Browsing by Author "Labrique, Alain B"
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- ItemBest practices in scaling digital health in low and middle income countries.(0000-00-00) Labrique, Alain B; Wadhwani, Christina; Williams, Koku Awoonor; Lamptey, Peter; Hesp, Cees; Luk, Rowena; Aerts, AnnHealthcare challenges in low and middle income countries LMICs have been the focus of many digital initiatives that have aimed to improve both access to healthcare and the quality of healthcare delivery Moving beyond the initial phase of piloting and experimentation these initiatives are now more clearly focused on the need for effective scaling and integration to provide sustainable benefit to healthcare systems Based on real life case studies of scaling digital health in LMICs five key focus areas have been identified as being critical for success Firstly the intrinsic characteristics of the programme or initiative must offer tangible benefits to address an unmet need with end user input from the outset Secondly all stakeholders must be engaged trained and motivated to implement a new initiative and thirdly the technical profile of the initiative should be driven by simplicity interoperability and adaptability The fourth focus area is the policy environment in which the digital healthcare initiative is intended to function where alignment with broader healthcare policy is essential as is sustainable funding that will support long term growth including private sector funding where appropriate Finally the extrinsic ecosystem should be considered including the presence of the appropriate infrastructure to support the use of digital initiatives at scale At the global level collaborative efforts towards a less siloed approach to scaling and integrating digital health may provide the necessary leadership to enable innovative solutions to reach healthcare workers and patients in LMICs This review provides insights into best practice for scaling digital health initiatives in LMICs derived from practical experience in real life case studies discussing how these may influence the development and implementation of health programmes in the future
- ItemEthical issues in mHealth research involving persons living with HIV/AIDS and substance abuse.(2013-10-30) Labrique, Alain B; Kirk, Gregory D; Westergaard, Ryan P; Merritt, Maria WWe aim to raise awareness and stimulate dialogue among investigators and research ethics committees regarding ethical issues that arise specifically in the design and conduct of mHealth research involving persons living with HIV AIDS and substance abuse Following a brief background discussion of mHealth research in general we offer a case example to illustrate the characteristics of mHealth research involving people living with HIV AIDS and substance abuse With reference to a well established systematic general ethical framework for biomedical research with human participants we identify a range of ethical issues that have particular salience for the protection of participants in mHealth research on HIV AIDS and substance abuse
- ItemEthics of mobile phone surveys to monitor non-communicable disease risk factors in low- and middle-income countries: A global stakeholder survey.(0000-00-00) Ali, Joseph; DiStefano, Michael J; Coates McCall, Iris; Gibson, Dustin G; Al Kibria, Gulam Muhammed; Pariyo, George W; Labrique, Alain B; Hyder, Adnan AActive public health surveillance has traditionally been carried out through face to face household surveys or contact with providers which can be time and resource intensive The increasing ubiquity of mobile phones and availability of phone survey platforms provide an opportunity to explore the use of mobile phone surveys MPS for active disease and risk factor surveillance including for non communicable diseases NCDs Scholars are increasingly examining the ethics implications of mobile health mHealth but few have focused on the ethics of mHealth in low and middle income countries LMICs and even fewer on mHealth for active surveillance Given that little is known about ethics related attitudes and practices of stakeholders invested in the conduct and oversight of mHealth in LMICs we undertook a cross sectional global stakeholder survey of ethics related issues implicated by active observational MPS with a contextual frame of monitoring NCD risk factors in LMICs We analyse these findings with an organising focus on ethical issues that arise before during and after conduct of an MPS including defining the activity anticipating harms and benefits obtaining consent data ownership access and use and ensuring sustainability Finally we present a set of empirical conceptual and normative considerations that arise from this analysis and merit further consideration
- ItemGeographic variation in access to dog-bite care in Pakistan and risk of dog-bite exposure in Karachi: prospective surveillance using a low-cost mobile phone system.(2013-12-18) Zaidi, Syed Mohammad Asad; Labrique, Alain B; Khowaja, Saira; Lotia-Farrukh, Ismat; Irani, Julia; Salahuddin, Naseem; Khan, Aamir JavedBACKGROUND Dog bites and rabies are under reported in developing countries such as Pakistan and there is a poor understanding of the disease burden We prospectively collected data utilizing mobile phones for dog bite and rabies surveillance across nine emergency rooms ER in Pakistan recording patient health seeking behaviors access to care and analyzed spatial distribution of cases from Karachi METHODOLOGY AND PRINCIPAL FINDINGS A total of 6212 dog bite cases were identified over two years starting in February 2009 with largest number reported from Karachi 59 7 followed by Peshawar 13 1 and Hyderabad 11 4 Severity of dog bites was assessed using the WHO classification Forty percent of patients had Category I least severe bites 28 1 had Category II bites and 31 9 had Category III most severe bites Patients visiting a large public hospital ER in Karachi were least likely to seek immediate healthcare at non medical facilities Odds Ratio 0 20 95 CI 0 17 0 23 p valueUnder0 01 and had shorter mean travel time to emergency rooms adjusted for age and gender 32 78 min 95 CI 31 82 33 78 p valueUnder0 01 than patients visiting hospitals in smaller cities Spatial analysis of dog bites in Karachi suggested clustering of cases Moran s I 0 02 p valueUnder0 01 and increased risk of exposure in particular around Korangi and Malir that are adjacent to the city s largest abattoir in Landhi The direct cost of operating the mHealth surveillance system was USD 7 15 per dog bite case reported or approximately USD 44 408 over two years CONCLUSIONS Our findings suggest significant differences in access to care and health seeking behaviors in Pakistan following dog bites The distribution of cases in Karachi was suggestive of clustering of cases that could guide targeted disease control efforts in the city Mobile phone technologies for health mHealth allowed for the operation of a national level disease reporting and surveillance system at a low cost
- ItemmHealth innovations as health system strengthening tools: 12 common applications and a visual framework.(2014-10-03) Labrique, Alain B; Vasudevan, Lavanya; Kochi, Erica; Fabricant, Robert; Mehl, GarrettThis new framework lays out 12 common mHealth applications used as health systems strengthening innovations across the reproductive health continuum
- ItemUnderstanding the role of mHealth and other media interventions for behavior change to enhance child survival and development in low- and middle-income countries: an evidence review.(2014-09-11) Higgs, Elizabeth S; Goldberg, Allison B; Labrique, Alain B; Cook, Stephanie H; Schmid, Carina; Cole, Charlotte F; Obregón, Rafael AGiven the high morbidity and mortality among children in low and middle income countries as a result of preventable causes the U S government and the United Nations Children s Fund convened an Evidence Summit on Enhancing Child Survival and Development in Lower and Middle Income Countries by Achieving Population Level Behavior Change on June 3 4 2013 in Washington D C This article summarizes evidence for technological advances associated with population level behavior changes necessary to advance child survival and healthy development in children under 5 years of age in low and middle income countries After a rigorous evidence selection process the authors assessed science technology and innovation papers that used mHealth social transmedia multiplatform media health literacy and devices for behavior changes supporting child survival and development Because of an insufficient number of studies on health literacy and devices that supported causal attribution of interventions to outcomes the review focused on mHealth social transmedia and multiplatform media Overall this review found that some mHealth interventions have sufficient evidence to make topic specific recommendations for broader implementation scaling and next research steps e g adherence to HIV AIDS antiretroviral therapy uptake and demand of maternal health service and compliance with malaria treatment guidelines While some media evidence demonstrates effectiveness in changing cognitive abilities knowledge and attitudes evidence is minimal on behavioral endpoints linked to child survival Population level behavior change is necessary to end preventable child deaths Donors and low and middle income countries are encouraged to implement recommendations for informing practice policy and research decisions to fully maximize the impact potential of mHealth and multimedia for child survival and development
- ItemUsing the lives saved tool (LiST) to model mHealth impact on neonatal survival in resource-limited settings.(2014-07-12) Jo, Youngji; Labrique, Alain B; Lefevre, Amnesty E; Mehl, Garrett; Pfaff, Teresa; Walker, Neff; Friberg, Ingrid KWhile the importance of mHealth scale up has been broadly emphasized in the mHealth community it is necessary to guide scale up efforts and investment in ways to help achieve the mortality reduction targets set by global calls to action such as the Millennium Development Goals not merely to expand programs We used the Lives Saved Tool LiST an evidence based modeling software to identify priority areas for maternal and neonatal health services by formulating six individual and combined interventions scenarios for two countries Bangladesh and Uganda Our findings show that skilled birth attendance and increased facility delivery as targets for mHealth strategies are likely to provide the biggest mortality impact relative to other intervention scenarios Although further validation of this model is desirable tools such as LiST can help us leverage the benefit of mHealth by articulating the most appropriate delivery points in the continuum of care to save lives