JMIR Publications

ABSTRACT

Background:

The need for noncommunicable disease (NCD) prevention and control in humanitarian emergencies is well recognized, but there is little evidence to guide responses, leading to varying care delivery. The Sana.NCD mHealth application, initially developed in Lebanon, is the only known mHealth tool for NCD management designed to increase care quality and coverage appropriate for varied providers in primary and community settings.

Objective:

To evaluate a specialized mHealth application consisting of an abbreviated medical record for patients with hypertension and/or diabetes adapted for a Kenyan refugee camp setting.

Methods:

We tested an adapted version of the Sana.NCD application (diabetes and hypertension medical record) in an 11-month (May 2021 - March 2022) mixed-methods prospective evaluation in Kenya’s Hagadera refugee camp. Leveraging rollout of a general electronic medical record (EMR) system in Kakuma refugee camp, we compared a specialized NCD management application to a general EMR. We analyzed secondary data collected in the Sana.NCD application for 1,539 patients and EMR data for 68 NCD patients from Kakuma’s surgical and outpatient departments, and key informant interviews focused on Hagadera clinic staff perceptions of the Sana.NCD app.

Results:

During the study period, the Hagadera NCD clinic reported 18,801 consultations, 42.1% (n=7,918) of which were reported in the NCD application. Kakuma reported 350,776 total visits, of which 9,385 were for NCDs including 4,264 for hypertension and 2,415 for diabetes. Completeness of reporting was used as a metric of quality of care. Age, sex, prescribed medicines, random blood sugar, and smoking status were consistently reported in both the NCD application (>98%) and EMR (100%), while co-morbidities, complications, HbA1C, and diet were rarely reported in either platform (≤7% NCD application; 0% EMR). Number of visits, weight/height, physical activity, and next visit were frequently reported in the NCD application (≥99%) but not the EMR (≤15%). In the NCD application, completeness of reporting was high across the implementation period, with little meaningful change. Though not significantly changed during the study, elevated blood sugar and blood pressure were reported for sizable proportions of patients in the first (62.8% and 54.8%, respectively) and last (62.1% and 51.6%) study quarter. Providers were satisfied with the app, indicated it standardized patient information and made consultations easier, and believed access to historic patient information was easier, benefiting NCD control and follow-up.

Conclusions:

In this study, a specialized record for NCDs outperformed a more general record intended for use in all patients in terms of reporting completeness. This CommCare-based NCD application can easily be rolled out in similar humanitarian settings with minimal adaptation; however, adaptation of technologies to the local context and use case is critical for uptake and ensuring that workflows and time burden do not outweigh the benefits EMRs.