Supporting eradication of maternal child malnutrition in developing countries: a case from Nicaragua scenario.

World Health Organization actively stresses the importance of health, nutrition and well-being of the mother to foster children development. This issue is critical in the rural areas of developing countries where monitoring of health status of children is hardly performed since population suffers from a lack of access to health care. The aim of this research is to design, implement and deploy an e-health information and communication system to support health care in 26 rural communities of Cusmapa, Nicaragua. The final solution consists of an hybrid WiMAX/WiFi architecture that provides good quality communications through VoIP taking advantage of low cost WiFi mobile devices. Thus, a WiMAX base station was installed in the health center to provide a radio link with the rural health post "El Carrizo" sited 7,4 km. in line of sight. This service makes possible personal broadband voice and data communication facilities with the health center based on WiFi enabled devices such as laptops and cellular phones without communications cost. A free software PBX was installed at "San José de Cusmapa" health care site to enable communications for physicians, nurses and a technician through mobile telephones with IEEE 802.11 b/g protocol and SIP provided by the project. Additionally, the rural health post staff (midwives, brigade) received two mobile phones with these same features. In a complementary way, the deployed health information system is ready to analyze the distribution of maternal-child population at risk and the distribution of diseases on a geographical baseline. The system works with four information layers: fertile women, children, people with disabilities and diseases. Thus, authorized staff can obtain reports about prenatal monitoring tasks, status of the communities, malnutrition, and immunization control. Data need to be updated by health care staff in order to timely detect the source of problem to implement measures addressed to alleviate and improve health status population permanently. Ongoing research is focused on a mobile platform that collects and automatically updates in the information system, the height and weight of the children locally gathered in the remote communities. This research is being granted by the program Millennium Rural Communities of the Technical University of Madrid.

A Tele-Health Communication and Information System for Underserved Children in Rural Areas of Nicaragua

Millennium Development Goals point out the necessity of actively promoting maternal-child health care status, especially in underserved areas. This article details the development actions carried out between 2008 and 2011 in some rural communities of Nicaragua with the aim to provide a low-cost tele-health communication service. The service is managed by the health care center of Cusmapa, which leads the program and maintains a communication link between its health staff and the health brigades of 26 distant communities. Local agents can use the system to report urgent maternal-child health care episodes to be assessed through WiMAX-WiFi voice and data communications attended by two physicians and six nurses located at the health care center. The health and nutritional status of the maternal-child population can be monitored to prevent diseases, subnutrition, and deaths. The action approach assumes the fundamentals of appropriate technology and looks for community- based, sustainable, replicable, and scalable solutions to ensure future deployments according to the strategies of the United Nations.

Deployment and validation of a smart system for screening of language disorders in primary care

Neuro-evolutive development from birth until the age of six years is a decisive factor in a child?s quality of life. Early detection of development disorders in early childhood can facilitate necessary diagnosis and/or treatment. Primary-care pediatricians play a key role in its detection as they can undertake the preventive and therapeutic actions requested to promote a child?s optimal development. However, the lack of time and little specific knowledge at primary-care avoid to applying continuous early-detection anomalies procedures. This research paper focuses on the deployment and evaluation of a smart system that enhances the screening of language disorders in primary care. Pediatricians get support to proceed with early referral of language disorders. The proposed model provides them with a decision-support tool for referral actions to trigger essential diagnostic and/or therapeutic actions for a comprehensive individual development. The research was conducted by starting from a sample of 60 cases of children with language disorders. Validation was carried out through two complementary steps: first, by including a team of seven experts from the fields of neonatology, pediatrics, neurology and language therapy, and, second, through the evaluation of 21 more previously diagnosed cases. The results obtained show that therapist positively accepted the system proposal in 18 cases (86%) and suggested system redesign for single referral to a speech therapist in three remaining cases.

Evaluating a web-based clinical decision support system for language disorders screening in a nursery school

Background: Early and effective identification of developmental disorders during childhood remains a critical task for the international community. The second highest prevalence of common developmental disorders in children are language delays, which are frequently the first symptoms of a possible disorder. Objective: This paper evaluates a Web-based Clinical Decision Support System (CDSS) whose aim is to enhance the screening of language disorders at a nursery school. The common lack of early diagnosis of language disorders led us to deploy an easy-to-use CDSS in order to evaluate its accuracy in early detection of language pathologies. This CDSS can be used by pediatricians to support the screening of language disorders in primary care. Methods: This paper details the evaluation results of the ?Gades? CDSS at a nursery school with 146 children, 12 educators, and 1 language therapist. The methodology embraces two consecutive phases. The first stage involves the observation of each child?s language abilities, carried out by the educators, to facilitate the evaluation of language acquisition level performed by a language therapist. Next, the same language therapist evaluates the reliability of the observed results. Results: The Gades CDSS was integrated to provide the language therapist with the required clinical information. The validation process showed a global 83.6% (122/146) success rate in language evaluation and a 7% (7/94) rate of non-accepted system decisions within the range of children from 0 to 3 years old. The system helped language therapists to identify new children with potential disorders who required further evaluation. This process will revalidate the CDSS output and allow the enhancement of early detection of language disorders in children. The system does need minor refinement, since the therapists disagreed with some questions from the CDSS knowledge base (KB) and suggested adding a few questions about speech production and pragmatic abilities. The refinement of the KB will address these issues and include the requested improvements, with the support of the experts who took part in the original KB development. Conclusions: This research demonstrated the benefit of a Web-based CDSS to monitor children?s neurodevelopment via the early detection of language delays at a nursery school. Current next steps focus on the design of a model that includes pseudo auto-learning capacity, supervised by experts.