Malaria and Pneumonia: Diagnosing the Problem in East Africa

Malaria and Pneumonia in East Africa

In May 2018 the World Health Organisation agreed a new strategic plan for the next five years that aims to help deliver the Sustainable Development Goals. Under the Health and Wellbeing initiative the UN agreed a goal by 2030 to end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.

Despite vast amounts of funding there is still plenty of work to be done to eradicate epidemics in malaria and other diseases such as pneumonia. This is not through failure to deliver, as there has been significant progress made, but rather it is the scale of the challenge: globally there are still 920 000 deaths in children under 5 years old of pneumonia every year, and 303 000 deaths in Africa alone caused by malaria. With the right access to diagnosis and treatment the scale of mortality is entirely preventable.

A COMPLEX HEALTH PROBLEM IN EAST AFRICA

Extensive public education programmes across East Africa have successfully highlighted the risk and symptoms of malaria to the public and have done much to reduce the burden, but an unprecedented effect is that common symptoms of the illness, such as fever and nausea, are immediately thought to be caused by the parasite rather than looking for an accurate diagnosis.

Malaria and pneumonia in particular exhibit very similar symptoms. It is highly uncommon that a patient is infected by both diseases and misdiagnosis will put the patient’s life at risk. Moreover, the incorrect use of over the counter medicines also accelerates antibiotic and antimalarial drug resistance.

For children under the age of 5, malaria is diagnosed through blood sample analysis. Pneumonia diagnosis is less invasive but requires careful monitoring of breathing and fever and in some cases referral to larger health centres is necessary for chest x-rays. These procedures require a degree of expertise and training to perform; while this exists at health facilities, doctor to patient ratios are low throughout regions of East Africa contributing to caseloads becoming overwhelming during peak periods.

The most needy populations across East Africa are often situated far from adequate care facilities. Communities have access to different levels of service and expertise depending on location, and community clinics often have to deal with so many patients that key tasks are often delegated to nursing staff who do not have the deep levels of training required. Currently many countries are trialling electronic and mobile health care solutions. Termed Telemedicine, this is a process of bringing expertise into the care facility or home when geographical distance is an issue. While the potential benefits are well understood, uptake has been slow because of the shortage of health professionals; a lack of government support; a rapidly growing population which is outstripping the production of health workers; unstable power provision; and high telecommunication cost. Alternative solutions are required so that accurate diagnosis can be provided quickly.

LOCAL INNOVATION FOR A GLOBAL PROBLEM

Two teams of researchers in Kampala, Uganda are attempting to tackle these issues at home; developing truly innovative technology in the process. In doing so they have highlighted some of the challenges in developing and taking a product to market, not only in their home country, but across the Sub-Saharan African continent.

Matibabu and MamaOpe are both healthcare technology developers. One was born in the Computer Science labs of Makerere University in Kampala, the other was formed after a family member of one of the co-founders sadly lost their life due to the mis-diagnosis of pneumonia.

Matibabu’s vision is to connect healthcare with communities through the provision of low-cost medical devices. They are currently developing a hardware device that uses the principles of light-scattering and magnetism to detect red blood cells infected by the malaria parasite. By leveraging mobile technology they can convert the results to provide the end-user with a simple and easily-interpretable diagnosis.

MamaOpe is developing a wearable diagnostic vest for children under 5 to accurately diagnose pneumonia. It uses simple, low-cost, durable technology to identify the distinct breathing patterns of the disease and presents a diagnostic result to the medical practitioner in a matter of minutes without the need for laboratory tests and lengthy analysis times.

UNDERSTANDING THE UGANDAN HEALTHCARE SYSTEM

Both of these solutions combine to tackle the same fundamental constraint: resource. Currently the doctor to patient ratio is extremely low in Uganda (around 8 physicians to 100,000 patients). The trend for remote doctor to patient relationships and outsourcing some of the more basic analysis to junior staff has become a means of dealing with the long patient queues. What MamaOpe and Matibabu have achieved through use of data and clever algorithms is to provide a diagnosis that even someone with zero medical expertise can understand. Tracking this data also means that they have the opportunity to create data sets of infection across the country in real-time which could enable governments to be more targeted with the resources they have available in times of need.

The medical system in Uganda is extremely fragmented. Tiers of services, public and private, are designed to provide healthcare from rural communities to large towns and cities. The need for a low-cost solution is greatest in the rural health clinics where demand is often very high, and medical resources are spread thinly. An effect of the low doctor to patient ratio is that medical practitioners are too busy to provide peer-to-peer advice and training, so adoption of new technology can become a hard sell. To access the smaller clinics both MamaOpe and Matibabu must ensure the technology can be adopted first by national and regional referral hospitals, followed by smaller hospitals and eventually clinics. In doing so they plan to work collaboratively with the healthcare community to develop training materials. Additionally, Matibabu and MamaOpe must also consider the patient education required to provide assurance that the new device is as accurate as the traditional tests. Initial feedback in early trials indicated that the majority of patients would prefer the traditional blood test as it was perceived as a more trustworthy source. For a parent who is already worried about the health of their young child, convincing them that the new test is as accurate is a huge hurdle.

Even before the teams can take their product to market they must first navigate the regulatory system and take their devices through several long rounds of clinical trials. Taking a medical device to market means adhering to strict laws which govern the quality and ethics of the device. Finding experts able to support through this journey has been a challenge, however both teams are supported by the ResilientAfrica Network, a partnership of 18 Universities across 13 Countries funded by USAID. RAN offer the teams guidance and access to expertise, as well as access to funding through the ResilientAfrica Network to help develop and pilot scalable solutions.

A GLOBAL REACH THROUGH CORPORATE COLLABORATION

The really exciting aspect of MamaOpe’s and Matibabu’s visions is their global potential. Pneumonia and malaria affect people around the world. Those in rural and less-wealthy urban communities are impacted disproportionately and building out tailored go-to-market strategies requires a deep understanding of the communities and the healthcare systems. Developing a macro level understanding is critical and partnerships with corporates with relevant expertise could be vital to their success, helping provide assistance both with gaining necessary regulatory and legal approval, and with developing a strategy that facilitates the scale- up required to meet global demand.

The Baobab Network ran a week long Entrepreneur in Residence programme linking the MamaOpe and Matibabu teams with consultants and investment specialists from across the globe to assist with developing their financial models, go-to-market strategies and build out their development roadmaps. While the paths to take their products to market are complex, both teams are driven by a desire to tackle a local issue affecting some of the vulnerable members of society.