Physician-scientist develops app to help health workers diagnose cholera
February 6, 2017 -- GAINESVILLE, Fla. -- Working in collaboration with a mobile phone application developer as well as colleagues in the United States and Bangladesh, a UF investigator helped create and test an app that helps physicians diagnose cholera and other diarrheal diseases with greater accuracy.
“Diarrheal diseases are responsible for one in ten deaths among children under five,” said Eric Nelson, M.D., Ph.D., an assistant professor in the department of pediatrics and a member of the Emerging Pathogens Institute. Nelson was the senior author of the report.
“This study aimed to find out how a piece of consumer technology like a phone app could be used to decrease the rate of morbidity and mortality from these diseases,” he added.
The authors were interested in how technologies accessible in resource-limited settings might improve a doctor or other health care professional’s ability to diagnose diarrheal diseases and adhere to international guidelines, specifically those regarding antibiotic selection for diarrheal disease management in such settings. They adapted WHO guidelines to a smartphone platform and tested it out at two rural hospitals in Bangladesh.
Using the decision-support tool resulted in a decrease of intravenous fluid with associated cost-savings yet without compromising safety; furthermore, the use of recommended antibiotics increased, while the prescription of non-recommended medications decreased.
The app, called the “Rehydration Calculator,” was designed to be easily accessible to end-users working in high case volume, low-resource settings. Field clinical providers and other health care workers provided guidance during the design process.
The calculator works by capturing basic information about the patient – such as age, gender, whether he has a watery or blood stool, and whether he is exhibiting any of the five clinical signs of dehydration – and using this information to calculate the recommended treatment plan.
In Netrokona, Bangladesh, where the study took place, the district hospitals see about 5,000 diarrheal patients a month; using the Rehydration Calculator resulted in both a significant decrease in the volume of IV fluid given to patients, along with an increase in the prescription of azithromycin, the antibiotic recommended to combat cholera infection.
The study showed that, prior to implementing the Rehydration Calculator, most patients admitted to the hospital with diarrheal symptoms were given IV fluids; while using the calculator led to a decrease in IV fluid use and an increase in prescription of the recommended antibiotic for cholera or dysentery. Future studies will have to focus on codifying the application’s language in order to decrease the number of unnecessary antibiotic prescriptions.
The article, titled “Evaluation of a Smartphone Decision-Support Tool for Diarrheal Disease Management in a Resource-Limited Setting,” was published in PLOS Neglected Tropical Diseases.
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