Brian DeRenzi

E-imci: improving pediatric health care in low-income countries

Every year almost 10 million children die before reaching the age of five despite the fact that two-thirds of these deaths could be prevented by effective low-cost interventions. To combat this, the World Health Organization (WHO) and UNICEF developed the Integrated Management of Childhood Illness (IMCI) treatment algorithms.n In Tanzania, IMCI is the national policy for the treatment of childhood illness. This paper describes e-IMCI, a system for administering the IMCI protocol using a PDA. Our preliminary investigation in rural Tanzania suggests that e-IMCI is almost as fast as the common practice and potentially improves care by increasing adherence to the IMCI protocols. Additionally, we found clinicians could quickly be trained to use e-IMCI and were very enthusiastic about using it in the future.

Mobile phone tools for field-based health care workers in low-income countries.

In low-income regions, mobile phone-based tools can improve the scope and efficiency of field health workers. They can also address challenges in monitoring and supervising a large number of geographically distributed health workers. Several tools have been built and deployed in the field, but little comparison has been done to help understand their effectiveness. This is largely because no framework exists in which to analyze the different ways in which the tools help strengthen existing health systems. In this article we highlight 6 key functions that health systems currently perform where mobile tools can provide the most benefit. Using these 6 health system functions, we compare existing applications for community health workers, an important class of field health workers who use these technologies, and discuss common challenges and lessons learned about deploying mobile tools.

Improving community health worker performance through automated SMS

Community health workers (CHWs) have been shown to be an effective and powerful intervention for improving community health. Routine visits, for example, can lower maternal and neonatal mortality rates. Despite these benefits, many challenges, including supervision and support, make CHW programs difficult to maintain. An increasing number of mHealth projects are providing CHWs with mobile phones to support their work, which opens up opportunities for real-time supervision of the program. Taking advantage of this potential, we evaluated the impact of SMS reminders to improve the promptness of routine CHW visits, first in a pilot study in Dodoma, Tanzania, followed by two larger studies with 87 CHWs in Dar es Salaam, Tanzania. The first Dar es Salaam study evaluated an escalating reminder system that sent SMS reminders directly to the CHW before notifying the CHWs supervisor after several overdue days. The reminders resulted in an 86% reduction in the average number of days a CHWs clients were overdue (9.7 to 1.4 days), with only a small number of cases ever escalating to the supervisor. However, when the step of escalating to the supervisor was removed in the second study, CHW performance significantly decreased.

Engaging Pregnant Women in Kenya with a Hybrid Computer-Human SMS Communication System

A growing body of HCI4D research studies the use of SMS communication to deliver health and information services to underserved populations. This paper contributes a novel dimension to this field of study by examining if a hybrid computer-human SMS system can engage pregnant women in Kenya in health-related communication. Our approach leverages the different strengths of both the computer and the human. The computer automates the bulk-sending of personalized messages to patients, allowing the human to read patients replies and respond to those in need of attention. Findings from a 12-month deployment with 100 women show that our approach is capable of engaging the majority of participants in health-related conversations. We show that receiving messages from the system triggers participant communication and the amount of communication increases as participants approach their expected due date. In addition, analysis of participants messages shows that they often contain sensitive health information conveyed through a complex mixture of languages and txting abbreviations, all of which highlight the benefits of including a human in the workflow. Our findings are relevant for HCI researchers and practitioners interested in understanding or engaging underserved populations.

Value-Sensitive Design and Health Care in Africa

In this paper, we describe our approach of using value-sensitive design to guide the design, development, and implementation of health information systems for use in rural areas of two developing countries in Africa. By using shared conceptual investigation, we are able to create a generalized list of stakeholders and values that span multiple projects without losing any of the power of the conceptual investigation. This process can be applied to other projects to develop a stronger set of stakeholders and values. We also present a technical investigation of a vaccine delivery project in Sub-Saharan Africa and plans for an upcoming empirical investigation for a mobile-phone-based support tool for community health workers in East Africa.

Automated quality control for mobile data collection

Systematic interviewer error is a potential issue in any health survey, and it can be especially pernicious in low- and middle-income countries, where survey teams may face problems of limited supervision, chaotic environments, language barriers, and low literacy. Survey teams in such environments could benefit from software that leverages mobile data collection tools to provide solutions for automated data quality control. As a first step in the creation of such software, we investigate and test several algorithms that find anomalous patterns in data. We validate the algorithms using one labeled data set and two unlabeled data sets from two community outreach programs in East Africa. In the labeled set, some of the data is known to be fabricated and some is believed to be relatively accurate. The unlabeled sets are from actual field operations. We demonstrate the feasibility of tools for automated data quality control by showing that the algorithms detect the fake data in the labeled set with a high sensitivity and specificity, and that they detect compelling anomalies in the unlabeled sets.

Reliable data collection in highly disconnected environments using mobile phones

Over four and a half billion people live in the developing world and require access to services in the financial, agricultural, business, government and healthcare sectors. Due to constraints of the existing infrastructure (power, communications, etc), it is often difficult to deliver these services to remote areas in a timely and efficient manner.n The CAM framework has found success as a flexible platform for quickly developing and deploying high-impact applications for these environments. Many of the applications built with CAM have relied on a model where a field worker with a mobile phone regularly returns from a disconnected environment to one with connectivity. In this connected state, the phone and a centralized server can exchange information and get the collected data backed up on reliable media.n We propose extending CAMs networking model to enable continual operation in disconnected environments. Using a set of heterogeneous paths made available through social and geographic relationships naturally present among workers, we describe a system for asynchronously routing data in a best-effort manner.

Exploring time/resource trade-offs by solving dual scheduling problems with the ant colony optimization

Design space exploration during high-level synthesis is often conducted through ad hoc probing of the solution space using some scheduling algorithm. This is not only time consuming but also very dependent on designers experience. We propose a novel design exploration method that exploits the duality of time- and resource-constrained scheduling problems. Our exploration automatically constructs a time/area tradeoff curve in a fast, effective manner. It is a general approach and can be combined with any high-quality scheduling algorithm. In our work, we use the max-min ant colony optimization technique to solve both time- and resource-constrained scheduling problems. Our algorithm provides significant solution-quality savings (average 17.3% reduction of resource counts) with similar runtime compared to using force-directed scheduling exhaustively at every time step. It also scales well across a comprehensive benchmark suite constructed with classic and real-life samples.

Using behavioral data to identify interviewer fabrication in surveys

Surveys conducted by human interviewers are one of the principal means of gathering data from all over the world, but the quality of this data can be threatened by interviewer fabrication. In this paper, we investigate a new approach to detecting interviewer fabrication automatically. We instrument electronic data collection software to record logs of low-level behavioral data and show that supervised classification, when applied to features extracted from these logs, can identify interviewer fabrication with an accuracy of up to 96%. We show that even when interviewers know that our approach is being used, have some knowledge of how it works, and are incentivized to avoid detection, it can still achieve an accuracy of 86%. We also demonstrate the robustness of our approach to a moderate amount of label noise and provide practical recommendations, based on empirical evidence, on how much data is needed for our approach to be effective.

USSD: The Third Universal App

In this paper we argue for the use of Unstructured Supplementary Service Data (USSD) as a platform for universal cell phone applications. We examine over a decade of ICT4D research, analyzing how USSD can extend and complement current uses of IVR and SMS for data collection, messaging, information access, social networking and complex user initiated transactions. Based on these findings we identify situations when a mobile based project should consider using USSD with increasingly common third party gateways over other mediums. This analysis also motivates the design and implementation of an open source library for rapid development of USSD applications. Finally, we explore three USSD use cases, demonstrating how USSD opens up a design space not available with IVR or SMS.