A shift in the global health burden from communicable diseases to non-communicable diseases has led to increased morbidity and mortality rates in the developing world. The situation further intensifies in low- and middle-income countries (LMICs) due to major inadequacies of health systems in response to emerging health challenges. Pakistan faces a similar situation with an increasingly high number of people suffering from hypertension, dyslipidemia, cardiovascular diseases and diabetes mellitus. An estimated 2000 people die each day from a serious cardiovascular incident in Pakistan. The 2010 Global Burden of Disease data estimates about 3.87 million premature deaths as a result of cardiovascular diseases by 2025.
AKDN dHRC in collaboration with the Department of Medicine at the Aga Khan University designed and developed Meri Shifa (meaning ‘my health’ in the local Urdu language), which assists with early detection and management of cardiovascular disease patients. The application was developed as a part of pilot feasibility study, funded by the George Institute for Global Health, to demonstrate feasibility of leveraging the power of mHealth together with the infrastructure of one of the largest health care systems in Pakistan to provide an early, preventive health care plan with potential national consequences to inform policy and practice.
The Meri Shifa app consists of a mobile application and a web portal, which assists in the early detection and management of cardiovascular diseases (CVDs) in individuals at risk through screening, referrals, treatment and lifestyle modifications. The app facilitates convenient, real-time management of patients at risk of CVDs and generates real-time reports. The app has the ability to function in online and offline modes, allowing access around the clock. It is adapted for use in LMIC settings and encompasses several questionnaires: Indian Diabetes Risk Score (IDRS); International Short Physical Activity Questionnaire; Global Adult Tobacco Survey; Food Frequency Questionnaire; Questionnaire to Verify Stroke Free Status; Rose Angina screening; and direct questions to detect hypertension. Based on the answers the integrated Artificial Intelligence (AI) algorithms categorize each participant into low, moderate or high risk categories. All information is saved offline in the app and synchronized with the central server upon availability of internet connectivity. Moderate to high risk individuals undergo further clinical investigations and teleconsultation through the app. Lifestyle change messages are sent to participants to ensure on-going support. During the clinical investigation, a health care provider records findings on the Meri Shifa web portal.
The project aims to capitalize on an existing infrastructure of 270 laboratories and 16 integrated medical centres across Pakistan. Currently, the pilot study is ongoing in a union council of the Malir Town in Karachi. Interested individuals were enrolled to the study though a registration form with in the app. This app is currently being tested for real-time efficacy as it provides digital prescriptions.
AKDN dHRC developed an mHealth application, PurUmeed Aghaaz, for a research study aiming to assess the effectiveness of web-based/mHealth coaching in improving the nutrition and use of supplements (folic acid, iron and Vitamin D) during pregnancy compared to standard counseling.
The PurUmeed Aghaaz application has been developed as a component of a research project based on the Barker’s hypothesis of the fetal origin of adult disease. The Barker hypothesis suggests that poor nutrition during the antenatal period will not only affect pregnancy outcome, but may also derange epigenetic programming.
The PurUmeed Aghaaz mobile application is designed to advise and counsel women during pregnancy regarding maintaining a healthy diet, recommended consumption of micronutrients and following a healthy lifestyle during pregnancy. The application will also collect data on food and supplements consumed by pregnant women over the period prior to each antenatal visit, using questionnaires. The questionnaires will be auto-filled with the help of a food log maintained though integrated Artificial Intelligence (AI). The application also allows pregnant women to log information on lifestyle habits, including physical activity.
Through the data provided by the user, the app generates a score and recommendations. Scores generated from the predefined six food groups are a combination of a qualitative and quantitative score, with a good diet having a lower score. Each participant will receive customized push notifications or advice, three times a week. The recommendations will enable women to improve the dietary intake, use of supplements and their habits. Women with a lower score and adequate exercise receive motivational notification to keep up compliance.
The PurUmeed Aghaaz research project is led by Dr Rozina Nuruddin, Assistant Professor, Department of Community Health Sciences, Aga Khan University, Karachi in collaboration with AKDN dHRC and the Department of Obstetrics and Gynecology, Erasmus Medical Centre, University Medical Centre, Rotterdam, Netherlands.
Umeed-e-Nau (New Hope)
During 2016, the Aga Khan University (AKU), Karachi launched Umeed-e-Nau, a project aimed at improving maternal, child and adolescent health in Pakistan. Umeed-e-Nau, meaning ‘new hope’ in the local Urdu language, is research project aims to test various approaches to develop insights and evidence around maternal, child and adolescent health care to influence policy. Under the leadership of Dr Zulfiqar Bhutta, Director, Department of Paediatrics and Child Health, Division of Woman and Child Health and Founding Chair, Centre of Excellence in Women and Child Health, Aga Khan University, the project will develop public-private partnerships (PPP) to deliver proven interventions in efforts to improve the quality health care in 14 health facilities in rural districts of Balochistan, Southern Punjab, Sindh provinces of Pakistan and in urban slums of the city of Karachi.
For the project, AKDN dHRC is developing innovative digital health solutions for the – a mobile application and a Learning Management System (LMS). The Umeed-e-Nau application is an Android-based application with a web portal based on District Health Information Software version 2 (DHIS2) architecture customized with image processing. The application aims to improve the health information management system by digitizing the process of data compilation and health facility reports.
At the rural health facility, physician manually develops paper-based records for reporting to the District Headquarters (DHQ) hospitals. The AKU team visits the rural facility and captures a photograph of these paper-based reports via the app. Through the defined, intelligent algorithms within the app, data entries are counted and reports are generated automatically. The reports and other data entries are synchronized with the central server and accessible via the Umeed-e-Nau web portal.
The Umeed-e-Nau LMS is a capacity building, web-based application, which can also act as a native application. The application ensures the availability of teaching modules and other course content used by the AKU physicians during the sessions conducted in rural health facilities in Balochistan, Southern Punjab and Sindh. The LMS enables physicians at the rural health facility to access the content prior to the in-class sessions in order to take full advantage.
The Umeed-e-Nau mobile application and LMS are currently under development. Plans are to roll-out the applications in the first quarter of 2020.
The five-year project is funded by a USD 25 million grant from the Bill and Melinda Gates Foundation.
The Thrive Global Development Alliance is a five-year, USD 20 million project that expands the Aga Khan Foundation (AKF) and United States Agency for International Development (USAID) partnership both technically and geographically to reach 16 districts within Tajikistan, along the Tajik-Afghan border.
AKF has partnered with the Aga Khan Health Service, Tajikistan (AKHS, Tj) to work in collaboration for the Water, Sanitation and Hygiene (WASH) component of the Thrive Project. Under this component, AKDN dHRC is assisting AKHS, Tj in developing an mHealth solution to create WASH-related awareness in the target communities of Tajikistan.
In August 2019, team members of the AKDN dHRC visited the Gorno-Badakhshan Autonomous Oblast (GBAO) and Khatlon Oblast regions to identify the gaps and needs of the communities to promote behavior change and to assess the feasibility of the potential of an mHealth solution. A report was developed, describing the needs and recommendations of the target population.
Based on the assessment, AKDN dHRC proposed an intervention consisting of a mobile application and web portal. The mobile app will consist of baseline questionnaire and behaviour change communication content, including videos, brochures and periodic messages and IVR. The web portal will include reports and graphs, according to the defined indicators.
The Thrive Project aims to enhance integrated socioeconomic development of the GBAO and Khatlon Oblast region. To achieve this goal, the project will ensure local governance institutions deploy resources and social services effectively through: improved management of resources and social services by local governance institutions; and increased access and use of quality social services in targeted communities.