Health Innovation

Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness, and death.
Across the globe, AMR has been recognized as one of the greatest threats to human and animal health. When this trickles down to Ethiopia, studies have reported that AMR prevalence in Ethiopia is increasing at an alarming rate. In order to mitigate this issue, various actions are being taken by researchers and innovators alike, with mHealth innovation on the rise in order to build a stronger health system through the design and implementation of data-driven solutions that respond to local needs whilst also underserving communities with tools to lead healthier lives.
One such innovator and researcher is Minyahil Tadesse, an evidence to policy translation research specialist who works at the Armauer Hansen Research Institute. Minyahil, who is currently a Ph.D. student at Jimma University pursuing a doctorate in Evidence-based Health Care, recently received intellectual property rights for a user-friendly and easily accessible mobile health app (mHealth app) which targets to promote antibiotic stewardship for the Ethiopian treatment guideline. Capital reached out to Minyahil for insights on the innovation. Excerpts;

Capital: What led you to delve into this particular health innovation (mobile health app)?
Minyahil Tadesse: Antimicrobial Resistance (AMR) is a major threat to the long-term security of public health and has the potential to negatively impact our society. It is a serious and growing global health security risk, which needs to be prioritized at local and international levels. In response to the growing threat of antibiotic resistance, countries have introduced numerous prescribing tools in order to improve rates of appropriate antibiotic prescribing, among which is the provision of national treatment guidelines. It is a known fact that high levels of adherence to antibiotic guidelines result in improved patient safety, improved treatment outcomes, and reduced antibiotic resistance.
The main problem in Ethiopia is that adherence to national treatment guidelines among health care providers often remains very low. Several factors are thought to contribute to the lower adherence of prescribers to the treatment guideline such as difficulties with accessing the guidelines; prescribers’ lack of confidence in the processes used for guideline development and their perceptions that their own expertise results in better treatment decisions than those suggested by the guidelines. The Ethiopian national treatment guideline is available to prescribers in the form of a print book, and on the website of the Ethiopian Food and Drug Administration-EFDA. However, these approaches to providing treatment guidelines faced several challenges, such as ensuring doctors carry the bulky 1700 pages of the print guide, and the need to issue new physical copies of the guidelines when they are updated.
Thus, this concept materialized with the objective of developing user friendly and easily accessible mobile health app (ET-STGapp) for the Ethiopian treatment guideline to promote antibiotic stewardship. This innovation is smoothly integrable due to the recent upturn in smartphone use in the general population which has been matched by the increased development of smartphone apps geared toward use in the healthcare system. At the point of care, physicians are likely to be in constant contact with their phones, in contrast to print guidelines, desktop computers, and reference handbooks. Besides, information found on a smartphone might be accessed more frequently at the patient’s bedside, and be easier to update remotely without needing to issue new physical copies. Therefore, the essence of this project is to present the national treatment guideline as a mobile app in order to facilitate access to the resources for point of care decision-making. I strongly believe and know that the app will be very important to significantly improve the inconsistency in antibiotic prescription and decrease antimicrobial resistance; with the ultimate goal to improve the quality of patient care.

Capital: What makes this innovation a significant improvement upon standard practice?
Minyahil Tadesse: Countries usually have standard antimicrobial or antibiotic guidelines which are prepared to help as a reference to health professionals to follow a certain standard. The EFDA leads the preparation of national treatment guidelines. Even though there is a national standard treatment guideline, it is a big document with pages and is not user-friendly. This may be evidenced by a usual practice by physicians to use international references such as Medscape and Up-to-Date which are easy to use because they can be downloaded on smartphones and can be accessed offline with easy searching mechanisms. Our innovation enables the national treatment guidelines to be uploaded and accessed offline. The app will have a search box where users can type in the words and have immediate access to complete information. This would significantly improve the inconsistent antibiotic prescription which in the end will help to decrease antimicrobial resistance.

Capital: What is the specific problem you are addressing through the App? Who are the primary beneficiaries of this App?
Minyahil Tadesse: In Ethiopia, the unregulated over-the-counter sale of antimicrobials, mainly for self-treatment of suspected infection in humans and animals without prescription would inevitably lead to the emergence and rapid dissemination of resistance. Particularly, the appropriate antimicrobial utilization in the case of hospitalized patients is crucial not only in ensuring an optimal outcome but also in curtailing the emergence of resistance and containing costs. A survey done by FMHACA in 2009 revealed that most bacteria that are involved in causing infections in human beings and animals showed a significant degree of resistance to commonly used first-line antimicrobials with a progressive increase over the years 1996-2000 E.C. (FMHACA, 2011). These pieces of evidence are alarming and unless significant interventions are applied, it is likely that most of our locally available antimicrobials will lose their efficacy and we will run out of options. In addition, it is difficult to make newer generations of antimicrobials accessible due to the high cost.
Even though there are diverse strategies that need to be implemented in order to curb the problem, rational use of antimicrobials is the cornerstone. This can be assured by making sure that prescribers use the national treatment guideline among other interventions. Making the guideline easily accessible and user-friendly is likely to have a significant impact on the probability of prescribers making use of it. So, our innovation help prescribers access the latest national antimicrobial guideline at their tap which will definitely improve their compliance with the guideline and practice rational use of antimicrobials. Likewise, if we use our available antimicrobials at hand wisely, it is likely that we will prolong the life of antimicrobials with adequate efficacy and avert the disaster of multidrug-resistant microorganisms. The primary target of this innovation is physicians, clinical pharmacists, and druggists who are the main players in the choice, prescription, and advice on the use of antimicrobials. And the ET-STGapp will be accessed by end-users by downloading the App on an Android device which later can be accessed offline.

Capital: How is this innovation substantially different from other approaches to address the stated problem and how does it improve upon the best existing alternatives?
Minyahil Tadesse: The spread of antimicrobial resistance in developing countries is associated with complex and interconnected factors, such as excessive and unnecessary prescribing of antimicrobials, increased self-prescribing by the people and poor quality of available antimicrobials. Moreover, the failure to implement infection control practices and the dearth of routine susceptibility testing and surveillance magnify the problems. This may spread the inappropriateness of prescribing, ending up with the spread of antimicrobial resistance.
Using a standardized approach to antimicrobial prescription is one of the most important interventions which help to tackle this problem. Even though a national standard treatment guideline is available in Ethiopia, its accessibility is questionable. In addition, in this era of technology, end users are likely to incline to other references which are at their disposal.
So, our innovation of a national antimicrobial usage App, will help health access information related to antimicrobial prescription with significant ease. Besides, this generation has a propensity to use technology which helps to make sure health professionals follow local guidelines which are likely to be based on local evidence.

Capital: How does your solution demonstrate its potential to scale and sustain health and development impacts?
Minyahil Tadesse: The African region has developed an eHealth strategy. The report emphasizes that the use of e-Health solutions can enhance service delivery; develop the health workforce and improve performance by eliminating distance and time barriers; and improve the availability, quality, and use of information and evidence.
Health care professionals use mHealth apps for point of care clinical decision-making. According to research in Saudi Arabia in 2018, medical apps most commonly used by medical practitioners are: Medscape, Oxford medical dictionary, Skyscape, UpToDate. In this study, some of the most common use of Installed smartphone medical apps was for revision of medical knowledge, during ward rounds, viewing of medication, and drug guides.
Similarly, in a study conducted among physicians working at referral hospitals in the Amhara region in Ethiopia in 2019, showed that the most commonly used medical application by the respondents were: Up to date, Medscape, Medcalc and Doximity. The drawback of these apps is that they are not easily accessible and that they are not based on local evidence and local treatment guidelines. The print-based and soft copies of the national treatment guidelines are not easy to access and use. Availing this document with the mhealth app will facilitate access to the resources for point of care decision making and hence improve the quality of care. At the point of care, physicians can check information with the ET-STGapp for possible differential diagnoses, treatment options, and drug information using the search words for drug or disease. Designing and applying this app using the local evidence will have a greater and long-term impact on health care, both on antimicrobial stewardship and quality of care.
Moreover, this app can be scaled up to a larger health professional community as it only needs smartphones and it will be used similarly to the existing apps. For scale-up and sustained use of the ET-STGapp, the Ministry of Health of Ethiopia has started to mobilize funding.

Capital: In the long run, how will you measure the success of this innovation? Are there any plans for measuring results and indicators of success?
Minyahil Tadesse: To measure the impact of the ET-STGapp for the antibiotic treatment guideline, the monkey survey will be carried out every time an update in the application has been made. In addition, a computer-based self-reporting performance measure will be developed, which shows the amount of time the health care workers have used the application.
The specific indicators for ET-STGapp Implementation program success are: Significant improvement in compliance to the antibiotic treatment guideline, improved health system information flow performance promoting antibiotic stewardship, single-window tracking system for antibiotic resistance in Ethiopia and increased uptake of the produced evidence by the policy decision making body.


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