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Dell N.,University of Washington | Francis I.,Global Solutions for Infectious Diseases | Sheppard H.,Global Solutions for Infectious Diseases | Simbi R.,Zimbabwe Ministry of Health and Child Care | Borriello G.,University of Washington
MobileHCI 2014 - Proceedings of the 16th ACM International Conference on Human-Computer Interaction with Mobile Devices and Services | Year: 2014

The worldwide adoption of mobile devices presents an opportunity to build mobile systems to support health workers in low-resource settings. This paper presents an in-depth field evaluation of a mobile system that uses a smartphone's built-in camera and computer vision to capture and analyze diagnostic tests for infectious diseases. We describe how health workers integrate the system into their daily clinical workflow and detail important differences in system usage between small clinics and large hospitals that could inform the design of future mobile health systems. We also describe a variety of strategies that health workers developed to overcome poor network connectivity and transmit data to a central database. Finally, we show strong agreement between our system's computed diagnoses and trained health workers' visual diagnoses, which suggests that our system could aid disease diagnosis in a variety of scenarios. Our findings will help to guide ministries of health and other stakeholders working to deploy mobile health systems in similar environments. Copyright © 2014 ACM. Source

Takarinda K.C.,Zimbabwe Ministry of Health and Child Care | Harries A.D.,International Union Against Tuberculosis and Lung Disease | Harries A.D.,London School of Hygiene and Tropical Medicine | Nyathi B.,TB CARE Project | And 3 more authors.
BMC Public Health | Year: 2015

Background: Delayed presentation of pulmonary TB (PTB) patients for treatment from onset of symptoms remains a threat to controlling individual disease progression and TB transmission in the community. Currently, there is insufficient information about treatment delays in Zimbabwe, and we therefore determined the extent of patient and health systems delays and their associated factors in patients with microbiologically confirmed PTB. Methods: A structured questionnaire was administered at 47 randomly selected health facilities in Zimbabwe by trained health workers to all patients aged ≥18 years with microbiologically confirmed PTB who were started on TB treatment and entered in the health facility TB registers between 01 January and 31 March 2013. Multivariate logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CIs) for associations between patient/health system characteristics and patient delay >30 days or health system delay >4 days. Results: Of the 383 recruited patients, 211(55%) were male with an overall median age of 34 years (IQR, 28-43). There was a median of 28 days (IQR, 21-63) for patient delays and 2 days (IQR, 1-5) for health system delays with 184 (48%) and 118 (31%) TB patients experiencing health system delays >30 days and health system delays >4 days respectively. Starting TB treatment at rural primary healthcare vs district/mission facilities [aOR 2.70, 95% CI 1.27-5.75, p∈=∈0.01] and taking self-medication [aOR 2.33, 95% CI 1.23-4.43, p∈=∈0.01] were associated with encountering patient delays. Associated with health system delays were accessing treatment from lower level facilities [aOR 2.67, 95% CI 1.18-6.07, p∈=∈0.019], having a Gene Xpert TB diagnosis [aOR 0.21, 95% CI 0.07-0.66, p∈=∈0.008] and >4 health facility visits prior to TB diagnosis [(aOR) 3.34, 95% CI 1.11-10.03, p∈=∈0.045]. Conclusion: Patient delays were longer and more prevalent, suggesting the need for strategies aimed at promoting timely seeking of appropriate medical consultation among presumptive TB patients. Health system delays were uncommon, suggesting a fairly efficient response to microbiologically confirmed PTB cases. Identified risk factors should be explored further and specific strategies aimed at addressing these factors should be identified in order to lessen patient and health system delays. © 2015 Takarinda et al.; licensee BioMed Central. Source

Mutasa-Apollo T.,Zimbabwe Ministry of Health and Child Care | Shiraishi R.W.,Centers for Disease Control and Prevention | Takarinda K.C.,Zimbabwe Ministry of Health and Child Care | Dzangare J.,Zimbabwe Ministry of Health and Child Care | And 4 more authors.
PLoS ONE | Year: 2014

Background: Since establishment of Zimbabwe's National Antiretroviral Therapy (ART) Programme in 2004, ART provision has expanded from <5,000 to 369,431 adults by 2011. However, patient outcomes are unexplored. Objective: To determine improvement in health status, retention and factors associated with attrition among HIV-infected patients on ART. Methods: A retrospective review of abstracted patient records of adults ≥15 years who initiated ART from 2007 to 2009 was done. Frequencies and medians were calculated for rates of retention in care and changes in key health status outcomes at 6, 12, 24 and 36 months respectively. Cox proportional hazards models were used to determine factors associated with attrition. Results: Of the 3,919 patients, 64% were female, 86% were either WHO clinical stage III or IV. Rates of patient retention at 6, 12, 24 and 36 months were 90.7%, 78.1%, 68.8% and 64.4%, respectively. After ART initiation, median weight gains at 6, 12, and 24 months were 3, 4.5, and 5.0 kgs whilst median CD4+ cell count gains at 6, 12 and 24 months were 122, 157 and 279 cells/mL respectively. Factors associated with an increased risk of attrition included male gender (AHR 1.2; 95% CI, 1.1-1.4), baseline WHO stage IV (AHR 1.7; 95% CI, 1.1-2.6), lower baseline body weight (AHR 2.0; 95% CI, 1.4-2. 8) and accessing care from higher level healthcare facilities (AHR 3.5; 95% 1.1-11.2). Conclusions: Our findings with regard to retention as well as clinical and immunological improvements following uptake of ART, are similar to what has been found in other settings. Factors influencing attrition also mirror those found in other parts of sub-Saharan Africa. These findings suggest the need to strengthen earlier diagnosis and treatment to further improve treatment outcomes. Whilst decentralisation improves ART coverage it should be coupled with strategies aimed at improving patient retention. Source

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