• 1.

    GBD 2015 Mortality and Causes of Death Collaborators, 2016. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388: 14591544.

    • Search Google Scholar
    • Export Citation
  • 2.

    GBD 2015 Disease and Injury Incidence and Prevalence Collaborators, 2016. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388: 15451602.

    • Search Google Scholar
    • Export Citation
  • 3.

    Liu LOS, Hogan D, Perin J, Rudan I, Lawn JE, Cousens S, Mathers C, Black RE, 2015. Global, regional, and national causes of child mortality in 2000–13, with projections to inform post-2015 priorities: an updated systematic analysis. Lancet 385: 430440.

    • Search Google Scholar
    • Export Citation
  • 4.

    GBD 2013 Mortality and Causes of Death Collaborators, 2015. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385: 117171.

    • Search Google Scholar
    • Export Citation
  • 5.

    Fischer Walker CL, Sack D, Black RE, 2010. Etiology of diarrhea in older children, adolescents and adults: a systematic review. PLoS Negl Trop Dis 4: e768.

    • Search Google Scholar
    • Export Citation
  • 6.

    Lamberti LM, Bourgeois AL, Fischer Walker CL, Black RE, Sack D, 2014. Estimating diarrheal illness and deaths attributable to Shigellae and enterotoxigenic Escherichia coli among older children, adolescents, and adults in south Asia and Africa. PLoS Negl Trop Dis 8: e2705.

    • Search Google Scholar
    • Export Citation
  • 7.

    Kotloff KLN et al. 2013. Burden and aetiology of diarrhoeal disease in infants and young children in developing countries (the Global Enteric Multicenter Study, GEMS): a prospective, case-control study. Lancet 382: 209222.

    • Search Google Scholar
    • Export Citation
  • 8.

    Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI, 2003. Global illness and deaths caused by rotavirus disease in children. Emerg Infect Dis 9: 565572.

    • Search Google Scholar
    • Export Citation
  • 9.

    Bartsch SM, Lopman BA, Ozawa S, Hall AJ, Lee BY, 2016. Global economic burden of norovirus gastroenteritis. PLoS One 11: e0151219.

  • 10.

    Truninger K, 2014. Diarrhea in the elderly. Ther Umsch 71: 545550.

  • 11.

    Fischer Walker CL, Perin J, Aryee MJ, Boschi-Pinto C, Black RE, 2012. Diarrhea incidence in low- and middle-income countries in 1990 and 2010: a systematic review. BMC Public Health 12: 220.

    • Search Google Scholar
    • Export Citation
  • 12.

    Green A, 2017. Cholera outbreak in the horn of Africa. Lancet 389: 2179.

  • 13.

    Parker LA et al. 2017. Adapting to the global shortage of cholera vaccines: targeted single dose cholera vaccine in response to an outbreak in South Sudan. Lancet Infect Dis 17: e123e127.

    • Search Google Scholar
    • Export Citation
  • 14.

    Freedman SB, Vandermeer B, Milne A, Hartling L; Pediatric Emergency Research Canada Gastroenteritis Study Group, 2015. Diagnosing clinically significant dehydration in children with acute gastroenteritis using noninvasive methods: a meta-analysis. J Pediatr 166: 908916.e1-6.

    • Search Google Scholar
    • Export Citation
  • 15.

    Steiner MJ, DeWalt DA, Byerley JS, 2004. Is this child dehydrated? JAMA 291: 27462754.

  • 16.

    Hooper L et al. 2015. Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people. Cochrane Database Syst Rev 4: CD009647.

    • Search Google Scholar
    • Export Citation
  • 17.

    Armstrong LE, Kavouras SA, Walsh NP, Roberts WO, 2016. Diagnosing dehydration? Blend evidence with clinical observations. Curr Opin Clin Nutr Metab Care 19: 434438.

    • Search Google Scholar
    • Export Citation
  • 18.

    World Health Organization, 2005. The Treatment of Diarrhoea: A Manual for Physicians and Other Senior Health Workers. Geneva, Switzerland: World Health Organization.

  • 19.

    Pringle K, Shah SP, Umulisa I, Mark Munyaneza RB, Dushimiyimana JM, Stegmann K, Musavuli J, Ngabitsinze P, Stulac S, Levine AC, 2011. Comparing the accuracy of the three popular clinical dehydration scales in children with diarrhea. Int J Emerg Med 4: 58.

    • Search Google Scholar
    • Export Citation
  • 20.

    Levine AC, Glavis-Bloom J, Modi P, Nasrin S, Atika B, Rege S, Robertson S, Schmid CH, Alam NH, 2016. External validation of the DHAKA score and comparison with the current IMCI algorithm for the assessment of dehydration in children with diarrhoea: a prospective cohort study. Lancet Glob Health 4: e744e751.

    • Search Google Scholar
    • Export Citation
  • 21.

    Colaci D, Chaudhri S, Vasan A, 2016. mHealth interventions in low-income countries to address maternal health: a systematic review. Ann Glob Health 82: 922935.

    • Search Google Scholar
    • Export Citation
  • 22.

    ICT Data and Statistics Division, International Telecommunication Union, 2016. ICT Facts and Figures 2016. Available at: http://www.itu.int/en/ITU-D/Statistics/Pages/stat/default.aspx. Accessed June 8, 2017.

  • 23.

    Haque F et al. 2017. Evaluation of a smartphone decision-support tool for diarrheal disease management in a resource-limited setting. PLoS Negl Trop Dis 11: e0005290.

    • Search Google Scholar
    • Export Citation
  • 24.

    Khatun F, Heywood AE, Ray PK, Bhuiya A, Liaw ST, 2016. Community readiness for adopting mHealth in rural Bangladesh: a qualitative exploration. Int J Med Inform 93: 4956.

    • Search Google Scholar
    • Export Citation
  • 25.

    ICDDR B, 2016. Health and Demographic Surveillance System-Matlab. Registration of Health and Demographic Events 2014. Scientific Report No. 133 Dhaka, 49.

  • 26.

    Modi P, Nasrin S, Hawes M, Glavis-Bloom J, Alam NH, Hossain MI, Levine AC, 2015. Midupper arm circumference outperforms weight-based measures of nutritional status in children with diarrhea. J Nutr 145: 15821587.

    • Search Google Scholar
    • Export Citation
  • 27.

    James WP, Mascie-Taylor GC, Norgan NG, Bistrian BR, Shetty PS, Ferro-Luzzi A, 1994. The value of arm circumference measurements in assessing chronic energy deficiency in Third World adults. Eur J Clin Nutr 48: 883894.

    • Search Google Scholar
    • Export Citation
  • 28.

    Walter SD, Eliasziw M, Donner A, 1998. Sample size and optimal designs for reliability studies. Stat Med 17: 101110.

  • 29.

    Diggins KC, 2008. Treatment of mild to moderate dehydration in children with oral rehydration therapy. J Am Acad Nurse Pract 20: 402406.

    • Search Google Scholar
    • Export Citation
  • 30.

    Fonseca BK, Holdgate A, Craig JC, 2004. Enteral vs intravenous rehydration therapy for children with gastroenteritis: a meta-analysis of randomized controlled trials. Arch Pediatr Adolesc Med 158: 483490.

    • Search Google Scholar
    • Export Citation
  • 31.

    Kabakyenga J et al. 2016. A demonstration of mobile phone deployment to support the treatment of acutely ill children under five in Bushenyi district, Uganda. Afr Health Sci 16: 8996.

    • Search Google Scholar
    • Export Citation
  • 32.

    Jauregui J, Nelson D, Choo E, Stearns B, Levine AC, Liebmann O, Shah SP, 2014. External validation and comparison of three pediatric clinical dehydration scales. PLoS One 9: e95739.

    • Search Google Scholar
    • Export Citation
  • 33.

    Levine AC, Glavis-Bloom J, Modi P, Nasrin S, Rege S, Chu C, Schmid CH, Alam NH, 2015. Empirically derived dehydration scoring and decision tree models for children with diarrhea: assessment and internal validation in a prospective cohort study in Dhaka, Bangladesh. Glob Health Sci Pract 3: 405418.

    • Search Google Scholar
    • Export Citation
  • 34.

    Walker CL, Rudan I, Liu L, Nair H, Theodoratou E, Bhutta ZA, O’Brien KL, Campbell H, Black RE, 2013. Global burden of childhood pneumonia and diarrhoea. Lancet 381: 14051416.

    • Search Google Scholar
    • Export Citation
 
 
 

 

 

 

 

 

 

Evaluation of Standard and Mobile Health–Supported Clinical Diagnostic Tools for Assessing Dehydration in Patients with Diarrhea in Rural Bangladesh

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  • 1 Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island;
  • | 2 Department of Pediatrics, University of Florida College of Medicine, Gainesville, Florida;
  • | 3 Brown University Warren Alpert Medical School, Providence, Rhode Island;
  • | 4 Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh;
  • | 5 Brown University School of Public Health, Providence, Rhode Island;
  • | 6 BeeHyv Software Solutions Pvt. Ltd., Telangana, India

Diarrhea remains a leading cause of morbidity and mortality in patients worldwide. The objective of this study was to determine the relative inter-rater reliability and usability of standard and Mobile health (mHealth)-supported World Health Organization (WHO) algorithms for dehydration assessment in patients with acute diarrhea in a rural, low-income country hospital. Two nurses blinded to each other’s examinations assessed dehydration status on patients soon after hospital arrival using either the standard WHO algorithm printed on a laminated card or an mHealth-supported WHO algorithm downloaded onto a smartphone. The assignment of assessment tool was based on odd or even enrollment date. The inter-rater reliability for dehydration assessment between the two nurses was calculated using Cohen’s K statistic for each study group. A total of 496 patients (< 5 years N = 349, > 5 years N = 147) were enrolled in the study; 132 (27%) had some or severe dehydration, and 364 (73%) had no dehydration on arrival. Cohen’s K statistic demonstrated greater reliability for the mHealth-supported dehydration assessment (0.59) compared with the standard assessment (0.50) in the overall population (P < 0.0001), as well as in the pediatric (0.43 versus 0.37, P < 0.0001) and adult (0.79 versus 0.57, P < 0.0001) populations individually. This is the first study to show that mHealth can improve the reliability of nursing dehydration assessment in patients with acute diarrhea and the first to report on the reliability of the WHO algorithm in adult patients specifically. Future studies should focus on the impact of mHealth-supported dehydration assessment on patient-centered outcomes and examine its reliability in different settings worldwide.

Author Notes

Address correspondence to Adam C. Levine, The Warren Alpert Medical School of Brown University, Department of Emergency Medicine, 55 Claverick Street, Room 112, Providence, RI 02903. E-mail: adam_levine@brown.edu

Financial support: A. L. reports grants from National Institutes of Health, during the conduct of the study. S. T. received routine salaried payment from Beehyv Software Solutions Private Limited during the conduct of the study.

Authors’ addresses: Saadiyah Bilal and Adam Levine, Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, RI, E-mails: saadiyah_bilal@brown.edu and adam_levine@brown.edu. Eric Nelson, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, E-mail: eric.nelson@ufl.edu. Lars Meisner, Brown University Warren Alpert Medical School, Providence, RI, E-mail: lars_meisner@brown.edu. Mahfuj Alam, Saad Al Amin, Md Khan, and Nur Alam, Centre for Nutrition and Food Security, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh, E-mails: mahfujbd1991@gmail.com, dr.saad.ullah@hotmail.com, fazal@icddrb.org, and nhalam@icddrb.org. Yokabed Ashenafi, Brown University School of Public Health, Providence, RI, E-mail: yokabed_ashenafi@brown.edu. Shivani Teegala, BeeHyv Software Solutions Pvt. Ltd., Telangana, India, E-mail: shivani@beehyv.com.

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