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Health worker mobile top-up usage analysis

Earlier this week one of my research colleagues sent me a spreadsheet with the breakdown for the last 6 months (Sept 2012 to Feb 2013) of how the health workers in our project have been making use of voice, SMS and data on their smartphones. The breakdown looks like this:

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The data shows that each health worker (per month) makes approximately 160 mins of voice calls, downloads 27Mb of data and sends 3 SMSs.

Few notes and comments:

  • the data was directly from the mobile company – not from any analysis tools/apps installed on the phones, so is about as accurate as we’d ever be able to get
  • in the data above I’ve only included the health extension workers and midwives, the supervisors usage is not included (although we have figures for them too)
  • we are giving 100 birr top-up per month to each health worker and we don’t restrict what this can be used for
  • for the data it’s clear that the the health workers are adding their own top-up balance too (in addition to the 100 birr we give)

What interesting for us is that the health workers are clearly using the data connection for much more than simply submitting the protocol forms and the accessing the mobile scorecard, although at an average of 27Mb per month, this is a long way from the 500Mb+ per month many people in EU/US often get through.

The very low level of text messaging (less than 3 SMSs sent per month) is also very interesting to see. One possible reason for this (and this also came from our baseline survey interviews) was that the health workers don’t use text messaging because they are not confident in using the Latin alphabet, or perhaps they know the recipient of the message cannot read the Latin alphabet, or doesn’t have a Ge’ez capable phone.

There’s a lot more analysis and info we how we can get from this data – especially when we look at matching up usage of the patient management tools and whether increased usage of these tools also corresponds to increased data usage – but we’ll save much of this for our upcoming technical paper.

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New research paper: Risk factors for intestinal parasitic infections

Mahmud, one of the phd students we’ve been working with the last couple of years, has just had a new research paper published, “Risk factors for intestinal parasitosis, anaemia, and malnutrition among school children in Ethiopia”. The full article can be found here, but here is the abstract:

Research on associated risk factors for intestinal parasitic infections and malnutrition in various geographic regions is needed for the development of appropriate control strategies. The aim of this study was to determine the risk factors associated with intestinal parasitic infections, anaemia, and malnutrition in schoolchildren, living in urban and rural areas of northern Ethiopia. Six hundred school children, aged 6–15 years,were randomly selected in a cross-sectional survey from 12 primary schools. Sociodemographic andanthropometric data were collected. Faecal samples were examined using direct, concentration, and the Kato–Katz methods. Urine specimens were analysed for Schistosoma haematobium ova. Haemoglobinwas measured using a HemoCue spectrometer. The overall prevalence of intestinal parasitosis was 72%(95% confidence interval (CI): 66–76%). The prevalence of anaemia, stunting, and thinness were 11% (95%CI: 8–13%), 35% (95% CI: 31–38%), and 34% (95% CI: 30–38%), respectively. Poor personal hygiene habits were generally associated with anaemia and nutritional deficiency (low body mass index). Multivariate logistic regression models related Schistosoma mansoni infection with boys. Boys were also more likely to be malnourished. Hookworm infection was associated with anaemia and unhygienic fingernails. Access to clean water and latrines, with some hygiene and sanitation communication activities, could improve health of children in Ethiopia. The use of smartphone technology in demographic data collection proved to be successful. The potential advantage offered by this technology for parasitological field surveys merits further investigation.

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New thin client lab at ECSU

We’ve recently been collaborating with Escape Computing, an Addis-based company specializing in providing thin client and zero client solutions and services. Over the last 2 weeks, our colleague Edu has been over in Ethiopia, with Simon from Escape Computing, to set up a new thin client lab at the Ethiopian Civil Service University. We anticipate this new lab can be used as a showcase/demonstration to other educational institutions looking to provide scalable, cost-efficient and supported computer access for their students. I’ll post up some more of the technical detail of the new lab set-up in the coming days, but for now, here are a few photos of the new lab:

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Patient visit records graph

Here’s a graph of the numbers of patient visit records the HEWs have been submitting over the last year or so (click to view a larger version):

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The numbers of visit records submitted have been grouped by week, we’re not yet sure why there seem to be so many peaks & troughs in the numbers submitted each week, although the increase in the last couple of months will be attributable to us now having more HEWs and midwives working with us – in total we now have around 30 HEWs and midwives, it varies quite often as staff go away for further study, move on to other jobs, or go on maternity leave.

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Patient management tools – one year on

Our group of HEWs and midwives have now been using the ODK-based patient management tools for just over a year – that is using the tools with actual patients, they were using the tools for several months before this just for testing and for refining the patient visit forms.

Despite only working with a small group of HEWs and midwives (although recently approx 20 more joined the project), we now have over 1000 patients (pregnant mothers) registered who have attended ante-natal care or post-natal care visits. We also have nearly 300 deliveries recorded, although given we have 1000 pregnant mothers, we would expect this to increase substantially in the coming months.

Looking back over the patient visits forms submitted each day, we can see that the HEWs and midwives are making use of the tools more regularly, although we still see spikes in the number of forms submitted on some days – likely to coincide with ‘immunization days’ when more people attend the health centres/posts.

Now that we’re building up a lot of experience, data and knowledge in how the tools are being used, As I’ve already posted up (here and here) Araya has already had a couple of research papers published in this area, and we’re now working on completing the feasibility study and technical papers.

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