Keane, Edmund

School of Public Health



Non Communicable Disease Risk Factor Surveillance Using Novel Mobile Phone

Non-communicable diseases (NCDs) are a growing burden in lower-and middle-income countries.  Tobacco use, alcohol consumption, physical inactivity, and inadequate diet are four self-reported risk factors that explain over two-thirds of global NCD deaths.  In many LMICs, the surveillance of NCD risk factors is infrequent due to the high cost and time commitment associated with household surveys where interviewers administer the survey to respondents in a face-to-face manner.

Telephone and mobile phone surveys have been utilized to collect population level estimates of health and demographics in high income countries, but their application has not been extensively studied in lower income countries. As the number of mobile phones approaches the global population level, opportunities exist to leverage mobile health (mHealth) technologies to improve the efficiency, timeliness, and cost-effectiveness of data collection in lower income countries by interviewing respondents over their own personal mobile phone.

As part of the Bloomberg Data for Health Initiative, JHSPH faculty, CDC colleagues, and the implementing team from NCD division of the Moroccan Ministry of Health, this project aims to assess the feasibility, quality, and validity of a national NCD risk factor survey sent to citizen’s mobile phones.  This is a ten country project with field sites also in Zambia and Bangladesh.

Global Health Mentor/PI: Dustin Gibson, PhD

Globally, approximately 18.7 and 20.1 million children do not receive the third dose of DTP (diphtheria, tetanus toxoid, and pertussis containing antigens) or measles vaccine, respectively. Given that every year immunization programs are estimated to save over 2.5 million lives globally and with the majority of deaths averted occurring in Africa, innovative interventions that target these hard-to-reach populations are needed. The study I worked to support for my practicum examined opportunities to leverage mobile-health (mHealth) technologies to target demand-side deficiencies and improve immunization.

Initially I was very excited to experience both the culture and the work in Kisumu, Kenya. Many things about research or work in LMICs cannot be taught in classroom, which is one reason this experience is invaluable. Some amenities we rely upon to keep the pace of our research might not be as reliable in developing countries. This can be a necessary adaptation for researchers who are responsible for the progress of a study in an LMIC setting.

Some dynamics of life in the field can be shocking; especially the first time one experiences them. Living in areas with elevated infectious disease prevalence can be quite upsetting. Personally, maintaining a daily routine amidst certain upsetting visual manifestations of poverty and disease was outside of my comfort zone. Another dynamic of daily life I remarked upon was the transportation infrastructure. Where urbanization and proliferation of motor vehicles occurs in resource-limited populations, there has been a related explosion on the number of road-traffic injuries (RTIs). Where there aren’t resources to retrospectively develop traffic safety infrastructure, inexpensive alternatives abound. In Kisumu, one may be shocked at the size and prevalence of speed bumps, which may be an less expensive alternative to traffic lights and stop signs, of which there are none.

Previous studies showed in two areas near Kisumu, Gem and Asembo, that only 70% of children received measles vaccination by 10 months of age (scheduled to be given at 9 months). The limited resources of the population were related to the study’s methodology. Barriers to immunization can include transportation/geography as well as economics. Many participants experience an overlap of both categories of barrier, as limited transportation infrastructure can cause alternative modes of transportation to increase in expense beyond the reach of some caregivers. This study is currently ongoing but the potential is promising for immunization coverage hear and in other resource-limited environments where the option to leverage existing mHealth technologies exists.

While the support I received both from JHSPH and in the field was exceptional, there were many challenges to overcome during my practicum placement. I am pleased to say that I feel confident in my career direction and my eagerness to return to a similar project in the not-so-distant future. Exposure to the activity in the field with this type of international health program gave me a firm understanding of where the opportunities for more research might lie. I am very much looking forward to more experience and personal development in this area.


September 2020



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