Geo-spatial reporting for monitoring of household immunization coverage through mobile phones: Findings from a feasibility study.

BACKGROUND: The addition of Global Positioning System (GPS) to a mobile phone makes it a very powerful tool for surveillance and monitoring coverage of health programs. This technology enables transfer of data directly into computer applications and cross-references to Geographic Information Systems (GIS) maps, which enhances assessment of coverage and trends. OBJECTIVE: Utilization of these systems in low and middle income countries is currently limited, particularly for immunization coverage assessments and polio vaccination campaigns. We piloted the use of this system and discussed its potential to improve the efficiency of field-based health providers and health managers for monitoring of the immunization program. METHODS: Using "30×7" WHO sampling technique, a survey of children less than five years of age was conducted in random clusters of Karachi, Pakistan in three high risk towns where a polio case was detected in 2011. Center point of the cluster was calculated by the application on the mobile. Data and location coordinates were collected through a mobile phone. This data was linked with an automated mHealth based monitoring system for monitoring of Supplementary Immunization Activities (SIAs) in Karachi. After each SIA, a visual report was generated according to the coordinates collected from the survey. RESULT: A total of 3535 participants consented to answer to a baseline survey. We found that the mobile phones incorporated with GIS maps can improve efficiency of health providers through real-time reporting and replacing paper based questionnaire for collection of data at household level. Visual maps generated from the data and geospatial analysis can also give a better assessment of the immunization coverage and polio vaccination campaigns. CONCLUSION: The study supports a model system in resource constrained settings that allows routine capture of individual level data through GPS enabled mobile phone providing actionable information and geospatial maps to local public health managers, policy makers and study staff monitoring immunization coverage.

Outcome of chemoradiation in treating carcinoma esophagus.

OBJECTIVE: To observe the role of chemoradiation in treating carcinoma of esophagus, its complications and outcome of disease. DESIGN: Analytical descriptive study. PLACE AND DURATION OF STUDY: Conducted at IRNUM in collaboration with Hayatabad Medical Complex (HMC), Peshawar, for one year. PATIENTS AND METHODS: A total of 47 males and 53 females with an average age of 53 +/- 13 years were inducted in this study. Patients having upper end carcinoma or esophageal surgery were excluded from this study. They were treated with radio as well as chemotherapy. Those patients who had completed radiation six months before were planned for repeat endoscopies. Response evaluation was categorized as no evidence of disease, residual disease or stricture formation simulating carcinoma. Seventy percent of endoscoped patients were disease free and 30% were having residual disease. Of these 30%, 10% were having growth while rest of the 20% showed stricture formation due to radiation. RESULTS: Out of 100 patients, 70% were palliated maximally and no evidence of disease was found on endoscopy done after 1-6 months. Only 30% came up again with dysphagia. Out of these 30%, 20% were having esophageal stricture, which on dilatation improved the quality of life. Rest of the 10% were having stricture hiding the residual disease. Giving 1-2 cycles of chemotherapy before the start of radiation reduced the disease burden and predicted response to radiation by improving dysphagia. CONCLUSION: In spite of certain complications like neutropenia, emesis and stricture formation, chemoradiation is still the best treatment option available. It is because of its safety, well-tolerability and cost effectiveness. It is equally good for patients who refuse surgery and those with advanced disease.