Making strides in Uganda with unique program
Many deadly diseases that are no longer a threat in the U.S. are on the rise in other countries. Tuberculosis (TB), for instance, has been curable for over 50 years but still kills nearly 2 million people annually. The drugs that can cure TB are cheap, powerful, and able to cure almost all new cases. But the epidemic is driven by an old problem—inefficient management practices that do not ensure that all infectious patients are completely cured. And there's a new threat—the rapid spread of HIV can cause old, latent TB infections to break out in people who would otherwise probably never fall ill. Since an estimated 2 billion people today have latent TB infections, the spread of HIV can trigger a TB epidemic.
New approaches using computer technology offer better management of tuberculosis patients so that nearly all of them can be cured. One such effort is taking shape in Uganda, a country with one of the world's highest TB rates. The program uses an application running on HP iPAQ Pocket PCs to monitor every patient's diagnosis, medication, and documented progress toward cure. This allows early action to help patients who are not progressing, and makes local, regional, and national authorities knowledgeable and accountable about what is happening in health facilities and among care givers in their areas.
With better management information there can be few excuses for infectious patients remaining ill and further spreading the TB germ. Just as importantly, nearly 100% of all new cases can be monitored so that drug-resistant forms of TB do not develop due to ineffective, repeated treatment of patients. Both foreign aid agencies and domestic governments benefit when field data is quickly integrated with a country's health ministry TB database. This improves the success of the TB fight, encourages the responsible use of money, and eliminates the delays and inefficiencies associated with traditional paper records.
Field trials are underway with 200 patients in the Kanungu District, one of the poorest areas in Uganda that has one of the country's highest TB rates. While Pocket PCs have previously been used for collecting field data in disease surveys, this may be the first time they are playing a key role in an active public health program.
New eHealth initiative
The heart of this program is a Pocket PC application called eDOTS, developed and managed by International Development Projects (IDP), a Bakersfield, California-based non-profit organization (http://www.idpintl.org). The program is an "eHealth intervention"—an emerging area of Public Health using information and communication technology (ICT) to improve the delivery of care. It includes a complete rural health care infrastructure by combining technology, medical services, and community involvement.
eDOTS (Fig. 1) is an electronic equivalent of the DOTS record-keeping system. DOTS (Directly Observed Treatment Short-course) was developed by the World Health Organization (WHO) for treating TB worldwide. When followed correctly, the DOTS strategy quickly turns infectious patients into non-infectious patients, which breaks the cycle of transmission, thus protecting the patient's family and their community. The DOTS program mandates careful monitoring, especially during the initial weeks of intensive treatment while the patient is still infectious. But just as important is monitoring after the period of intensive treatment but while the patient is still on a less demanding drug regime.
Fig. 1: The eDOTS application runs on HP iPAQ Pocket PCs.
In countries like Uganda, one health worker often manages a large numbers of cases. One of the biggest problems is maintaining detailed daily tracking and monitoring of the TB patients to ensure that they are complying with their treatment, and that their TB is in fact being cured.
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