Gaetano Borriello’s research while affiliated with University of Mary Washington and other places

mPneumonia user manual. (DOCX)

COREQ checklist. (DOCX)

Caregiver dataset. (XLSX)

Health care provider dataset. (XLSX)

Pneumonia is the leading cause of infectious disease mortality in children. Currently, health care providers (HCPs) are trained to use World Health Organization Integrated Management of Childhood Illness (IMCI) paper-based protocols and manually assess respiratory rate to diagnose pneumonia in low-resource settings (LRS). However, this approach of relying on clinical signs alone has proven problematic. Hypoxemia, a diagnostic indicator of pneumonia severity associated with an increased risk of death, is not assessed because pulse oximetry is often not available in LRS. To improve HCPs’ ability to diagnose, classify, and manage pneumonia and other childhood illnesses, “mPneumonia” was developed. mPneumonia is a mobile health application that integrates a digital version of the IMCI algorithm with a software-based breath counter and a pulse oximeter. A design-stage qualitative pilot study was conducted to assess feasibility, usability, and acceptability of mPneumonia in six health centers and five community-based health planning and services centers in Ghana. Nine health administrators, 30 HCPs, and 30 caregivers were interviewed. Transcribed interview audio recordings were coded and analyzed for common themes. Health administrators reported mPneumonia would be feasible to implement with approval and buy-in from national and regional decision makers. HCPs felt using the mPneumonia application would be feasible to integrate into their work with the potential to improve accurate patient care. They reported it was “easy to use” and provided confidence in diagnosis and treatment recommendations. HCPs and caregivers viewed the pulse oximeter and breath counter favorably. Challenges included electricity requirements for charging and the time needed to complete the application. Some caregivers saw mPneumonia as a sign of modernity, increasing their trust in the care received. Other caregivers were hesitant or confused about the new technology. Overall, this technology was valued by users and is a promising innovation for improving quality of care in frontline health facilities.

Accredited Social Health Activists (ASHAs) have been shown to have a positive impact on health outcomes of the households they visit, particularly in maternal and neonatal health. As the first line of the public health system in many countries, they are a critical link to the broader public health infrastructure for community members. Yet they do this all with minimal training and limited support infrastructure. To a pregnant woman, an ASHA is a trusted ally in navigating the health system---information gathered is returned by appropriate advice and counseling. To the health system, the ASHA is a key channel of valuable householdlevel information for the public health system, yet she generally receives minimal guidance in return. In this paper we present ASTA---the ASHA Self-Tracking Application---a system that provides ASHAs with timely, on-demand information regarding their own performance compared to their peers. Using ASTA, ASHAs access comparative performance data through both a web-based and voice-based interface on demand. We evaluated ASTA through a 12-month deployment with 142 ASHAs in Uttar Pradesh, India, assessing the impact of providing feedback on ASHA performance. We find that ASHAs with access to the ASTA system made significantly more client visits, with average monthly visits 21.5% higher than ASHAs who had access to a control system. In addition, higher ASHA performance was correlated with increased usage of ASTA. However, the performance improvement was front-loaded, with the impact of the system decreasing toward the end of the study period. Taken together, our findings provide promising evidence that studying and incorporating tools like ASTA could be cost effective and impactful for ASHA programs.

Cost and accessibility have impeded the adoption of spirometers (devices that measure lung function) outside clinical settings, especially in low-resource environments. Prior work, called SpiroSmart, used a smartphone's built-in microphone as a spirometer. However, individuals in low- or middle-income countries do not typically have access to the latest smartphones. In this paper, we investigate how spirometry can be performed from any phone-using the standard telephony voice channel to transmit the sound of the spirometry effort. We also investigate how using a 3D printed vortex whistle can affect the accuracy of common spirometry measures and mitigate usability challenges. Our system, coined SpiroCall, was evaluated with 50 participants against two gold standard medical spirometers. We conclude that SpiroCall has an acceptable mean error with or without a whistle for performing spirometry, and advantages of each are discussed.

Global poverty reduction efforts value monitoring and evaluation, but often struggle to translate lessons learned from one intervention into practical application in another intervention. Commonly, data is not easily or often shared between interventions and summary data collected as part of an impact evaluation is often not available until after the intervention is complete. Equally limiting, the workflows that lead to research results are rarely published in a reproducible, reusable, and easy-to-understand fashion for others. Information and communication technologies widely used in commercial and government programs are growing in relevance for international global development professionals and offer a potential towards better data and workflow sharing. However, the technical and custom nature of many data management systems limits their accessibility to non-ICT professionals. The authors propose an end-to-end data collection, management, and dissemination platform designed for use by global development program managers and researchers. The system leverages smartphones, cellular based sensors, and cloud storage and computing to lower the entry barrier to impact evaluation.

Designing mobile applications for challenged network environments necessitates new abstractions that target deployment architects, non-developers who are charged with adapting an ensemble of off-the-shelf software to a deployment context. Data transfer is integral to mobile application design and deployments have inherent and contextual requirements that determine what data should be transferred and when. In this paper, we investigate building mobile applications in challenged network environments by focusing on abstractions to support disconnected environments and areas of sparse heterogeneous connectivity. We explore and characterize various methods of transmitting data using: existing synchronization tools, peer-to-peer communication, and sparse networks. We also introduce a new software tool called ODK Submit to help streamline application customization to challenged network environments.

Pneumonia is the leading infectious cause of death in children worldwide. Each year, pneumonia kills an estimated 935,000 children under five years of age, with most of these deaths occurring in developing countries. The current approach for pneumonia diagnosis in low-resource settings-using the World Health Organization Integrated Management of Childhood Illness (IMCI) paper-based protocols and relying on a health care provider's ability to manually count respiratory rate-has proven inadequate. Furthermore, hypoxemia-a diagnostic indicator of the presence and severity of pneumonia often associated with an increased risk of death-is not assessed because pulse oximetry is frequently not available in low-resource settings. In an effort to address childhood pneumonia mortality and improve frontline health care providers' ability to diagnose, classify, and manage pneumonia and other childhood illnesses, PATH collaborated with the University of Washington to develop "mPneumonia," an innovative mobile health application using an Android tablet. mPneumonia integrates a digital version of the IMCI algorithm with a software-based breath counter and a pediatric pulse oximeter. We conducted a design-stage usability field test of mPneumonia in Ghana, with the goal of creating a user-friendly diagnostic and management tool for childhood pneumonia and other childhood illnesses that would improve diagnostic accuracy and facilitate adherence by health care providers to established guidelines in low-resource settings. The results of the field test provided valuable information for understanding the usability and acceptability of mPneumonia among health care providers, and identifying approaches to iterate and improve. This critical feedback helped ascertain the common failure modes related to the user interface design, navigation, and accessibility of mPneumonia and the modifications required to improve user experience and create a tool aimed at decreasing mortality from pneumonia and other childhood illnesses in low-resource settings.