Reducing Diagnostic Costs and Improving Outcomes via Smartphone-Enabled Microscopy for Tuberculosis in Developing Regions
The smartphone has changed our lives. Its constant presence means we always have access to a camera for still or video images, voice or data communication, as well as Internet and social media access nearly everywhere we go.
Smartphones and mobile broadband services have changed health as well. And not just in the number of stiff necks from hunching over to look at screens, or arthritic thumbs. Smartphone-enabled mHealth has the potential to improve access to healthcare, health literacy levels, and outcomes around the world.
Smartphone-Assisted Global Health
Accurate and prompt diagnosis is among our first lines of defense against communicable diseases. While many in the developed world live a stone’s throw away from a healthcare facility of some kind, people living in developing countries have less access to medical care. Some have poor health-seeking habits due to cost or the stigma associated with illnesses like tuberculosis.
While health education is an essential aspect of eradicating disease, reducing costs and increasing accessibility of care could make a significant difference in the lives of millions. CellScope, a project begun at University of California at Berkley, has developed a portable digital fluorescence microscope to assist in the remote diagnosis of blood-born communicable diseases, specifically tuberculosis, malaria, and sickle cell disease.
The standard for initial diagnosis is brightfield imaging via a Ziehl-Neelsen stained sputum smear, which is laborious and can be hazardous if inhaled, touched, or ingested on both an acute and a long-term basis.
Fluorescent stains are increasing in popularity, as they are easier to read, possibly less toxic to prepare, and may give a more accurate diagnosis. However, in many developing regions fluorescent stains are rarely used either because of lack of equipment or the cost to maintain equipment.
Researchers on the CellScope team believe that their cell-phone microscope, combined with telehealth consultations, can reduce the burden of disease in developing regions.
“We expect such a telemedicine system for global healthcare via mobile phone – offering inexpensive brightfield and fluorescence microscopy integrated with automated image analysis – to provide an important tool for disease diagnosis and screening, particularly in the developing world and rural areas where laboratory facilities are scarce but mobile phone infrastructure is extensive.”
Automated Efficiencies with Impressive Sensitivity and Specificity
Using CellScope’s microscope technology can improve diagnostic efficiency by using simple image processing software to label and count tuberculosis bacteria. This automation would improve record keeping, and relieve healthcare workers from the task of manual counting.
Funded by the Gates Foundation, Vodafone, Microsoft, and Intel, CellScope tested its cell-phone based microscopy technology in regions where the cost of diagnosing and monitoring patients with tuberculosis are significant. Diagnostic sensitivity and specificity between unskilled laborers using CellScope was within 15% of those achieved by trained technicians using traditional diagnostic methods. Although this accuracy is insufficient for field diagnosis, the CellScope platform—combined with mHealth consultations—may significantly reduce costs associated with diagnosis and treatment while circumventing operator errors.
CellScope was piloted in areas that bear significant burdens of disease from tuberculosis. According to the World Health Organization, the tuberculosis rates per 100,000 people were 171 in India, 156 in Nepal, 166 in Uganda, and144 in Vietnam.
Lina Nelsson, a scientist at UC Berkley’s engineering lab, told the Times of India, that CellScope is “taking clinical microscopy out of specialized laboratories and into field settings for disease screening and diagnosis. A time will come when patients’ blood or sputum smears can be imaged with a mobile digital microscope. After using a computer algorithm for automated disease detection, [patients] could proceed immediately to treatment, without stepping foot in a city hospital or medical lab.”
Think Global, Act Local
Sometimes big ideas can solve small problems too. Eric Douglas, co-founder of CellScope, indicated that testing the microscopy technology overseas made him wonder about applications closer to home.
In the United States, the group has just released CellScope Oto HOME™ and Oto PRO™. Oto HOME™ allows concerned parents to record and send images of their children’s ears to physicians to rule out possible ear infections without an office visit. The Oto PRO™ allows physicians to maintain records of ear images in order to track treatment efficacy or to aide in patient education.
Jenn Lonzer has a B.A. in English from Cleveland State University and an M.A. in Health Communication from Johns Hopkins University. Passionate about access to care and social justice issues, Jenn writes on global digital health developments, research, and trends. Follow Jenn on Twitter @jnnprater3.