A mobile health technology platform for quality assurance and quality improvement of malaria diagnosis by community health workers
Open accessAbstract
BACKGROUND: Community health workers (CHWs) play an important role in improving access to services in areas with limited health infrastructure or workforce. Supervision of CHWs by qualified health professionals is the main link between this lay workforce and the formal health system. The quality of services provided by lay health workers is dependent on adequate supportive supervision. It is however one of the weakest links in CHW programs due to logistical and resource constraints, especially in large scale programs. Interventions such as point of care testing using malaria rapid diagnostic tests (RDTs) require real time monitoring to ensure diagnostic accuracy. In this study, we evaluated the utility of a mobile health technology platform to remotely monitor malaria RDT (mRDT) testing by CHWs for quality improvement. METHODS: As part of a large implementation trial involving mRDT testing by CHWs, we introduced the Fionet system composed of a mobile device (Deki Reader, DR) to assist in processing and automated interpretation of mRDTs, which connects to a cloud-based database which captures reports from the field in real time, displaying results in a custom dashboard of key performance indicators. A random sample of 100 CHWs were trained and provided with the Deki Readers and instructed to use it on 10 successive patients. The CHWs interpretation was compared with the Deki Reader's automatic interpretation, with the errors in processing and interpreting the RDTs recorded. After the CHW entered their interpretation on the DR, the DR provided immediate, automated feedback and interpretation based on its reading of the same cassette. The study team monitored the CHW performance remotely and provided additional support. RESULTS: A total of 1251 primary and 113 repeat tests were performed by the 97 CHWs who used the DR. 91.6% of the tests had agreement between the DR and the CHWs. There were 61 (4.9%) processing and 52 (4.2%) interpretation errors among the primary tests. There was a tendency towards lower odds of errors with increasing number and frequency of tests, though not statistically significant. Of the 62 tests that were repeated due to errors, 79% achieved concordance between the CHW and the DR. Satisfaction with the use of the DR by the CHWs was high. CONCLUSIONS: Use of innovative mHealth strategies for monitoring and quality control can ensure quality within a large scale implementation of community level testing by lay health workers.
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As digital technologies support data collection, outcome reporting, surveillance, and communication, there are opportunities to improve health system efficiency and quality of care.
“As digital technologies support non-specialist health workers in data collection, outcome reporting, surveillance, and communication with patients and supervisors, there are important opportunities to inform continuous improvements to the efficiency of health systems and the quality of care delivered.23,49”
From Digital Technology for Building Capacity of Nonspecialist Health Workers for Task Sharing and Scaling Up Mental Health Care Globally (2019) · cites this paper as [49]
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- Authors
- Laktabai, J., Platt, A., Menya, D., Turner, E. L., Aswa, D., Kinoti, S., & O’Meara, W. P.
- Affiliations
- Moi University (KE)
- Duke University (US)
- AMPATH (KE)
- Fio Corporation (Canada) (CA)
- Corresponding author
- Laktabai, Jeremiah
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2018-02-01
- Volume
- 13
- Issue
- 2
- Pages
- e0191968
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC5794091
- OpenAlex
- W2792976195
- Cited by
- 39
- References
- 19
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 10 · 2023: 8 · 2022: 3 · 2021: 4 · 2020: 4 · 2019: 3 · 2018: 4
- FWCI
- 5.73
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Clinical and translational science award (UL1TR001117)
- National Institute of Allergy and Infectious Diseases (R01AI110478)
- Topics
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Malaria Research and Control
- Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
- Keywords
- malaria rapid diagnostic tests, community health workers, mobile health, distant supervision, quality assurance, quality improvement, point-of-care testing, diagnostic accuracy, cloud-based data collection, key performance indicators
- MeSH terms
- Adult, Community Health Workers, Female, Humans, Kenya, Malaria, Male, Middle Aged, Telemedicine, Biomedical Technology, Quality Improvement
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