We have just published in the International Journal of Medical Informatics a new research paper entitled, “Quality of routine health data collected by health workers using smartphones at primary health care in Ethiopia.”. This article gives a comprehensive account of Health Extension Workers’s experiences using mobile health data collection tools. Here is the abstract:

Mobile phone based applications are considered by many as potentially useful for addressing challenges and improving the quality of data collection in developing countries. Yet very little evidence is available supporting or refuting the potential and widely perceived benefits on the use of electronic forms on smartphones for routine patient data collection by health workers at primary health care facilities.

A facility based cross sectional study using a structured paper checklist was prepared to assess the completeness and accuracy of 408 electronic records completed and submitted to a central database server using electronic forms on smartphones by 25 health workers. The 408 electronic records were selected randomly out of a total of 1772 maternal health records submitted by the health workers to the central database over a period of six months. Descriptive frequencies and percentages of data completeness and error rates were calculated.

When compared to paper records, the use of electronic forms significantly improved data completeness by 209 (8%) entries. Of a total 2622 entries checked for completeness, 2602 (99.2%) electronic record entries were complete, while 2393 (91.3%) paper record entries were complete. A very small percentage of error rates, which was easily identifiable, occurred in both electronic and paper forms although the error rate in the electronic records was more than double that of paper records (2.8% vs. 1.1%). More than half of entry errors in the electronic records related to entering a text value.

With minimal training, supervision, and no incentives, health care workers were able to use electronic forms for patient assessment and routine data collection appropriately and accurately with a very small error rate. Minimising the number of questions requiring text responses in electronic forms would be helpful in minimizing data errors.


Congratulations to our colleague, Selamawit Mengesha Bilal, who has just completed her PhD thesis entitled “The father’s role in child nutrition in Ethiopia”, as a scholar of the joint PhD program between Maastricht and Alcalá Universities. Digital Campus has been collaborating with Selam for the past years, so we’re really pleased she’s now completed her doctorate studies and we look forward to continue to working and collaborating with her once she’s back in her full time role in the College of Health Sciences at Mekelle University (Ethiopia), where she will be the first female professor with a PhD degree.


During the last weeks we’ve been training a cohort of 160 HEWs and their tutors/ trainers in Tigray (Ethiopia) on how to use OppiaMobile. These first training workshops are simply to get the HEWs and Tutors used to the phones, find out what problems and issues they may have, navigating the courses and activities, recharging, completing quizzes etc.

The training is going quite well, and the HEWs (mostly women) seem very eager to learn how to use the phones and soon became quite comfortable using them. Over the coming weeks we’ll introduce more OppiaMobile functionalities  and we’ll find out what challenges may exist and the feasibility for using smartphones for training support in this environment.

We had a few of technical issues that we are looking at, but this is to be expected given that we’re still in the technical feasibility stage. One of the issues we’re still finding is the level of English of the HEWs, so we are working to provide a glossary of the most common medical terms and definitions in both English and Amharic / Tigrinyan.


Mahmud thesis

Congratulations to our colleague, Mahmud Abdulkader, who has just completed his PhD in “Intestinal parasitosis and under-nutrition in Ethiopia. Prevalence, risk factors and prevention”. Digital Campus has been collaborating with Mahmud for the past years, so we’re really pleased he’s now completed and we look forward to continue to working and collaborating with him once he’s back in his full time role in the College of Health Sciences at Mekelle University (Ethiopia).


We have just published in Human Resources for Health  a new research paper, “Mobile health data collection at primary health care in  Ethiopia: a feasible challenge”. This article gives a detailed account of Community Health Workers’s experiences using mobile health data collection tools. Here is the abstract:


Mobile health (mHealth) applications, such as innovative electronic forms on smartphones, could potentially improve the performance of health care workers and health systems in developing countries. However, contextual evidence on health workers’ barriers and motivating factors that may influence large-scale implementation of such interfaces for health care delivery is scarce.


A pretested semistructured questionnaire was used to assess health workers’ experiences, barriers, preferences, and motivating factors in using mobile health forms on smartphones in the context of maternal health care in Ethiopia. Twenty-five health extension workers (HEWs) and midwives, working in 13 primary health care facilities in Tigray region, Ethiopia, participated in this study.


Over a 6-month period, a total of 2,893 electronic health records of 1,122 women were submitted to a central computer through the Internet. Sixteen (69.6%) workers believed the forms were good reminders on what to do and what questions needed to be asked. Twelve (52.2%) workers said electronic forms were comprehensive and 9 (39.1%) workers saw electronic forms as learning tools. All workers preferred unrestricted use of the smartphones and believed it helped them adapt to the smartphones and electronic forms for work purposes. With regards to language preference, 18 (78.3%) preferred using the local language (Tigrinya) version of the forms to English. Indentified barriers for not using electronic forms consistently include challenges related to electronic forms (for example, problem with username and password setting as reported by 5 (21.7%), smartphones (for example, smartphone froze or locked up as reported by 9 (39.1%) and health system (for example, frequent movement of health workers as reported by 19 (82.6%)).


Both HEWs and midwives found the electronic forms on smartphones useful for their day-to-day maternal health care services delivery. However, sustainable use and implementation of such work tools at scale would be daunting without providing technical support to health workers, securing mobile network airtime and improving key functions of the larger health system.

We have recently had accepted and published a research paper entitled “The influence of father’s child feeding knowledge and practices on children’s dietary diversity: a study in urban and rural districts of Northern Ethiopia”  in Maternal & Child Nutrition.

Here is the abstract:

Infant and young child feeding has been recognized as an essential element to improve growth of children, especially in developing countries where malnutrition among children and its dire consequences are very prevalent. However, little attention has been paid on the influence of fathers on child feeding practices although fathers are very important in raising well-adjusted, happy and successful children. Therefore, this study aimed to assess the influence of fathers’ child feeding knowledge and practice on children’s dietary diversity.

A community based comparative cross sectional study was conducted among 850 eligible urban and rural households with children of 6 to 23 months. The father and mother of the child were interviewed on children’s dietary Diversity and fathers’ knowledge and practice of child feeding.

Nearly half (46%) of the children in the rural district did not meet the minimum dietary diversity, and in the urban district the rate was even worse (72%). Dairy products were the common food group given to the children in both districts, whereas vitamin A-rich food and other fruits and vegetables were the least commonly consumed food groups.

Almost all dimensions of fathers’ knowledge and practice were significantly related to children’s minimum dietary diversity; especially fathers’ knowledge of food groups was an important predictor (p value<0.001) in both districts. Interventions that focus on the fathers’ knowledge of child feeding, especially about food groups, is recommended to improbé children’s dietary diversity in the study communities.


Our research paper entitled  “Utilization of Sexual and Reproductive Health Services  in Ethiopia- does it affect sexual activity among high school students?” has recently been accepted and published in Sexual and Reproductive Healthcare.

Here is the abstract:


Universal access to Sexual and Reproductive Health (SRH) services for adolescents was added as a target to the revised Millennium Development Goals framework in 2005. However, the utilization of SRH services among adolescents and their sexual activity is not well explored in Ethiopia, with the result that there is no well-designed and sustainable school based intervention for high school students. We aimed to investigate the utilization of sexual and reproductive health services and sexual activity and, to provide evidence based information and recommendations for possible interventions.

Study design

A cross-sectional survey was conducted among 1031 female and male high school students aged 14–19 years in Mekelle town, Tigray Region, North Ethiopia. A total of 1031 students participated. Self-administered questionnaire was used.

Main outcome measures

Utilization of sexual and reproductive health services and sexual activity were investigated using a self-administered questionnaire.


One out of five students had used the SRH services in the past year. The primary reason for visiting the SRH services was to receive information. The mean age for the first sexual intercourse was 15.7 and one-quarter of the students had multiple sexual partners. Unwanted pregnancies and abortions were reported by female students.


SRH services are known and used by students. However, sexual activity at an early age among high school students and unwanted pregnancies and abortions among female students still call for attention. Therefore, providing accurate SRH information on safe sex and enhancing family–student discussion could be a good approach to reach SRH of adolescents.

We have just had a research paper entitled “Mobile health data collection at primary health care in  Ethiopia: a feasible challenge” accepted and published in The Journal of Clinical Epidemiology. The paper describes our experience working with community health workers in Ethiopia using mobile health data collection tools for recording and managing maternal care visits.

Here is the abstract:

Objectives: Feasibility assessment of mobile health (mHealth) data collection at primary health care in Ethiopia.

Study Design and Setting: A total of 14 health workers were recruited from 12 primary health care facilities to use smartphones,installed with customized data collection application and electronic maternal health care forms for assessing pregnant women’s health for 6 months. Qualitative approaches comprising in-depth interviews and field notes were used to document the users’ perception and experience in using the application and forms.

Results: All health workers had never had previous exposure to smartphones and electronic forms, but they got used to them easily. Over 6 months, all health workers completed a total of 952 patient records using the forms on smartphones. Health workers’ acceptability and demand for the application and forms were high. In introducing the application, nontechnical challenges were more difficult to solve than technical challenges.

Conclusion: Introducing an mHealth application at primary health care for routine collection of health data relevant to maternal health at a small scale was feasible. Nonetheless, implementing a system of assigning unique and consistent patient identifier, standardization of health services, and improving mobile network coverage would be prerequisites for scaled-up usage of such an application.