in promoting exclusive breastfeeding (EBF) among postpartum women in low-and middle-income countries (LMICs).

Methods

The PRISMA guidelines of reporting were followed for the searching of four databases and screening following eligibility criteria: articles presenting digital health interventions, conducted as randomized control trials (RCTs), quasi-experimental, or mixed-method studies, reporting on EBF duration and early initiation of breastfeeding, and published in the English language were included.

Results

Of 1595 articles screened, only 10 published between 2013 and 2023 met the criteria. Most studies were from Nigeria (n = 3), with others from Kenya, South Africa, Ethiopia, China, India, and Lebanon. Six were RCTs, and four were quasi-experimental. The meta-analysis shows digital health interventions significantly increase EBF duration, with the strongest effects at 6 months (odds ratio (OR) = 2,1.66-2.40), followed by 5, 3, 2, and 1 month postpartum, including the initial feed.

Conclusion

This suggests digital health interventions have the potential to enhance breastfeeding practices among postpartum mothers in LMICs. For future research, it is essential to consider accessibility, delivery intervention, healthcare professional collaboration, and the sustainable development of digital health interventions for postpartum mothers in LMICs.

Towards Inclusive Diagnostics for Neglected Tropical Diseases: User Experience of a New Digital Diagnostic Device in Low-Income Settings

Designing new and inclusive diagnostic tools to detect Neglected Tropical Diseases (NTDs) to achieve rational disease control requires a co-design process where end-users’ input is important. Failure to involve all potential end-users in new diagnostics for NTDs can result in low use and adoption failure, leading to persistent infection hot spots and ineffective disease control. There are different categories of potential end-users of new diagnostic tools for NTD control, and it is unclear if there are differences between the user efficiency, effectiveness, perception, and acceptability across these end-user categories. This study evaluated the usability, user perception, contextual factors affecting the user’s experience, and acceptability of a new digital optical diagnostic device for NTDs across three types of potential end users. A total of 21 participants were tested. Laboratory scientists, technicians, and Community Health Extension Workers (CHEWs) in training achieved similar scores on the usability and user perception questionnaires with no statistically significant difference between end-user categories. All participants also have high scores for the user perception domains which strongly correlate with the acceptability of the AiDx NTDx Assist device. This study indicates that, by providing digital diagnostic tools in combination with minimal training and support, CHEWs undergoing training and, by extension, CHEWs post-training, can be involved in the diagnoses of NTDs, potentially enhancing a community’s capabilities to diagnose, treat, and control NTDs.

Emerging computational technologies in human leishmaniasis: where are we?

Human leishmaniasis is a neglected tropical disease (NTD) with high morbidity and is endemic in low- to middle-income countries. Its diagnosis, treatment and epidemiological control methods are outdated and obsolete, which has become a challenge for health practitioners in controlling the disease. Computational methods have proven to be beneficial and have become popular in many fields of medicine, especially in affluent countries. However, they have not been widely used for NTDs. To date, few computational technologies have been employed for leishmaniasis. Although new technologies in leishmaniasis are theorized, they have only been minimally applied and have not been updated, even in other infections. Research and development on NTDs suffers from the inherent difficulties of the demographic regions the diseases afflict. In this narrative review we described the e-tools available in managing leishmaniasis, ranging from drug discovery to treatment.

Community perceptions and acceptability of mass drug administration for the control of neglected tropical diseases in Asia-Pacific countries: A systematic scoping review of qualitative research

BACKGROUND

Preventative chemotherapy and mass drug administration have been identified as effective strategies for the prevention, treatment, control and elimination of several NTDs in the Asia-Pacific region. Qualitative research can provide in-depth insight into the social dynamics and processes underlying effective implementation of and adherence to mass drug administration programs. This scoping review examines published qualitative literature to examine factors influencing community perceptions and acceptability of mass drug administration approaches to control NTDs in the Asia-Pacific region.

METHODOLOGY

Twenty-four peer reviewed published papers reporting qualitative data from community members and stakeholders engaged in the implementation of mass drug administration programs were identified as eligible for inclusion.

FINDINGS

This systematic scoping review presents available data from studies focussing on lymphatic filariasis, soil-transmitted helminths and scabies in eight national settings (India, Indonesia, Philippines, Bangladesh, Laos, American Samoa, Papua New Guinea, Fiji). The review highlights the profoundly social nature of individual, interpersonal and institutional influences on community perceptions of willingness to participate in mass drug administration programs for control of neglected tropical diseases (NTD). Future NTD research and control efforts would benefit from a stronger qualitative social science lens to mass drug administration implementation, a commitment to understanding and addressing the social and structural determinants of NTDs and NTD control in complex settings, and efforts to engage local communities as equal partners and experts in the co-design of mass drug administration and other efforts to prevent, treat, control and eliminate NTDs.

CONCLUSION

For many countries in the Asia-Pacific region, the "low hanging fruit has been picked" in terms of where mass drug administration has worked and transmission has been stopped. The settings that remain-such as remote areas of Fiji and Papua New Guinea, or large, highly populated, multi-cultural urban settings in India and Indonesia-present huge challenges going forward.

Digital health for quality healthcare: A systematic mapping of review studies

Objective

To systematically catalogue review studies on digital health to establish extent of evidence on quality healthcare and illuminate gaps for new understanding, perspectives and insights for evidence-informed policies and practices.

Methods

We systematically searched PubMed database using sensitive search strings. Two reviewers independently conducted two-phase selection via title and abstract, followed by full-text appraisal. Consensuses were derived for any discrepancies. A standardized data extraction tool was used for reliable data mining.

Results

A total of 54 reviews from year 2014 to 2021 were included with notable increase in trend of publications. Systematic reviews constituted the majority (61.1%, (37.0% with meta-analyses)) followed by scoping reviews (38.9%). Domains of quality being reviewed include effectiveness (75.9%), accessibility (33.3%), patient safety (31.5%), efficiency (25.9%), patient-centred care (20.4%) and equity (16.7%). Mobile apps and computer-based were the commonest (79.6%) modalities. Strategies for effective intervention via digital health included engineering improved health behaviour (50.0%), better clinical assessment (35.1%), treatment compliance (33.3%) and enhanced coordination of care (24.1%). Psychiatry was the discipline with the most topics being reviewed for digital health (20.3%).

Conclusion

Digital health reviews reported findings that were skewed towards improving the effectiveness of intervention via mHealth applications, and predominantly related to mental health and behavioural therapies. There were considerable gaps on review of evidence on digital health for cost efficiency, equitable healthcare and patient-centred care. Future empirical and review studies may investigate the association between fields of practice and tendency to adopt and research the use of digital health to improve care.

Assessment of the Chad guinea worm surveillance information system: A pivotal foundation for eradication

Background

In the absence of a vaccine or pharmacological treatment, prevention and control of Guinea worm disease is dependent on timely identification and containment of cases to interrupt transmission. The Chad Guinea Worm Eradication Program (CGWEP) surveillance system detects and monitors Guinea worm disease in both humans and animals. Although Guinea worm cases in humans has declined, the discovery of canine infections in dogs in Chad has posed a significant challenge to eradication efforts. A foundational information system that supports the surveillance activities with modern data management practices is needed to support continued program efficacy.

Methods

We sought to assess the current CGWEP surveillance and information system to identify gaps and redundancies and propose system improvements. We reviewed documentation, consulted with subject matter experts and stakeholders, inventoried datasets to map data elements and information flow, and mapped data management processes. We used the Information Value Cycle (IVC) and Data-Information System-Context (DISC) frameworks to help understand the information generated and identify gaps.

Results

Findings from this study identified areas for improvement, including the need for consolidation of forms that capture the same demographic variables, which could be accomplished with an electronic data capture system. Further, the mental models (conceptual frameworks) IVC and DISC highlighted the need for more detailed, standardized workflows specifically related to information management.

Conclusions

Based on these findings, we proposed a four-phased roadmap for centralizing data systems and transitioning to an electronic data capture system. These included: development of a data governance plan, transition to electronic data entry and centralized data storage, transition to a relational database, and cloud-based integration. The method and outcome of this assessment could be used by other neglected tropical disease programs looking to transition to modern electronic data capture systems.

Guinea worm disease has no pharmacological treatment or vaccines, and therefore existing prevention and control strategies (e.g., case containment, health education, chemical treatment of water bodies) are critically dependent on timely, accurate, and actionable data. We conducted informant interviews, used conceptual frameworks, and mapped data flow to evaluate the Chad Guinea Worm Eradication Program’s current information system. We identified areas for improvement including the need to consolidate variables across data collection forms and the need to develop streamlined workflows. We proposed a four-phased roadmap for transitioning to an electronic data capture system and centralizing data storage. Our approach and proposed roadmap could be adopted by other neglected tropical disease control programs looking to modernize data collection and storage procedures.