Teledermatology and AD in Subsaharan Africa

SESSION 2 / New fields in AD: big data mining, AD in sub-Saharan Africa, neuroinflammation

Garba MAHAMADOU (Lomé, Togo)
V Dorizy-Vuong, O Faye, CO Bagayoko, B Saka, P Pitché, A Taïeb.

Tele-AD project: overview

  1. Teledermatology in Subsaharan Africa
  2. Atopic dermatitis in Subsaharan Africa
  3. Tele AD Project: applications for AD management

Teledermatology procedures

Teleconsultation

  • Live Video
  • Telemonitoring, teleassistance, medical regulation

Teleexpertise

  • Store and Forward
  • Pictures/asynchronous

Teledermatology Programs
/projects in Africa

Multiple countries

  • RAFT: 20 countries
  • Africa Teledermatology Project: 12 countries

National Initiatives

  • Ghana
  • Mali: TelederMali©
  • Mauritania
  • South Africa
  • Tanzania
  • Togo

RAFT : Réseau en Afrique Francophone pour la Télémédecine

  • French speaking african countries network in telemedicine
  • « Supporting care professionals where they are most needed »
    • Dudal (E- learning): Low-bandwidth distance education
      • Interactive webcasting, 20-30 kbps bandwidth
    • Bogou (Web/mobile based platform)
  • founded by the university of Geneva,
  • 1000 health practitioners
    • Cardiology (electrocardiograms), gynecology (discussing difficult cases)
    • Teleechography, teleradiology, dermatology
Tele-AD

Africa Teledermatology Project (ATP)

  • 12 countries : Uganda, Botswana, Malawi, Swaziland, Burkina Faso, Lesotho, Kenya, South Africa, Eritrea, Liberia, Mozambique, Nigeria, South Africa, Tanzania
    • 1229 patients (2007-2013)
    • Secure website or mobile phone 13%
    • Response 1 week
  • Online archive of tropical skin conditions
  • Internet source of educational material for training and updating of medical specialists and health personnel.
  • Secure an active channel and platform for dermatological research collaboration
Tele-AD

JAAD 2015 Lipoff et al.


TelederMali :
Pilot project in Mali, 2015-2016

  • Subsaharan Africa (West Africa)
  • 10 Primary health care center
  • Modality: web based platform (Bogou), picture with camera then connection to a computer
  • 180 patients
  • Response of dermatologists delay 32h:
    diagnosis and recommandations
  • Eczema: 13 % of all skin diseases

Faye O et al Trop Med Infect Dis. 2018

Frequency skin disease teledermatology

Tele-AD

Skin disease in reference center of dermatology 2015

Tele-AD

Ghana, Mauritania, South Africa, Tanzania and Togo

Web based platform

  • Togo, Bogou
  • Mauritania, National program of telemedicine
  • South Africa,
  • Ghana, Mobile platform, ClickDoc and ATP

Teleconferencing/mailing

  • Tanzania (RDTC) and Switzerland (Zurich)
Tele-AD

Osei-tutu A. JAAD 2013


AD in Africa, Current difficulties

Difficulties of diagnosis

Difficulties of access to treatment

  • Access to emollients and corticosteroids : quality? Financial accessibility? Pharmacy avaibility
  • Not available: calcineurine inhibitors, immunosuppressants, biotherapy
  • Compliance: anaphalbetism, incorrect application of the cream (quantity, duration, adverse effects)

Difficulties of follow up:

  • Long term follow up: chronic disease
  • Lost to follow up patient
  • No therapeutic patient education
  • Impact of traditional medicine in chronic dermatosis
  • Religious/social mysticism for chronic dermatosis

*Gaffney R (2015) Global teledermatology


Geneva Workshop roadmap

  • AD:
    • one of the most common inflammatory dermatological diseases in primary, secondary and especially tertiary care in SSA.
    • significant emerging public health problem in SSA.
  • International health organizations, Foundations, international learned societies (WHO, IFD, ISAD) should encourage and support studies on AD in Africa for better recognition.
  • Participants agreed:
    • difficulties in diagnosis and treatment of AD, lack of medical infrastructure, in particular, trained primary care workers and certified dermatologists.
    • need to develop telemedicine in order to compensate for the low number and uneven distribution of dermatologists.
Tele-AD

Tele-AD

Connecting Derm specialist and primary health workers

Tele-AD

E-Learning

Tele-AD
  • Prerequisites:
    survey on AD in Cameroon (Kouotou BMC Dermato 2017) and Togo
  • Methods:
    • Initial and in-service training programme oriented towards AD.
    • Describe the diagnostic criteria of the disease, the procedure for using the digital tools of the programme.
    • Produce a normative good clinical practice guide.
    • Collaboration with CYBERDERM
  • Expected outcome
    • Trained health professionals will be able to recognize and manage AD.

Store & Forward Teledermatology

Tele-AD
  • Method:
    tele-expertise platform
    (clinical history + photography)
  • Expected results:
    • Definition of simple diagnostic criteria adapted to the primary care setting.
    • Epidemiology of AD (morbidity, mortality) and defined severity spectrum.
    • Diagnostic time will be shortened and quality of care increased.

Telemonitoring

Tele-AD
  • Prerequisites:
    training in the use of PO SCORAD (Eczema Foundation)
  • Methods:
    • Self-assessment of AD under the guidance of professionals in charge of long-term follow-up.
    • Simple cases handled in primary structures and complex cases included in a system of referral and sorting of requests by tele-expertise.
  • Expected results:
    • Better follow-up of AD patients
    • Long journeys avoided

Therapeutic Patient Education

  • Prerequisite:
    development of contents in different languages by local experts (sensibilization messages).
  • Methods:
    • YouTube channel / field animations,
    • Field visits with mobile teams,
    • SMS phone alerts.
  • Expected results:
    • Improving compliance and quality of life
    • Therapeutic success in patients

Where are we now?

  • Writing a comprehensive guide for AD in SSA
  • ATOPY TV for TPE
  • Bogou in use
  • Dudal in use, collaboration with CYBERDERM (Peter SCHMID)
  • PO SCORAD: adaptation, online training with Eczema Foundation is developed

Conclusion

  • Increase access to quality care services for patients in any situation in which there is a barrier to receiving treatment.
  • Project threats:
    • Access: cost of equipment, quality of internet
    • Resources (finance), stakeholders engagement

Ask questions to Garba MAHAMADOU:


Conflict of interest : none