Global Health Ideas

Finding global health solutions through innovation and technology

Are on-site doctors necessary for simple eye test to diagnose severe malaria?

The Science and Development Network (SciDev.net) carried a story today about new diagnostic method to detect cerebral malaria (“Simple eye test can diagnose severe malaria”). Although cerebral malaria is not the most prevalent form of the disease, it is the most lethal.

Diagnosing cerebral malaria ā€” a severe complication of malaria in which the Plasmodium falciparum parasite infects capillaries that flow through the tissues of the brain ā€” can be difficult, as patients can be unconscious and have a number of other illnesses.

Now researchers have found that certain changes on the retina, the light sensitive tissue at the back of the eye, are unique to severe forms of malaria.

This will enable doctors to determine whether a child is suffering from cerebral malaria or some other, unrelated illness, and prescribe immediate treatment accordingly…

The diagnosis only requires an instrument called an ophthalmoscope, which is commonly used in Africa for studying eye disease. “Diagnosis requires special training in eye examination, but is relatively straightforward and cost effective, which is essential in resource-poor settings such as Africa,” says Dr. Beare.

Although a larger study is underway in an attempt to scientifically replicate the preliminary findings, it is a promising diagnostic. My first thought reading this was ‘great! if the second study comes back with similar findings, all we’ll have to do is train docs to conduct the test’. But the continued brain drain of African healthcare professionals (see also the UN report on International Migration and Development) may require fresh thinking if the intervention is to be scaled. Research at the University of California, Berkeley on remote imaging may offer one option to bring distant patients within the reach of skilled healthcare workers. A June 2006 UC Berkeley press release (“New wireless networking system brings eye care to thousands in India”) describes a remote imaging pilot program in India:

Thousands of residents of rural villages in India are receiving quality eye care thanks to a collaborative effort between an Indian hospital network and the researchers at the University of California, Berkeley, and at Intel Corporation who have developed a new technology for low-cost rural connectivity.

This new technology, based on “Wi-Fi” wireless networks, allows eye specialists at Aravind Eye Hospital at Theni in the southern India state of Tamil Nadu to interview and examine patients in five remote clinics via a high-quality video conference.

Just 17 months old, the pilot project has proved so successful that the partners are announcing this week that it will be expanded in the state to include five hospitals that will be linked to 50 clinics that are expected to serve half a million patients each year.

In rural India, the scale of the health return justifies the initial system investment. In many rural African communities, the relatively few number of cerebral malaria cases may not pull sufficient resources on their own. But taking into consideration the likely high burden of undiagnosed ocular diseases, we can see the added value of detecting and treating time-sensitive malarial cases only underscores the urgency in scaling not only healthcare worker capacity but also the infrastructure for cost-effective healthcare management.

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Written by Ben

November 15, 2006 at 1:57 am

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