Mobilising a health revolution

On how the mHealth application strengthens TB detection and referrals

Doctor working with smartphone and digital tablet while touching the screen

It is no longer in the realm of contest if mobile health technologies are beneficial to health delivery and monitoring systems across the globe. With a rapidly expanding mobile user base and the availability of affordable data packages, mobile technology, it is clear, has come to stay in the health-care segment. Health-care professionals, who do harness technology, have continued to do so simply because of the enormous benefits they confer, not only to the process and delivery of health care itself but also for patients and their relatives.

From using mobile phones to facilitate retinal scans and even test one’s blood pressure — with or without accessories, from remote locations beamed on to the high-resolution screens in tertiary care centres — to using mobile phone cameras to videograph surgeries, using the mobile phone for health behaviour change communication, and the humble not-so-smart phone to merely text in vital public health information used by literally the last link in the public health pyramid, mHealth has come to stay.

Aiding the TB fight

More recently, researchers have tried to use mHealth as a battering ram in the hope of overcoming what is acknowledged as an intractable area of public health in India — tuberculosis case referrals. In India, statistics show that tuberculosis remains a major public health problem accounting for 23% of the global TB burden, and worse still, has a truculent hurdle in terms of reportage of cases. S. Chandha, A. Trivedi and K. Sagili of the International Union Against Tuberculosis and Lung Disease and S.B. Nagaraja say that mHealth technology has been highly effective in trying to address these concerns and increased both public and private health-care provider accountability to patients.

Despite efforts by the Revised National TB Control Programme (RNTCP), India has up to a third of the estimated three million TB cases that remain unnotified worldwide, they record in a paper in the June edition of

Public Health Action .

A project in Jharkhand

A mobile health (mHealth) technology-based application was developed to help rural health-care providers (RHCPs) identify and refer presumptive TB patients to the nearest microscopy centre for sputum examination using mobile applications on their smartphones. The project was implemented in the tribal population of Khunti district, Jharkhand.

Thirty of 171 rural health-care providers were trained to use an application to identify and refer patients with symptoms of TB. Of the 194 TB cases diagnosed, those using the app contributed 127 cases. The RHCPs installed the patient information management app, ‘ComCare’, on their phones. Any person believed to show symptoms of TB is usually referred to a microscopy centre, but seldom is there follow-up with the patient.

In addition to connecting the RHCP and labs virtually, the app was also configured to send a reminder to the patient if he or she failed to visit the microscopy centre within seven days of referral, besides providing counselling messages to the patient.

As a result, in addition to enhancing the number of referrals, it also reduced the time taken for diagnosis and treatment initiation. RHCPs using the technology referred nearly nine times more presumptive TB cases than other RHCPs. Diagnosis and treatment initiation via the app were eight to nine times more rapid than when it was not used, leading the authors to suggest that innovative mHealth use has the potential for replication across the country, specifically to fast-track the progress made in TB case detection and treatment.

ramya.kannan@thehindu.co.in