The app, developed by the EU-funded project Supporting LIFE, will take healthcare workers through steps to make an accurate diagnosis. Then they'll be able to decide whether to administer treatment on the spot or send the child to hospital.
Sick children in Malawi mostly can't see a doctor as there aren't enough to go around. They can see local Healthcare Surveillance Assistants (HSAs) – but these often don't have the training to diagnose accurately what's wrong. Partly as a result of this, only one in three children with fever are taken to a healthcare facility. And more than one in 10 children die by the age of five, often from treatable conditions, such as malaria and diarrhoea.
'The app will force them (HSAs) to go through certain steps and procedures,' said Dr John O’Donoghue, Co-Director of the Health Information Systems Research Centre at University College Cork, which is leading the project. Currently, he said, some healthcare workers do not have the necessary information or training, and even if they have a telephone they do not always know who to call.
The project shows another potential benefit of mobile communications in Africa. Mobile phones have already brought banking to people who lived too far from a branch to use one before.
At least 95 % of Malawi is covered by mobile phone networks, said Dr O'Donoghue, so the Supporting LIFE apps will be usable nearly everywhere in the country. The app will be device-independent, so healthcare workers will be able to use it on a smartphone or tablet.
“‘The app will force them to go through certain steps and procedures.’
The basis for the apps will be the Integrated Management of Childhood Illness (IMCI) strategy, developed in the 1990s by the World Health Organization (WHO) and UNICEF, the United Nations Children's Fund.
The IMCI guidelines use simple signs and symptoms to assess and classify sickness, and aim to reduce death from common, serious childhood illnesses including pneumonia, meningitis, and malaria. They are already being used in 75 countries across the world and have improved the quality of care, reducing mortality rates for children under five years old.
The Supporting LIFE app – which will be ready in experimental form in November – will take a healthcare worker through each step in the diagnosis. First, a child's age, weight, and temperature are entered into the app, as well as nutrition and immunisation history. Then come symptoms such as coughing, diarrhoea, fever, or ear problems.
After that, the healthcare worker will be pushed for further details, such as the state of the child's consciousness and breathing. Finally, a results page will propose a diagnosis and recommend action. Pneumonia, for example, could mean an antibiotic, or if the symptoms are severe, hospitalisation.
The project will experiment with different versions of the app, allowing the healthcare workers different degrees of discretion to see which has the best impact. 'We will do randomised control trials,' said O'Donoghue. 'What if we give them freedom? What if we force them to go through stages recommended by the WHO?'
Lund University in Sweden, one of the participants of the project, will develop a system to collect data on children’s health, thus providing accurate real-time disease statistics. Such heat maps could help national authorities realise quickly whether they face a potential outbreak of, say, diarrhoea rather than just the usual number of isolated cases. Then they could take action.
The project leaders hope eventually to give it enough momentum that the system will be used after the project terminates in 2017. That means involving Malawi's health ministry and setting up a research centre on the ground.
'We are trying to build a critical mass in the four years, so that we can sustain it,' said Dr O'Donoghue.
And if it works in Malawi, he hopes it will be taken up in other countries with high rates of similar conditions, such as Zambia and Sudan. 'We're looking at how transferable the tech we have is,' said Dr O'Donoghue. 'Different countries tend to develop guidelines based on national needs, but 90 % are the same.'
Why are children dying in the developing world?
Pneumonia, diarrhoea, malaria, measles, and malnutrition are the main reasons why children in the developing world die.
They suffer from these diseases because they do not have access to the routine vaccinations that children in the developed world are given; their diets lack sufficient vitamin A and other essential micronutrients, and they live in circumstances that allow disease-causing organisms to thrive.
These are the main diseases that kill children in the developing world each year, according to UNICEF, the United Nations Children's Fund:
| Illness | Vaccine | No. of deaths |
Malaria | No vaccine | > 1 000 000 |
Rotavirus | No vaccine | 600 000 |
Measels | Vaccine available | > 500 000 |
Haemophilus influenzae type b | Vaccine available | 450 000 |
Whooping cough | Vaccine available | 300 000 |
Tetanus | Vaccine available | 200 000 |
Yellow fever | Vaccine available | 30 000 |
Polio | Vaccine available | 1 300 |
For details, visit http://www.unicef.org/immunization/index_why.html
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