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Portable Health Clinic: An Advanced Tele-Healthcare System for Unreached Communities

Authors:
  • Graneen Communications, BANGLADESH

Abstract and Figures

The Portable Health Clinic (PHC) system endeavors to take healthcare facilities along with remote doctors' consultancy to the doorsteps of the unreached people using an advanced telemedicine system. Thus, the necessity of having physical healthcare peripheries specially in the developing countries can be mitigated. The PHC system promotes preventive healthcare by encouraging regular health checkups so that diseases can be prevented as well as their severity can be mitigated, leading to a reduction on healthcare expenses. Thus, the number of patients along with excessive workload on existing healthcare human resources can be minimized. The current project in rural Bangladesh alone has served more than 41,000 people so far by the PHC system and a simple analysis of this data shows some significant findings on regional health status. A simple expansion of this program, covering a wider service area, can produce a big data to reflect the whole country's health profile.
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Portable Health Clinic: An Advanced Tele-Healthcare System for Unreached
Communities
Rafiqul Islama, Yasunobu Noharaa, Md Jiaur Rahmanb, Nazneen Sultanab, Ashir Ahmedc, Naoki
Nakashimaa
a Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
b Grameen Communications, Dhaka, Bangladesh
c Department of Advanced Information Technology, Kyushu University, Fukuoka, Japan
Abstract
The Portable Health Clinic (PHC) system endeavors to take
healthcare facilities along with remote doctors’ consultancy to
the doorsteps of the unreached people using an advanced
telemedicine system. Thus, the necessity of having physical
healthcare peripheries specially in the developing countries
can be mitigated. The PHC system promotes preventive
healthcare by encouraging regular health checkups so that
diseases can be prevented as well as their severity can be
mitigated, leading to a reduction on healthcare expenses. Thus,
the number of patients along with excessive workload on
existing healthcare human resources can be minimized. The
current project in rural Bangladesh alone has served more than
41,000 people so far by the PHC system and a simple analysis
of this data shows some significant findings on regional health
status. A simple expansion of this program, covering a wider
service area, can produce a big data to reflect the whole
country`s health profile.
Keywords:
Preventive Healthcare, Telemedicine, Triage
Introduction
Healthcare facility is a basic right for all human beings.
Unfortunately, the shortage of qualified doctors and health
workers, insufficient medical facilities and lack of healthcare
awareness remain as some major obstacles for ensuring a
standard level of healthcare service in the developing countries
[1, 2]. Under this circumstance, telemedicine with preventive
healthcare could be considered as a key to overcome this
situation. Keeping this in mind, the Portable Health Clinic
(PHC) system has been developed as an advanced telemedicine
system for the rural communities in Bangladesh [3, 4]. This
system, also called “Doctor in Box”, enables bringing
healthcare services to the doorsteps of the rural communities at
a affordable price (Figure 1).
Nowadays, the prevalence of non-communicable diseases like
Diabetes Mellitus and Hypertension has increased to a cautious
extent. Being a developing country, Bangladesh is not an
exception. From our studies, we have learned that not only the
urban people, but the people in suburban and rural areas are
equally affected by these diseases. These diseases and the
consecutive complications can be effectively prevented by
taking cautions beforehand. Prevention is more important in
countries like Bangladesh because of the limited ability of
people to spend on health bills and the absence of provision
from government. Preventing such diseases to occur or
diagnosing it at early stage can help people to save substantially
on medical bills. For this, regular screening of health status is
important which can be facilitated by the PHC. Thus, the PHC
system has been developed in a preventive healthcare approach
with a special focus on non-communicable diseases [5, 6]. One
of the main obstacles for ensuring basic healthcare service in
developing countries is the poor doctor-patient ratio. According
to World Health Organization (WHO), where it requires at least
12 doctors for standard healthcare service to every 10,000
populations, Bangladesh have just 4 doctors. However, it is not
that easy to increase the number of doctors in a short period of
time. When it is not easy to improve this doctor-patient ratio by
increasing the number of doctors alone, decreasing the number
of patients is very important. The PHC system also aims to
contribute in improving this doctor-patient ratio by introducing
preventive healthcare to reduce patients by advance
intervention to the problem.
Figure 1. Portable Health Clinic (“Doctor in Box”)
The PHC system made it possible to provide primary healthcare
services to the doorstep of the rural communities through a
telemedicine system. However, to ensure better consultancy by
the remote doctor, accurate and a wide range of diagnosis
reports of the patient are required to be available to the remote
doctor. Unfortunately, most of the developing countries do not
have enough quality diagnosis laboratories in the rural areas
with qualified pathologists for producing reliable reports.
Therefore, this work introduces a new module to the PHC
system called the “Tele-Pathology” system that enables rural
laboratory technologists to gain assistance from a remote
professional pathologist using an online tele-healthcare system
and receive the verified report from the pathologist [7]. This
involves a very simple technology using available devices like
a camera and microscope, and it can be easily replicated.
While providing this primary healthcare service in rural
Bangladesh, a huge need of eye care services was identified.
MEDINFO 2019: Health and Wellbeing e-Networks for All
L. Ohno-Machado and B. Séroussi (Eds.)
© 2019 International Medical Informatics Association (IMIA) and IOS Press.
This article is published online with Open Access by IOS Press and distributed under the terms
of the Creative Commons Attribution Non-Commercial License 4.0 (CC BY-NC 4.0).
doi:10.3233/SHTI190296
616
Considering this demand in rural Bangladesh, this work also
added another new module with the PHC system called the
“Tele-EyeCare” system for ensuring eye care services [7].
The main objective of this work is to improve the PHC system
and expand the service scope so that it can respond to the wide
range of demands of rural patients with quality consultancy
aided by accurate diagnosis. Addition of Tele-Pathology and
Tele-EyeCare modules will contribute significantly in this
direction.
Methods
PHC System Structure & Operations
The PHC system consists of 4 components: 1) PHC box with
various medical sensors, internet enabled tablet pc and printer,
2) health worker 3) online dataserver for sharing and
preservation of health data and 4) remote doctor call center
(Figure 2). The health worker brings this PHC box to the patient
to measure the vital information and upload this data, along
with the medical history of the patient to the online server using
the system application (app). The remote doctor gains access to
this data and makes a video call to the patient for further
verification. Finally, the doctor produces an online prescription
and preserves it in the server under the patient`s personal file.
Then, the health worker prints the prescription from the server
and passes to the patient with detail explanation instantly
(Figure 3). The whole process to serve one patient takes about
15 minutes excluding doctor`s consultancy time.
Figure 2. PHC System Structure
The PHC system introduces a triage process based on the
concept of “B Logic” for the people of Bangladesh. It classifies
the subjects under investigation in four categories, namely, (i)
green or healthy (ii) yellow or caution (iii) orange or affected
and (iv) red or emergent, based on the gradual higher risk status
of health [8-11]. The subjects under orange and red are
primarily diagnosed as in the risky zone who need doctor`s
consultancy. However, the major part of the subjects who are
diagnosed in the alarming zone (yellow) can be served by the
trained health workers without medication and they can be
prevented from shifting to the risky zone (orange and red) being
under the guided lifestyle. This reduces the pressure on the
doctors, enabling them to focus on the risky patients who
deserve better attention.
Tele-Pathology System
The Tele-Pathology module of the PHC system enables the
rural diagnostic centers operated by laboratory technologists
(diploma) for producing quality pathological report with the
support of the qualified remote pathologist (Figure 3). At
present, this system is capable of a blood hematological (CBC)
test, routine examination of urine, routine examination of stool
and a skin scarping test. In this system, the rural laboratory
technologist (1) collects the sample, prepares the physical
report, produces the test slide, (2) takes a number of
microscopic images of the slide with varying positions and then
(3) uploads the images along with the physical report to the
online server. The remote pathologist then (4) diagnoses the
sample based on the microscopic slide images with the
reference of physical report, finalizes the pathology report and
preserves to the online server.
Figure 3. Tele-Pathology System
In case a pathological report is required by the call center doctor
(physician), the doctor can gain access to the report from the
online server for preparing a prescription. If needed, the
laboratory technologist can also download this report to deliver
to the patient.
Tele-EyeCare System
The Tele-EyeCare module of the PHC system ensures primary
eye care services for the rural communities. This module has
added a Digital Fundus Camera to the PHC box for retinal
imaging (both Mydriatic & Non-Mydriatic) of the patients. This
enables the health workers to have a better view of the retina
and the peripheral for identifying the problem with certainty.
Thus, the trained local health workers check and classify the
patients as per severity of the problem. Low risk patients with
simple complications are served by the health workers.
However, in case of doubtful cases, the patients` vital
information, initial primary checkup reports and ophthalmic
images are shared with a remote ophthalmologist using the
online server (Figure 4).
Figure 4. Tele-EyeCare Service System
The ophthalmologist then checks the initial primary checkup
reports produced and shared by the local health worker,
investigates the ophthalmic images, directly talks to the patients
over video conference system, reconfirms their status and
finally, provide online prescriptions. If needed, the
ophthalmologist can ask for further investigation of the patient
by the health worker and can also provide glasses prescription
with the support of the health workers. Thus, this system
enables to provide basic eye care to the ordinary patients by the
health workers and special care for the critical patients by
R. Islam et al. / Portable Health Clinic: An Advanced Tele-Healthcare System for Unreached Communities 617
professional ophthalmologist who really deserve special
attention.
Village Service Delivery Model
In village service delivery model, preferably one female health
worker works in a village as she can gain better access to the
female patients due to privacy reasons. Usually, she uses a local
village medicine shop (pharmacy) as her service point for daily
service and general village patients come there for PHC service
(Figure 5). However, she also visits door to door in case of
elderly or disabled patients, pregnant women, emergency
patients or special on-call service.
Figure . Village Service Delivery Model
Urban Service Delivery Model
Although, it was developed for the low income rural
communities, it is found equality useful for the urban, rich, and
aged community for home delivery service. The main clients
are aged people who are suffering from non-communicable
diseases like hypertension and diabetic that need regular
checkups. Although, they are financially rich but as it is
difficult for them to visit hospital regularly due to physical
stress, trouble to arrive at doctor`s appointment at expected
time, traffic congestion, etc. So the PHC home delivery service
is offered to the pre-registered urban patients and the health
workers visit the patients as per schedule.
Personal Health Record
The PHC system preserves all medical data of the patients in
the online server so that the doctor can refer previous data in
need. All checkup data, pathological reports, medical histories
and prescriptions are preserved sequentially. Also, all the
patients are provided with their respective user id and password
for their access to their personal, health record which is
maintained with high security and privacy (Figure 6). They can
change their profile information but only monitor the health
records with graphical representations.
Figure 6. Personal Health Record & PHC Prescription
The prescriptions produced in the PHC system are unique in
shape and format considering the targeted patients of the rural
communities (Figure 7). It contains both the measured health
data in the left side and doctor medication with advice on the
right side. As most of the patients do not understand the
significance of digits, it shows all health data with
corresponding color sign. The same four colors of the triage
system (green, yellow, orange and red) are used against each
data point so that they can easily understand the severity of any
particular item.
Results
The PHC healthcare services have been offered in 18 districts
of Bangladesh at more than 70 service points all over the
country (Figure 7). Until April 22, 2018, the number of patients
served by the PHC system in Bangladesh alone was 41,949.
Besides, the PHC activities are also continued in Cambodia,
India, Thailand and Pakistan under the supervision and
management of local partners.
Figure 7. PHC Service Statistic in Bangladesh
The diagnosed major diseases found in PHC healthcare services
are hypertension (1,944), diabetes (1,365), anemia (647), and
ophthalmic problem (138).
The Tele-Pathology service started in 4 rural diagnostic centers
under 4 districts (Barisal, Bogura, Manikganj and Thakurgaon)
of Bangladesh. So far, this system has served patients with a
total of 1,610 Hematological (CBC) reports and 918 Routine
Examination of Urine using remote pathologists.
The Tele-EyeCare mobile service has recently started in 1 rural
center called “Vision Center” in the Nator district of
Bangladesh on a test basis. So far, it has already served 2,410
checkups for 2,046 patients using remote ophthalmologists.
Soon this service will be extended to other parts of the country.
Discussion
Out of a total 41,949 PHC healthcare patients, 61% (24,786)
was green and yellow patients who were served by the health
workers alone. The rest of the patients 39% (16,198) were
served by doctors who needed medication. So, the PHC system
can reduce the work load of a professional doctor by 61% that
can be managed by local health workers. Thus, the best use of
the valued resource of a doctor can be ensured and only the
people who really need expert`s consultancy can avail it.
Due to its easy operation, a huge number of health data can be
collected by the PHC system and this big data can be used for
countrywide disease pattern analysis. For example, this
research has found some significant differences of health
parameters in different areas. In one area, we have found a
5
R. Islam et al. / Portable Health Clinic: An Advanced Tele-Healthcare System for Unreached Communities618
significantly small number of anemic cases among the adult
women compared to the rest of the country. In another area, we
have identified very high urine protein compared to the rest.
Thus, the detail analysis of this data may show some significant
findings including environmental issues.
Similar to the shortage of physicians, there is a huge shortage
of ophthalmologists and it is just 0.063 ophthalmologist for
every 10,000 populations in Bangladesh. The Tele-EyeCare
module of the PHC system can highly contribute to ensure the
best use of this valued resources for dealing with complicated
cases and manage ordinary cases by health workers. For the
further advancement of the Tele-EyeCare system, a new
development has been started using Artificial Intelligence (AI).
It will use ophthalmic image recognition technology with the
aid of neural network and deep learning for automatic diseases
identification. This will facilitate both the village health
workers and ophthalmologists for better and prompt services.
Conclusions
At present, the PHC tele-healthcare system offers a unique
opportunity for ensuring better healthcare service covering
primary healthcare, eye care and pathological services to the
unreached rural communities. However, this modular system
will gradually be expanded in other healthcare service areas to
cover common healthcare issues based on the local demand.
Now, we are working on an Obs & Gyne module and Dental
Care module to be added soon to the PHC system.
The concept of the PHC system came from the local demand of
Bangladesh. However, since most of the developing countries
are facing the same problem and having similar situations, an
easily replicable PHC system can be in good use there. So far,
this system has been replicated in India, Pakistan, Cambodia
and Liberia with some localizations. However, there is still
plenty of opportunities for further improvement of the system
and expansion of the service to the other parts of the world.
Since the aging communities are increasing in the developed
countries, they are also facing a similar crisis of doctor shortage
in their rural areas. Therefore, there will arise a huge demand
of PHC services in the developed countries as well [12]. To
address this demand, the PHC system can be further improved
with the aid of technologies. One of these attempts is to include
Bluetooth enabled medical sensors so that the measured vital
data from the sensors will be automatically transferred to the
online server to avoid typing error from manual data entry [13].
Also, there is a requirement to develop the PHC box as an
integrated unit so that it will be low cost, handy and light weight
for easy operation by a rural health worker.
Acknowledgements
This research has been supported by Grameen Communications
of Bangladesh and Kyushu University of Japan. The authors
sincerely acknowledge the contribution from both the sides.
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Address for Correspondence
Rafiqul Islam (Maruf), Ph.D.
Medical Information Center, Kyushu University Hospital
3-1-1, Maidashi, Higashi-Ku, Fukuoka, 812-8582 Japan
Tel: +81 92-642-5881; Fax: +81 92-642-5889
Email: rimaruf@med.kyushu-u.ac.jp
R. Islam et al. / Portable Health Clinic: An Advanced Tele-Healthcare System for Unreached Communities 619
... The PHC COVID-19 system has been developed as a total solution for supporting this second stage of service as well. The basic PHC has primarily been developed as a remote healthcare system for primary healthcare services with a special focus on Non-Communicable Diseases (NCDs) [12][13][14]. Later the functionality of this system has been extended to the areas of Tele-Pathology, Tele-Eye care, and Maternal & Child Health (MCH) care [14]. ...
... The basic PHC has primarily been developed as a remote healthcare system for primary healthcare services with a special focus on Non-Communicable Diseases (NCDs) [12][13][14]. Later the functionality of this system has been extended to the areas of Tele-Pathology, Tele-Eye care, and Maternal & Child Health (MCH) care [14]. Besides, a new algorithm for the post-disaster operation has also been established [15]. ...
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Background A developing country like Bangladesh suffers very much from the sudden appearance of the COVID-19 pandemic due to the shortage of medical facilities for testing and follow-up treatment. The Portable Health Clinic (PHC) system has developed the COVID-19 module with a triage system for the detection of COVID-19 suspects and the follow-up of the home quarantined COVID-19 patients to reduce the workload of the limited medical facilities. Methods The PHC COVID-19 system maintains a questionnaire-based triage function using the experience of the Japanese practice of diseases management for early detection of suspected COVID-19 patients who may need a confirmation test. Then only the highly suspected patients go for testing preventing the unnecessary crowd from the confirmation PCR test centers and hospitals. Like the basic PHC system, it also has the features for patients’ treatment and follow-up for the home quarantined COVID-19 positive and suspect patients using a telemedicine system. This COVID-19 system service box contains 4 self-checking medical sensors, namely, (1) thermometer, (2) pulse oximeter, (3) blood pressure machine, and (4) glucometer for patient's health monitoring including a tablet PC installed with COVID-19 system application for communication between patient and doctor for tele-consultancy. Results This study conducted a COVID-19 triage among 300 villagers and identified 220 green, 45 light-yellow, 2 yellow, 30 orange, and 3 red patients. Besides the 3 red patients, the call center doctors also referred another 13 patients out of the 30 orange patients to health facilities for PCR tests as suspect COVID-19 positive, and to go under their follow-up. Out of these (3 + 13 =) 16 patients, only 4 went for PCR test and 3 of them had been tested positive. The remaining orange, yellow and light-yellow patients were advised home quarantine under the follow-up of the PHC health workers and got cured in 1-2 weeks. Conclusions This system can contribute to the community healthcare system by ensuring quality service to the suspected and 80% or more tested COVID-19 positive patients who are usually in the moderate or mild state and do not need to be hospitalized. The PHC COVID-19 system provides services maintaining social distance for preventing infection and ensuring clinical safety for both the patients and the health workers.
... Of the four solutions, the VSAT broadband network and SMS/MMS were successfully implemented in 108 villages throughout India [74]. Raspberry Pi have been used in Telecytology, Tele-pathology system, Tele-EyeCare Service System to transfer images from areas with limited mobile network coverage to distant specialist centres for example in Indonesia and Bangladesh [74][75][76]. Pregnancy monitoring system: Three studies reported the mobile app monitoring tools deployed in India and Pakistan to monitor pregnancy [77][78][79]. The Daksh system monitored intra partum care [79]; the Continuum of Care mhealth platform was used for pregnancy registration and monitoring care [80], and a mhealth app in Pakistan managed the clinical workforce and provision of health care equipment [81]. ...
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... To tackle this situation, a low-cost but appropriate approach to technology can play an important role. The Portable Health Clinic (PHC) system has been developed as a telehealth system for primary health care [3]- [4]. To tackle the Maternal and Child Health (MCH) care issues, the MCH module has been added to the PHC system. ...
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Rural women in developing countries do not have any option but to visit the distant city to see the obstetricians and gynecologists in case of any maternal and child health issues. However, it becomes more difficult to travel during the COVID-19 pandemic situation. Thus, the telehealth service using the Portable Health Clinic can be very effective for maternal and child health care services. Since the PHC system provides home delivery services through the local health workers, the rural women can avail regular continuum of care services. This study found a 300% increase in participation in the continuum of care. This is not because they receive the service at home but also because they can receive consultancy from urban specialist doctors without travel during the pandemic situation.
... [9] Following that structured approach, Grameen Communications (GC) developed a TP system and started a pilot project in 2016 in four different rural and suburban hospitals of Bangladesh (Barisal, Bogra, Thakurgaon, and Manikganj). [10] In their experiment, one online pathologist is assigned for four districts remote rural pathology centers. There is a lack of focused research on TP in Bangladesh. ...
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... However, a PHR system is not generally utilized in Bangladesh yet. In this context, when the portable health clinic (PHC) system was designed in 2010 by Grameen Communications, Bangladesh, in a joint collaboration with Kyushu University, Japan, as a telemedicinebased healthcare system [ Figure 1], an EMR system existed from the beginning in which patients' vital information was preserved in an electronic format on the online server together with the patients' medical history and feedback [4]. A simple PHR service was also added in the PHC system as a personal service for patients. ...
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... A variety of medical service models have been proposed with the development of science and technology; for example, physiological data are measured through IoT physiological sensing devices in daily life for long-term tracking [1][2][3][4] . There is a large demand for data exchange and integration in different forms of remote care services [ [5][6][7] ], various personal health management applications, health insurance payment applications, and data applications between medical institutions. While it is convenient and efficient to transmit data through information communication technology, it is critical to protect the privacy and correctness of the data. ...
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Background and Objective COVID-19, a serious infectious disease outbreak started in the end of 2019, has caused a strong impact on the overall medical system, which reflects the gap in the volume and capacity of medical services and highlights the importance of clinical data ex-change and application. The most important concerns of medical records in the medical field include data privacy, data correctness, and data security. By realizing these three goals, medical records can be made available to different hospital information systems to achieve the most complete medical care services. The privacy and protection of health data require detailed specification and usage requirements, which is particularly important for cross-agency data exchange. Methods This research is composed of three main modules. "Combined Encryption and Decryption Architecture", which includes the hybrid double encryption mechanism of AES and RSA, and encrypts medical records to produce "Secured Encrypted Medical Record". "Decentralize EMR Repository", which includes data decryption and an exchange mechanism. After a data transmission is completed, the content verification and data decryption process will be launched to confirm the correctness of the data and obtain the data. A blockchain architecture is used to store the hash value of the encrypted EMR, and completes the correctness verification of the EMR after transmission through the hash value. Results The results of this study provide an efficient triple encryption mechanism for electronic medical records. SEMRES ensures the correctness of data through the non-repudiation feature of a blockchain open ledger, and complete integrated information security protection and data verification architecture, in order that medical data can be exchanged, verified, and applied in different locations. After the patient receives medical services, the medical record is re-encrypted and verified and stored in the patient's medical record. The blockchain architecture is used to ensure the verification of non-repudiation of medical service, and finally to complete the payment for medical services. Conclusions The main aim of this study was to complete a security architecture for medical data, and develop a triple encryption authentication architecture to help data owners easily and securely share personal medical records with medical service personnel.
... The PHC has been developed as a telehealthcare system for unreached rural communities of Bangladesh [5]. Initially, it was designed for primary healthcare with a special focus on preventive care for noncommunicable diseases (NCDs). ...
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The number of deaths of a mother and child caused by maternal and child healthcare (MCH) issues has been greatly decreased recently, but still, the number is extremely high especially in developing countries. Although the governments have been given a priority in this issue, the lack of financial and human resources brings a limit. Thus, the use of low-cost but appropriate technology is required. Portable Health Clinic (PHC), a telemedicine system developed for providing primary healthcare, is such a technology. This study aimed to address this MCH issue with the aid of a low-cost PHC service involving a continuum-of-care protocol to the rural communities of Bangladesh. Moreover, this study introduces a triage protocol to distinguish high-risk patients from the early stage of the continuum of care who need special care and refer to specialized physicians to prevent unwanted deaths.
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Portable Health Clinic (PHC) system has been developed as a telemedicine system primarily for providing basic healthcare services as a part of population management with a special focus on non-communicable diseases to the rural unreached communities of the developing countries like Bangladesh. The home delivery healthcare service model ensures the healthcare service accessibility to the rural communities, specially to the village women, who suffer from the shortage of healthcare facilities. As a modular system, the PHCs have gradually added tele-pathology, tele-eye care, and maternal and child healthcare features for advanced treatment based on the local demands. Recently, COVID-19 module has been added to tackle the pandemic. Due to its service portability, PHCs are equally useful for the urban aging communities who prefer to avoid city traffic congestion for regular hospital visits, waiting time in service queues, and can enjoy the service at home on schedule. Thus, this system can equally be useful for the aging communities in the developed countries. Also, the PHC system is matching to the concept of patient engagement which WHO has promoted.KeywordsTelemedicineHealthcaremHealthPatientMobileTriagePreventiveUnreachedCommunity
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Background Despite the growing burden of chronic kidney disease (CKD), disease knowledge and understanding are still lacking, especially in Bangladesh. Objective The aim of this study was to evaluate the outcome of a health education intervention in order to enhance knowledge, health-related quality of life (QOL), and motivation regarding healthy lifestyles among rural and periurban adults suffering from CKD. Methods A parallel-group (1:1) randomized controlled trial is ongoing in the Mirzapur subdistrict, Bangladesh, where two groups of patients with CKD are being compared. Patients aged 18 years and over with CKD (stages 1-3) were enrolled in November 2020. Patients were randomly allocated into either the intervention group (n=63) or the control group (n=63). The control group received usual treatment, while the intervention group received health education through a CKD campaign facilitated by a nephrologist and via mHealth (ie, periodic mobile phone calls) from community health workers. Both groups were followed up for a period of 6 months. The primary endpoint is patients’ increased knowledge measured using the Chronic Kidney Disease Knowledge Questionnaire. The secondary endpoints are improved QOL measured using the standardized EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire as well as improvements in the levels of blood pressure, BMI, serum creatinine, fasting blood sugar, hemoglobin, cholesterol, high-density lipoprotein cholesterol, triglyceride, serum uric acid, blood urea nitrogen, and albumin to creatinine ratio. Results Enrollment of participants began in November 2020; the intervention and follow-up were completed in May 2021. We enrolled 126 patients in the study. Patients’ mean ages were 57.97 (SD 15.03) years in the control group and 57.32 (SD 14.37) years in the intervention group. There were 45 out of 63 (71%) females in the control group and 38 out of 63 (60%) females in the intervention group. In addition, there were 38 out of 63 (60%) literate patients in the control group and 33 out of 63 (52%) literate patients in the intervention group. Conclusions It is expected that a combined approach, incorporating both a CKD campaign and mHealth, for health education may be an effective tool for increasing knowledge and improving QOL among patients with CKD. Trial Registration ClinicalTrials.gov NCT04094831; https://clinicaltrials.gov/ct2/show/NCT04094831 International Registered Report Identifier (IRRID) DERR1-10.2196/30191
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Background and Objective : Regular health checkups are important for mothers and newborns to detect health problems at an early stage; however, this is often difficult in resource-limited settings. Therefore, the portable health clinic (PHC) for maternal and child health (MCH), a telemedicine health checkup system, was introduced as an intervention study in a rural area in Bangladesh. The aim of this research project was to report findings that we had observed at a mid-point of the intervention period. Methods : This was an intervention study conducted in Shariatpur, Bangladesh. The study population included pregnant/parturient women aged 15–49 years and their newborns. With the help of the newly created PHC for MCH, health workers, with a set of sensor devices in an attaché case, visited mothers and newborns at home to examine their health status. Their health status was triaged into four categories using a data management application, and in cases of affected or emergent health status, they were placed on remote video consultation with a doctor. Results : In total, 94 women were included in the PHC for MCH intervention. The rate of participants who received antenatal care at least four times or postnatal care at least once increased (from 29% to 51%, and from 27% to 78%, respectively) compared with before introducing PHC for MCH. Using the PHC for MCH, we detected health problems in pregnant/parturient women; a relatively high percentage had anemia (45–54%) and/or abnormal pulse rate (20–40%). Moreover, after introducing the PHC for MCH, more than 40% of women who received multiple antenatal care or postnatal care checkups improved their health status. Conclusions : The PHC for MCH could be an effective system to improve the health of mothers and newborns by increasing the availability of care. In the future, this system is expected to be used as a primary resource for maternity healthcare, not only in rural areas but also in other social environments.
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Bangladesh is identified as one of the countries with severe health worker shortages. However, there is a lack of comprehensive data on human resources for health (HRH) in the formal and informal sectors in Bangladesh. This data is essential for developing an HRH policy and plan to meet the changing health needs of the population. This paper attempts to fill in this knowledge gap by using data from a nationally representative sample survey conducted in 2007. The study population in this survey comprised all types of currently active health care providers (HCPs) in the formal and informal sectors. The survey used 60 unions/wards from both rural and urban areas (with a comparable average population of approximately 25 000) which were proportionally allocated based on a 'Probability Proportion to Size' sampling technique for the six divisions and distribution areas. A simple free listing was done to make an inventory of the practicing HCPs in each of the sampled areas and cross-checking with community was done for confirmation and to avoid duplication. This exercise yielded the required list of different HCPs by union/ward. HCP density was measured per 10 000 population. There were approximately five physicians and two nurses per 10 000, the ratio of nurse to physician being only 0.4. Substantial variation among different divisions was found, with gross imbalance in distribution favouring the urban areas. There were around 12 unqualified village doctors and 11 salespeople at drug retail outlets per 10 000, the latter being uniformly spread across the country. Also, there were twice as many community health workers (CHWs) from the non-governmental sector than the government sector and an overwhelming number of traditional birth attendants. The village doctors (predominantly males) and the CHWs (predominantly females) were mainly concentrated in the rural areas, while the paraprofessionals were concentrated in the urban areas. Other data revealed the number of faith/traditional healers, homeopaths (qualified and non-qualified) and basic care providers. Bangladesh is suffering from a severe HRH crisis--in terms of a shortage of qualified providers, an inappropriate skills-mix and inequity in distribution--which requires immediate attention from policy makers.
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One billion people (15% of the world population) are unreached in terms of access to quality healthcare services largely as a result of the paucity of healthcare facilities and medical experts in rural areas. We have prototyped “portable health clinic (PHC), a compact telehealth system with diagnostic equipment and GramHealth software for archiving and searching patients’ past health records. The back-end of the system consists of data servers and a medical call center. The front-end has the instances of portable briefcase consisting of medical sensors and measuring equipment operated by healthcare workers living in unreached communities. The front-end data transmission system and Skype telemedicine calls connect with the back-end using mobile network coverage and Internet. Doctors at the medical call center access GramHealth data cloud through the Internet or have a copy of the database in the call center server. Upon receiving a multimedia call from a patient, the doctor can find that patient’s previous EHR record and then create and send an e-Prescription. The healthcare worker’s PHC briefcase is designed to be low cost and portable. It is envisioned as costing less than US$300 (an amount an entrepreneur can borrow from micro-finance institutions such as Grameen Bank in Bangladesh) and light enough to be carried by a female health assistant. The PHC briefcase will be owned and operated by a village health assistant. This will be a sustainable business model as the health assistant can build a professional relationship with her local clientele. We carried out experiments in three remote villages and in two commercial organizations in Bangladesh by collaborating with local organizations to observe the local adoption of the technology. We are looking at the applicability of our PHC system for aging societies in developed countries.
Effectiveness of Preventive Healthcare through Telemedicine in Bangladesh
  • P Ghose
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P. Ghose, R. Islam, N. Nakashima, Y. Nohara, A. Ahmed, S. Shimizu, Effectiveness of Preventive Healthcare through Telemedicine in Bangladesh, Proceedings of 18th ISfTeH International Conference, 2013.
Diabetes, obesity, and hypertension in Bheramara Kushtia District, Bangladesh -Results from Portable Health Clinic Data
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GramHealth: An Integrated Tele-Healthcare System for Unreached Communities
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R. Islam, A. Ahmed, N. Nakashima, S. Shimizu, GramHealth: An Integrated Tele-Healthcare System for Unreached Communities, Proc. of 11st Asian Telemedicine Symposium, 2017.
Summary of a multicentre prospective clinical study of home telemedicine
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T. Hasegawa, R. Suzuki, T. Sakamaki, et.al. Summary of a multicentre prospective clinical study of home telemedicine. Japanese Journal of Telemedicine and Telecare, 13(2), 84-87, 2017-08.