PLoS Neglected Tropical Diseases (Feb 2021)

Adaptation and performance of a mobile application for early detection of cutaneous leishmaniasis.

  • Luisa Rubiano,
  • Neal D E Alexander,
  • Ruth Mabel Castillo,
  • Álvaro José Martínez,
  • Jonny Alejandro García Luna,
  • Juan David Arango,
  • Leonardo Vargas,
  • Patricia Madriñán,
  • Lina-Rocío Hurtado,
  • Yenifer Orobio,
  • Carlos A Rojas,
  • Helena Del Corral,
  • Andrés Navarro,
  • Nancy Gore Saravia,
  • Eliah Aronoff-Spencer

DOI
https://doi.org/10.1371/journal.pntd.0008989
Journal volume & issue
Vol. 15, no. 2
p. e0008989

Abstract

Read online

BackgroundDetection and management of neglected tropical diseases such as cutaneous leishmaniasis present unmet challenges stemming from their prevalence in remote, rural, resource constrained areas having limited access to health services. These challenges are frequently compounded by armed conflict or illicit extractive industries. The use of mobile health technologies has shown promise in such settings, yet data on outcomes in the field remain scarce.MethodsWe adapted a validated prediction rule for the presumptive diagnosis of CL to create a mobile application for use by community health volunteers. We used human-centered design practices and agile development for app iteration. We tested the application in three rural areas where cutaneous leishmaniasis is endemic and an urban setting where patients seek medical attention in the municipality of Tumaco, Colombia. The application was assessed for usability, sensitivity and inter-rater reliability (kappa) when used by community health volunteers (CHV), health workers and a general practitioner, study physician.ResultsThe application was readily used and understood. Among 122 screened cases with cutaneous ulcers, sensitivity to detect parasitologically proven CL was >95%. The proportion of participants with parasitologically confirmed CL was high (88%), precluding evaluation of specificity, and driving a high level of crude agreement between the app and parasitological diagnosis. The chance-adjusted agreement (kappa) varied across the components of the risk score. Time to diagnosis was reduced significantly, from 8 to 4 weeks on average when CHV conducted active case detection using the application, compared to passive case detection by health facility-based personnel.ConclusionsTranslating a validated prediction rule to a mHealth technology has shown the potential to improve the capacity of community health workers and healthcare personnel to provide opportune care, and access to health services for underserved populations. These findings support the use of mHealth tools for NTD research and healthcare.