eHealth Africa and Emory University take on Schistosomiasis in Kano State, Nigeria

Chibuzor Babalola and Angela Udongwo with eHA’s Tolulope Oginni (center)

Schistosomiasis (Snail fever) is one of twenty communicable diseases classified by the World Health Organization as Neglected Tropical Diseases. The disease has dire health and economic consequences including disability, infertility, stunting in children and death.

Its close link with poor hygiene and sanitation, make its burden higher in poor, rural communities. Schistosomiasis is contracted when people are exposed to water infested by parasitic worms called Schistosomes. According to the World Health Organization, over 250 million people worldwide are affected by this disease and 90% of them live in Africa.

This public health impact drove Emory University Masters students, Angela Udongwo and Chibuzor Babalola, to partner with eHealth Africa’s Kano Lab to conduct a two-month research study in Kano State Nigeria. In this interview, they share the inspiration behind the study and their expectations for the research.

Why Schistosomiasis? What inspired this project?

We were inspired to conduct this study because of the public health impact of schistosomiasis. Nigeria is one of the Schistosomiasis-endemic countries and in fact, has the highest number of cases worldwide. Kano state is one of the five states with the highest burden of the disease in Nigeria. There is a need for more cost-effective, accurate and sensitive field applicable diagnostics to achieve the goal of eliminating the disease.

What's the purpose of this research study?

The purpose of this research is to compare the sensitivities and specifities of three diagnostic methods—polymerase chain reaction (PCR), loop-mediated isothermal amplification (LAMP) and microscopy—for detecting Schistosoma haematobium (urinary blood fluke). The research will examine the appropriateness of these methods for field diagnosis in low-resource settings and for detecting both acute and chronic schistosomiasis. We are also administering questionnaires to assess the communities' knowledge, attitudes, and perceptions about schistosomiasis.

How did you end up doing this in Kano at eHealth Africa?

eHealth Africa was accepting interns from Emory University for summer research and having introduced my research idea to one of the co-founders at a previous event in my school, I applied. eHealth Africa is providing us with the lab space and equipment to conduct this research. Our project activities are supervised by the Lab team here in Kano and we are truly blessed to have this opportunity.

Their project is supervised by eHealth Africa’s Lab coordinator, Tolulope Oginni

What do you hope to accomplish at the end of the study?

The end goal of this study is to develop a device that is capable of detecting schistosomiasis among people with a low burden of infection. We intend to use the results of this research as preliminary data for future research and grant-funded projects. In the long term, we also hope that it will provide evidence to influence the improvement of policies on field diagnosis of schistosomiasis.

Going digital improves Disease Surveillance in Sierra Leone

By Sahr Ngaujah and Nelson Clemens

According to WHO, Sierra Leone is the first country in the Africa region to fully transform its national disease surveillance system from a paper-based system to a  web-based electronic platform. This is due to the introduction of the electronic Integrated Disease Surveillance and Response solution.

Sierra Leone was one of the hardest-hit countries during the 2014 EVD outbreak in West Africa. The country’s poor disease surveillance infrastructure highlighted the need for a robust disease surveillance mechanism. Introducing an electronic method for disease surveillance reporting became one identified remedy for improving disease surveillance in a country that was still trying to catch up with the rest of the world in terms of digital technology. 

Paper-based health data recording and reporting from across Sierra Leone’s 1300 health facilities became increasingly inadequate and inaccurate and was also characterized by late reporting, incomplete district-level reports, multiple data entry errors, and difficulty storing and retrieving data.

With an expertise in health informatics, eHealth Africa (eHA) designed the electronic Integrated Disease Surveillance and Response (eIDSR) solution and has been implementing the solution in collaboration with Sierra Leone’s Ministry of Health and Sanitation (MoHS), the U.S. Centers for Disease Control and Prevention (CDC), the World Health Organization, Focus 1000, and GIZ since 2016, with  the objective to enhance disease prevention and control through the digital capture and submission of data on epidemiologically-important diseases. The eIDSR project was funded by the CDC. 

eHA customized an open source health information tool from DHIS2 for the purpose-built digital data collection and reporting. The eIDSR tool is integrated into the national health system through its compatibility with the health information systemDHIS2, which is used in over 45 countries, especially those with vulnerable health systems like Sierra Leone. eHA developed the web form and custom mobile application, piloted both, and created a Short Message Service (SMS) submission solution for health workers to submit their weekly surveillance reports in locations where internet access is weak.

Nwanyibuife Obiako, Senior Programs Manager, eHA Sierra Leone, making a statement during the eIDSR rollout closing ceremony

As of June 2019, 2758 health care workers at the health facility and district level were trained by eHA on the use of eIDSR across Sierra Leone. These health care workers now monitor 26 disease categories digitally. Digitizing health-related data has yielded positive outcomes in Sierra Leone. eHA has supported the rollout of eIDSR to all 14 administrative districts in Sierra Leone and a ceremony was held on June 6th in Tonkolili district, with participants from the MoHS and other implementing partners, to celebrate the milestone achieved.

“Thanks to eIDSR, we have seen an improvement of multiple surveillance indicators, such as reporting completeness and timeliness. It’s evident that a critical part of this success is partnership and collaboration.”

— Nwanyibuife Obiako, Senior Programs Manager, eHA Sierra Leone

Nelson Clemens, eHA’s eIDSR Project Coordinator presenting during the eIDSR rollout closing event

The eIDSR system has also enhanced:

•  Reduced data entry errors

•  Reporting completeness, timeliness, and efficiency

Reducing data entry error

Optimal data management and quality are crucial to the delivery of high-quality healthcare services. Accurate data is essential to informed decision making and appropriate public health action. In the past, when health care workers submitted their reports, there was no opportunity for their superiors to perform data quality assurance. This sometimes resulted in erroneous data being sent to the national level, reducing the quality of data used for disease surveillance in Sierra Leone. With eIDSR, digital data is now managed in an efficient manner at District and National levels and made available to all relevant parties in the quickest way possible.

“The electronic system has reduced the number of data entry errors in half, and is capturing and verifying data 60% faster than the paper-based IDSR system.”

— CDC

Reporting completeness, timeliness, and efficiency 

The eIDSR tool was created to improve the speed of the flow of information within health systems. Through the electronic Integrated Disease Surveillance Response (eIDSR) solution, disease prevention, and control is enhanced through timely electronic capture and submission of data on epidemiologically-important diseases as data can now be submitted, reviewed and acted upon near real-time.

“...My colleague Surveillance Officers would agree with me that eIDSR has relieved our stress. eIDSR roll-out commenced in the Kambia district in November 2018. A week following the roll-out, we achieved 98% of timeliness of reporting and has not gone below 90% since.”

— Usman Barrie, District Surveillance Officer, MoHS, Kambia district.

Disease surveillance plays an important role in disease prevention, control and elimination. 

eHA continues to work with its partners to ensure eIDSR is sustainable in Sierra Leone.

Modelling Disease Surveillance Systems that work in Chad and Niger

By Tope Falodun and Emerald Awa-Agwu

Participants in Maradi, Niger after the training

Functional disease surveillance systems provide data that can be analyzed to yield insight for planning, project execution, monitoring, and evaluation of public health interventions. For a priority disease like Polio, surveillance systems are important because they monitor the burden of the disease and alert health systems of any increase in the occurrence of the disease in any location of implementation, ahead of time.

A key element that is often missing in disease surveillance systems is intersectoral action. In the past, the responsibility of finding, investigating, reporting and monitoring AFP cases rested solely on the disease surveillance officers (DSOs). This resulted in incomplete data because the DSOs could not cover every single community, and also manual errors as DSOs had to enter reports using paper-based tools.  Recognizing this, eHealth Africa (eHA) partnered with the World Health Organization (WHO), Novel-T, the Bill & Melinda Gates Foundation (BMGF) and the Ministries of Health in eight countries including Chad and Niger to develop the Auto- Visual AFP Detection and Reporting (AVADAR) system for improving AFP case identification and reporting. The goal of the project was to support health systems in polio-endemic and high-risk countries to find, report and investigate AFP cases using available, context-appropriate resources, in this case, community members. 

By partnering with local communities and enlisting members to serve as informants and investigators, some of the pressure on disease surveillance officers who performed all three functions of finding, investigating, reporting and monitoring suspected AFP cases were relieved. In addition, AVADAR infused digital data management and reporting innovations through the mobile application. With this, community informants report cases of suspected AFP via the AVADAR  mobile application. The investigators receive alerts of these reports on their mobile devices, locate the cases, investigate and collect stool samples for further laboratory tests in cases of true AFPs.  

In 2017, AVADAR was launched in 6 pilot districts in Chad and three pilot districts in Niger. By 2018, the project expanded to an additional three districts in both Chad and Niger. In total, eHA trained 849 and 509 community informants in Chad and Niger respectively. eHA also supported the training of 177 investigators by the WHO in Chad and 178 investigators in Niger. Within these periods, eHA supervised the activities of the informants, investigators, and technical officers, and also resolved technical issues relating to the mobile application, telecommunication, and network access on Android phones.

Chad 1st level supports going through pre-test during the transition training in Bokoro, Chad

“AVADAR has had a great impact on AFP surveillance, directly and disease surveillance as a whole by improving communication and information transfer.”

— Mbaielde Felix, Head of Abirebi Health Area, Bokoro District, Chad

After almost three years of supporting the health systems in Chad and Niger through AVADAR, it was evident that the model worked. eHA successfully handed over the continuation of the project in the pilot districts to the Ministries of Health and the World Health Organization in Chad and Niger. A total of 109 first and second line technical support officers in the two countries, were trained to continue to handle and resolve any technical issues that may arise. 

At eHA, we support health systems to effectively monitor and eradicate communicable diseases like polio by developing and supporting the development of creative surveillance methods and innovative data management solutions.

“AVADAR has allowed us to communicate with the informants, the district management team and the health delegation on the report of other diseases other than the AFP.”

— Abakar Mahamat Kalbassou, Head of Abgode Health Area, Bokoro District, Chad

Innovations in Newborn Sickle Cell Screening

By ZIllah Waminaje

In Africa, 50% to 90% of children who have sickle cell die before their fifth birthday1. To improve their chances of survival, health systems must integrate Newborn Screening (NBS) for Sickle Cell Disease (SCD) with comprehensive treatment and management plans.

For almost five decades, newborn screening for SCD has been conducted using conventional procedures such as electrophoretic techniques, isoelectric focusing (IEF), high-performance liquid chromatography (HPLC) and DNA analysis, which require specialized laboratories with stable electricity, long sample processing times, expensive equipment and reagents, and highly skilled personnel. These methods, while ideal and feasible for developed countries, are inappropriate for low-resource settings like sub-Saharan Africa where 70% of SCD sufferers reside.

Screening with Sickle SCAN Device

Sickle SCAN is an innovative, cost-effective point-of-care (POC) device that has been developed by Biomedics Inc. to address the challenges of SCD diagnostics in low-resource settings. It is a simple rapid point-of-care test kit that can detect the presence of Hemoglobin A, S, and C and yield results within 5 minutes using blood from a heel/ finger prick or vein. In addition to newborn screening, the Sickle SCAN device can be used for premarital/preconception genetic counseling, blood donor screening, and general screening.

Sickle SCAN

Several features make the Sickle SCAN ideal for low-resource settings and large-scale mass screening programs. The first is that it does not require specialized technical knowledge to administer or read the test results. Anyone can be trained to use the device. The device does not require any special equipment or electricity and thus, eliminates the time, resources and logistics needed to transport samples to a laboratory. Finally, the short result turnaround time allows for the prompt identification of SC-positive babies so that early treatment can commence and survival rates can improve.

Since December 2018, eHealth Africa has partnered with Sickle Cell Well Africa Foundation (SCWAF), Pro-Health International and the Presidential Committee on the North- East Initiative (PCNI) to hold Sickle Cell awareness and testing outreaches in Adamawa, Bauchi, and Gombe states. Over 1000 people in all three states were screened using Sickle SCAN rapid diagnostic test kits. Patients who tested positive for sickle cell disease were immediately given routine medication and referred to sickle cell clinics.

Sickle Cell Outreach in Hong LGA, Adamawa

Since healthcare in many African countries is community-based, rapid POC test kits like the Sickle SCAN can be easily integrated into existing health programs like routine immunization at primary health care centers or health insurance schemes to facilitate universal screening and ensure sustainability. This will ensure that relevant data on SCD births, morbidity and mortality rates and long term outcomes are captured.

Sickle Cell Awareness and Testing Outreach in Toro LGA, Bauchi

eHealth Africa continues to work with partners to address health inequalities by ensuring equal access to quality and effective diagnostic tools to achieve universal health coverage.

Expanding Cornbot to fight food insecurity

Chinedu Anarodo and Cornelius Adewale at the award ceremony

Last year, eHealth Africa’s CornBot Application was one of the finalists for the Fall Army Worm Tech Prize. The application received the Frontier Innovation Award for its ease of use and human-centric design. CornBot also received $50,000 in prize money. Six months later, CornBot’s, Chinedu Anarado and Cornelius Adewale share their progress and how they are using the prize money to expand CornBot so that the solution addresses more challenges in nutrition and food security.

Why did you develop CornBot?

One of eHA’s focus areas is Nutrition and Food Security Systems. Our goal with this program is to provide nutrition stakeholders at all levels of the value chain, with technological tools and data so that vulnerable populations in West Africa can have access to nutritious food.

When USAID called for innovations to address Fall Armyworm (FAW), a major pest that destroys various crops worth $2.4bn – $6bn annually, predisposing communities to food insecurity, we knew we had to respond. We partnered with the Washington State University (WSU) to design and build CornBot, a mobile application, that interacts with farmers in their local dialect and guides them through the process of detecting, preventing and treating FAW infestation on their farms. The application is synced to a dashboard to enable us and other stakeholders to easily aggregate data on FAW infestation and make informed decisions.

What scenario mapped the transition from CornBot to FMT?

After we received the Frontier Innovation Award and the prize money, we started thinking about what we could do to expand CornBot. During the field testing phase as well as during other field research carried out by WSU, we realized that smallholder farmers needed more than just a pest detection tool—they needed a platform where they could exchange and receive guidance and knowledge to increase their productivity. We then decided to invest the prize money in building a platform where farmers can gain additional information to enable them to yield as much as possible from their farms, in line with the Good Agricultural Practices (GAP) put forward by the Food and Agriculture Organization (FAO). So, CornBot went from an idea that helps in combating farm pests, to a platform for providing guidance on farming practices as a whole. For now, we call it the Farm Management Tool.

What do you hope to accomplish with the Farm Management Tool?

Farmers in Kano using Cornbot to identify FallArmy Worm

Overall, we want to improve the quality of livelihood among smallholder farmers and strengthen the resilience of communities against food insecurity. We know that by making small changes in their farming processes and decisions, and by adopting good agricultural practices, farmers can increase the crop yield from the same plot of land. They just do not know how to. Many of these farmers have been doing things the same way for years without ever knowing why. Our goal is to arm them with relevant information and ensure that they can produce more crops. If we can achieve this, it will be a huge success and it means that our solution is viable.  

What first steps have you taken?

We are currently working to build a mobile application. However, we held a workshop with 40 smallholder farmers in April to glean baseline data about their current agricultural practices, their level of knowledge, and current challenges, and to introduce them to our project and the concept of good agricultural practices. They have agreed to work with us for the pilot scheme and testing, as well as map out portions of their farmlands to test our concepts. We have also commenced field operations such as soil sample testing to understand the existing soil composition and what kinds of fertilizers will be needed.

The idea is to “hand-hold” the farmers throughout the planting season and see if there are significant differences from their previous outputs.

We are very excited about this platform and the possibilities that it presents for addressing food insecurity in communities across West Africa.

Meet the Team - Mohamed Sulaiman Kamara

Meet Mohamed Sulaiman Kamara, a die-hard Arsenal fan and the Chief Accountant in our Sierra Leone office!

Mohamed joined eHealth Africa (eHA) as a Project Accountant in 2017 and was promoted to this current position after consistent hard work and excellent performance. Mohamed has always worked closely with his team to ensure that they are working towards their team goals and the organization’s overall goals.

Mohamed’s role is a challenging but exciting one, he and his team primarily support all projects by ensuring their accounting and finance processes and procedures are in line with best practices. He ensures the books are closed on a monthly basis in compliance with regulatory standards and makes sure that all the i’s are dotted and t’s crossed for audits. Mohammed also guides and mentors the project accountants, he provides technical support to them when needed and ensures his team remains high performing.

For him, the most rewarding part of his job is the challenges. These challenges help him think critically and innovatively to come up with solutions. Mohammed also enjoys working with diverse teams that include partners and stakeholders, they ensure that no two days are the same at eHA.

In addition to his love and passion for Accounting and Arsenal, Mohammed loves reading motivational books and listening to business news.