The Aga Khan Development Network (AKDN) is a network of private, non-denominational (de jure) development agencies founded by the Aga Khan that work primarily in the poorest parts of Asia and Africa. Aga Khan IV succeeded to the office of the 49th hereditary Imam as spiritual and administrative leader of the Shia faith-rooted Nizari Ismaili Muslim supranational union in 1957. Ismailis consist of an estimated 25–30 million adherents (about 20% of the world's Shia Muslim population).The network focuses on health, education, culture, rural development, institution building and the promotion of economic development. The AKDN aims to improve living conditions and opportunities for the poor, without regard to their faith, origin or gender. Its annual budget for not-for-profit activities is approximately US $ 950 million – mainly in Africa, Asia, and the Middle East. The AKDN works in 30 countries around the world, and it employs approx 96,000 paid staff, mostly in developing countries. While the agencies are secular, they are guided by Islamic ethics, which bridge faith and society.
In lower-middle-income countries (LMICs) like Pakistan, the high incidence and mortality of ischemic stroke pose significant challenges due to limited infrastructure and the scarcity of neurologists. Mobile health (mHealth) applications may bridge this gap by facilitating rapid and accurate diagnoses, which are critical for effective intervention. This study aims to describe the design, development, and initial testing phases of InstaDx, an android-based clinical decision support tool designed to assist neurology trainees and physicians in diagnosing ischemic stroke subtypes in high-volume, resource-constrained settings. The app aims to support neurology trainees in distinguishing stroke subtypes, a highly specialized task that requires knowledge of stroke pathophysiology, vascular anatomy, and the ability to interpret diagnostic imaging. The goal is to assist trainees in achieving diagnostic accuracy comparable to that of a vascular neurologist, thereby improving stroke diagnosis and care in LMICs where stroke specialists may not be readily available. InstaDx facilitates the diagnosis of ischemic stroke subtypes through a user-friendly interface, designed to function under constrained infrastructure conditions. Key features include offline capabilities, PDF versions of critical stroke scales, and flexible user-interface widgets, ensuring compatibility across diverse devices and screen sizes. The application employs alerts and dialogues to guide accurate data entry, with case processing times ranging from 5 to 7 min. It also supports stroke risk stratification and diagnostic decision-making by incorporating laboratory findings to finalize the ischemic stroke subtype. Iterative testing phases—alpha (5 users), beta (10 users), and gamma (16 neurology residents)—led to significant enhancements, including layout adjustments, color scheme updates, and improvements to offline synchronization modules. Gamma testing with neurology residents highlighted the app’s potential to streamline the diagnostic process for ischemic stroke subtypes. InstaDx represents a significant advancement in stroke care for LMICs, offering a scalable solution to overcome the challenges posed by limited availability of stroke specialists. The application’s design and testing phases indicate strong potential for enhancing stroke diagnosis and management, with further studies needed to evaluate its impact on clinical outcomes.
Abstract Objective: Antibiotic resistance is a major global health threat, driven by inappropriate antimicrobial prescribing. Mobile health (mHealth)–based clinical decision-support systems (CDSS) may strengthen antibiotic stewardship, but evidence from resource-limited settings remains limited. This study reports the development and implementation of ComBact, an mHealth-based CDSS for seven infectious disease syndromes, examines physicians’ perceptions of its clinical utility, and evaluates system-level usability metrics at a private tertiary-care hospital in Pakistan. Methods: A convergent parallel mixed-methods design was used. Semi-structured focus group discussions (FGDs) were conducted with internal medicine physicians who had access to ComBact for one year. Transcripts were analyzed using Braun and Clarke’s thematic framework. Quantitative analysis included system-generated data on user registration, uptake, and detailed usage metrics. Findings from both components were integrated using a joint display. Results: 61 clinicians registered for ComBact, all accessing the dashboard at least once. The app recorded 134 sessions, with a mean of 1.23 pathway revisits per session and a mean workflow duration of 1 minute 25 seconds; 32.7% of users completed a ComBact plan. Mobile phones accounted for 57.4% of access and desktops for 42.6%. Two FGDs were conducted with fifteen physicians (median age 31 years (IQR: 27–34 yr). Five themes emerged: (1) clinical applicability, (2) user experience, (3) need of the app, (4) content limitations, and (5) recommendations. Conclusions: ComBact was perceived as a user-friendly tool with meaningful potential to support antimicrobial stewardship in LMICs, though significant content and functional enhancements are needed.
Pakistan faces significant challenges in attaining the Sustainable Development Goals for maternal and child health by the 2030 target. Separate vertical programmes, governance challenges due to paper-based systems, and limited availability of data contribute to the health system’s suboptimal functioning. An innovative mHealth tool, Hayat, was introduced in remote areas of Pakistan to digitalise record-keeping by frontline workers, provide evidence-based awareness content for dissemination, and track performance through transparency enhanced by geographical information system tracking. There has been a limited translation of mHealth evidence into policy change globally. Hayat is one of the few donor-funded programmes, and strengthens the health system in Pakistan. It secured matching funding from the government to sustain operations and for scale-up. The current paper was planned to describe the intrinsic and extrinsic factors that led to the intervention’s adoption by the government, including the technological and programmatic approaches, challenges and mitigation strategies, ---Continue
BackgroundMicronutrient deficiencies in folate, ferritin, calcium, and vitamin D are common during pregnancy in low- and middle-income countries, often due to inadequate diets. Micronutrient supplementation can address this need, whereas innovative awareness strategies in antenatal practices could enhance supplement use compliance. ObjectiveWe evaluated the efficacy of a personalized mobile health (mHealth) intervention, hypothesizing a 30% improvement in supplement use in the intervention group compared to a conventional face-to-face counseling group. MethodsIn an unblinded randomized controlled trial, we enrolled 306 first-trimester pregnant women from Aga Khan University Hospital between January 2020 and September 2021 who owned smartphones with internet connection. Women on regular medications or with dietary restrictions or critical illnesses were excluded. The intervention group received personalized micronutrient supplement use coaching through an mHealth app (PurUmeed Aaghaz) as thrice-a-week push messages and tailored recommendations over a 24-week period. The comparison group received standard face-to-face counseling at 6, 12, 18, and 24 weeks after enrollment. Baseline sociodemographic, obstetrics, anthropometric, dietary, and lifestyle data were collected through face-to-face interviews. At each follow-up, participants reported their weekly use of folic acid, iron, calcium, and vitamin D supplements, scored as 0 (daily), 1.5 (4-6 times weekly), and 3 (≤3 times weekly). Scores were summed to calculate the cumulative supplement use score (CSUS; 0-12), with higher scores indicating greater inadequacy. Every fourth woman was invited for biochemical micronutrient assessment. Data were analyzed using Stata (version 14), with random-effects linear and logistic panel regression to compare CSUS and supplement use between the 2 groups from baseline to endline. ResultsOf 153 participants per group, 107 (69.9%) in the intervention and 125 (81.7%) in the nonintervention group completed the study. After 24 weeks, the intervention group showed a greater but insignificant reduction in mean CSUS compared to the nonintervention group (β=–.27, 95% CI −0.65 to 0.12; P=.17). Daily supplement use improved by 20% versus 22.4% for folic acid, 11.2 times versus 2.1 times for iron, 1.2 times versus 14.2 times for calcium, and 3 times versus 1.3 times for vitamin D in the intervention versus nonintervention group, respectively. Multivariable analysis showed higher, though insignificant, odds of sufficient folic acid (adjusted odds ratio [aOR] 1.26, 95% CI 0.68-2.36; P=.46) and iron (aOR 1.31, 95% CI 0.95-1.81; P=.10) use in the intervention group, whereas vitamin D use was significantly higher (aOR 1.88, 95% CI 1.43-2.47; P<.001). Calcium intake improved in the nonintervention group (aOR 0.59, 95% CI 0.44-0.79; P<.001). Anemia decreased in the intervention group, whereas ferritin, calcium, and vitamin D deficiencies persisted or worsened, particularly in the nonintervention group. ConclusionsAn appropriately implemented mHealth intervention can improve antenatal vitamin D supplementation. Affordable, accessible, and personalized counseling through mHealth could ameliorate micronutrient status during pregnancy. Trial RegistrationClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/study/NCT04216446
