Dissertations / Theses on the topic 'Wireless communication systems in medical care – Zimbabwe'

Thesis (MTech (Information Technology))--Cape Peninsula University of Technology, 2016.
Zimbabwe has a fairly developed health-care delivery system that is served by public and private hospitals at district, provincial and national level. The public health-care system is the largest provider of health-care services and caters for the majority of the population but this is done in a resource-restricted context, typical of a developing context. In this context, this research sought to establish the potential of mHealth Technologies in Zimbabwe’s maternal health sector using Parirenyatwa and Harare hospitals as case studies. The reviewed body of knowledge, which was largely a comparative assessment of mHealth technology adoption in developing countries, indicated that the full adoption of the prevailing eHealth strategy in Zimbabwe remains hamstrung by the slow pace of policy implementation. This is a qualitative study and data was collected with unstructured interviews. Purposive and snowball sampling were used to recruit the participants. The gathered data was analyzed through content and thematic analysis. Four broad themes emerged from the primary data collected during the interviews and these include: trends in information dissemination in Zimbabwe’s Public Health System; information needs for expectant women and midwives; the prevalence of ICT use in Zimbabwe’s Public Health System, and mobile technology use in the maternal health sector in Zimbabwe. The research was able to establish that while there is a high proliferation of smartphone use among most expectant women, this has not translated into their use for health information-related purposes.

Thesis (DPhil (Informatics))--Cape Peninsula University of Technology, 2018.
As in many parts of the world, the need for healthcare services is increasing rapidly in South Africa. Owing to many official languages in the country, health service delivery is continuously challenged by spoken language and semantics. The challenges result to poor health services in many areas of the country. Thus, this study was undertaken with the aim: to develop a framework which can be used to guide the selection and implementation of mobile systems in the translation of language semantics for improved healthcare service delivery in South Africa. For this purpose, the study was based on one significant research question: How can the challenge(s) of semantics and language translation in South African healthcare delivery be addressed using mobile systems? In achieving the aim of the study, a qualitative study was conducted using the semi-strtructured interviews to collect the data. The analysis of the data was carried out using the hermeneutic approach within the interpretative paradigm, which was guided by two theories, actor network theory (ANT) and diffusion of innovation (DOI). The ANT was used to focus on the interaction and relationship between human and non-human actors within a heterogeneous networks, in the activities of healthcare. The DOI was employed to examine how mobiles systems can be diffused, in addressing the challenges and barriers which the health facilities encounter from language perspective. The case study approach was followed, based on three cases, two healthcare organisations, and a community in the northern part of South Africa were used in the study. Based on the analysis of the data, the influencing factors were found, and interpreted. The interpretation helps gain deeper understanding of the challenges, from which a framework (see Figure 6.5 in Chapter 6) was developed. From an understanding of the factors that influence language semantics, and its translaton by using mobile systems, challenges in the South African healthcare can be reduced, and quality improved. The way in which the theories were used brought a fresh perspective to the study. In practice, the framework can be used by both healthcare practitioners and ICT specialists to guide the selection, use and support of mobile systems for the translation of language semantics in South Africa. The complementary use of ANT and DOI in the study contributes methodologically.

The public healthcare sectors within developing nations face a lot of challenges because of constrained resources available to them. The South African public healthcare sector is no different. Although it serves the majority of the South African population, most of the financial resources are directed towards the private sector, which serves very few individuals when compared to the public healthcare sector. Apart from that, other challenges that the National Department of Health has to deal with include the lack of sufficiently trained healthcare employees who can work on the different levels of the public healthcare sector, as well as the burden of diseases such as HIV and Aids, tuberculosis and other chronic diseases. In order to improve service delivery, the National Department of Health is introducing Information and Communications Technology interventions that can increase efficiency and reduce costs, thereby improving the quality of service delivery. This research delivers an m-health application user experience framework to be proposed to the National Department of Health in South Africa, in order to assist in scaling up of m-health applications. The m-health applications that can benefit the South African population if scaled up successfully include those that can be used in remote data collection, treatment and compliance, accessing patients records, remote monitoring, communication and training for healthcare workers and applications that can be used for education and awareness. The study focused on three domains: the Human-Computer Interaction domain, public healthcare domain and Health Informatics domain. The proposed framework was realized by investigating mobile user experience components, mobile health requirements and the South African public healthcare domain components that contribute to the m-health user experience framework. This research was conducted through the interpretivist philosophy. Due to the exploratory nature of the study, an application of qualitative methodology was used. The conceptual theoretical framework was validated through a single case study approach by m-health user experience experts, who reside in South Africa. Data were analysed inductively. An m-health user experience framework was provided at the end of the study. An m-health user experience framework can assist the National Department of Health to look into design issues, address m-health requirements and put the domain needs in place, thus enabling the Department to successfully scale up implementations of m-health applications nationwide.

Dans cette thèse, nous avons proposé des solutions originales et performantes pour l’économie d’énergie dans les réseaux de capteurs sans fil (RCSF). Ces contributions s'organisent autour de deux grands axes : les réseaux de capteurs génériques et les réseaux de capteurs sans fil dédiés aux applications santé. Dans un premier temps, nous avons réalisé un état-de-l’art des mécanismes d'économie d’énergie pour les RCSF. Nous avons ensuite proposé deux solutions originales : la première optimise le déplacement d’une station de base, ainsi que la façon dont les données sont stockées dans les capteurs et routées vers le puit mobile ; la seconde optimise le déploiement de chargeurs mobiles, qui une fois dans le réseau permettent de satisfaire la demande en énergie des nœuds via la transmission d’énergie sans fil sur plusieurs sauts. Dans un second temps, nous nous sommes intéressés plus particulièrement aux applications des RCSF pour la supervision de patients à distance. Nous avons introduit une nouvelle classification des techniques économes en énergie adaptées à la spécificité de ces applications santé. Nous avons ensuite proposé une nouvelle architecture pour la supervision de patient à distance à l’aide de capteurs sans fil qui permet de prolonger la durée de vie des capteurs et de la station de base. Cette solution prend en compte l’environnement du patient et l’hétérogénéité des appareils. Nos résultats montrent que la durée de vie des réseaux de capteurs sans fil peut être étendue en utilisant les différentes stratégies proposées. L’efficacité de ces approches a été confirmée à l’aide de nombreuses expérimentations numériques et simulations
In this thesis, we propose new strategies for energy conservation in wireless sensor networks, so that the operational time of these networks can be extended. The work can be divided into two main focus area, namely general wireless sensor networks, and healthcareoriented wearable sensor networks. In the first part of this thesis we provide a comprehensive survey of the existing energy-efficient mechanisms. Then, we propose two new solutions: the first one optimizes the displacement of a mobile base station as well as buffer usage and data routing at sensor nodes; the second one optimizes the deployment of wireless chargers in the network to satisfy the energy demand of the sensors. The second part of this thesis is dedicated to healthcare application where wearable sensors are used to remotely supervise a patient. We begin with a state-of-the-art of the energy-efficient techniques existing in the literature. We then introduce a new energy-efficient architecture that allows to optimize the lifetime of both the sensor and the base station. This is a context-aware solution that takes into consideration heterogeneous devices. Our results show that the lifetime of the sensor networks can be extended using the proposed strategies. All the results obtained are supported by numerical experiments and extensive simulations

Human body is a complex system organized at different levels such as cells, tissues and organs, which contributes to 11 important organ systems. The functional efficiency of this complex system is evaluated as health. Traditional healthcare is unable to accommodate everyone's need due to the ever-increasing population and medical costs. With advancements in technology and medical research, traditional healthcare applications are shaping into smart healthcare solutions. Smart healthcare helps in continuously monitoring our body parameters, which helps in keeping people health-aware. It provides the ability for remote assistance, which helps in utilizing the available resources to maximum potential. The backbone of smart healthcare solutions is Internet of Things (IoT) which increases the computing capacity of the real-world components by using cloud-based solutions. The basic elements of these IoT based smart healthcare solutions are called "things." Things are simple sensors or actuators, which have the capacity to wirelessly connect with each other and to the internet. The research for this dissertation aims in developing architectures for these things, focusing on IoT-based smart healthcare solutions. The core for this dissertation is to contribute to the research in smart healthcare by identifying applications which can be monitored remotely. For this, application-specific thing architectures were proposed based on monitoring a specific body parameter; monitoring physical health for family and friends; and optimizing the power budget of IoT body sensor network using human body communications. The experimental results show promising scope towards improving the quality of life, through needle-less and cost-effective smart healthcare solutions.

Three decades of mobile phone diffusion, thousands of mobile-phone-based health projects worldwide ("mHealth"), and tens of thousands of health applications in Apple's iTunes store, but fundamental questions about the effect of phone diffusion on people's healthcare behaviour remain unanswered. Empirical, theoretical, and methodological gaps in the study of mobile phones and health reinforce each other and lead to simplifying assumptions that mobile phones are a ubiquitous and neutral platform for interventions to improve health and healthcare. This contradicts what we know from the technology adoption literature. This thesis explores the theoretical link between mobile phone diffusion and healthcare access; develops and tests a new multidimensional indicator of mobile phone adoption; and analyses the effects of phone use on people's healthcare-seeking behaviour. My mixed methods research design - implemented in rural Rajasthan (India) and Gansu (China) - involves qualitative research with 231 participants and primary survey data from 800 persons. My research yields a qualitatively grounded framework that describes the accessibility and suitability of mobile phones in healthcare-seeking processes, the heterogeneous outcomes of phone use and non-use on healthcare access, and the uneven equity consequences in this process. Quantitative analysis based on the framework finds that mobile phone use in rural India and China increases access to healthcare, but it also invites more complex and delayed health behaviours and the over-use of scarce healthcare resources. Moreover, increasing phone-aided health action threatens to marginalise socio-economically disadvantaged groups further. I present here the first quantitative evidence on how mobile phone adoption influences healthcare-seeking behaviour. This challenges the common view that mHealth interventions operate on a neutral platform and draws attention to potential targeting, user acceptance, and sustainability problems. The framework and tools developed in this thesis can support policy considerations for health systems to evaluate and address the healthcare implications of mobile phone diffusion.

The advances in communication technologies have resulted in a significant shift in the workplace culture. Mobile computing devices are increasingly becoming an integral part of workplace culture. Mobility has several advantages to the organisation, one such example is the “always online” workforce resulting in increased productivity hours. As a result, organisations are increasingly providing mobile computing devices to the workforce to enable remote productivity at the organisations cost. A challenge associated with mobility is that these devices are likely to connect to a variety of networks, some which may insecure, and because of their smaller form factor and perceived value, are vulnerable to loss and theft amongst other information security challenges. Increased mobility has far reaching benefits for remote and rural communities, particularly in the healthcare domain where health workers are able to provide services to previously inaccessible populations. The adverse economic and infrastructure environment means institution provided devices make up the bulk of the mobile computing devices, and taking away the ownership, the usage patterns and the susceptibility of information to adversity are similar. It is for this reason that this study focuses on information security on institution provided devices in a rural healthcare setting. This study falls into the design science paradigm and is guided by the principles of design science proposed by Hevner et al. The research process incorporates literature reviews focusing on health information systems security and identifying theoretical constructs that support the low-resource based secure deployment of health information technologies. Thereafter, the artifact is developed and evaluated through an implementation case study and expert reviews. The outcomes from the feedback are integrated into the framework.

In developing countries, acute respiratory infections (ARIs) are responsible for two million deaths per year. Most victims are children who are less than 5 years old. Pneumonia kills 5000 children per day. The statistics for cardiovascular diseases (CVDs) are even more alarming. According to a 2009 report from the World Health Organization (WHO), CVDs kill 17 million people per year. In many resource-poor parts of the world such as India and China, many people are unable to access cardiologists, pulmonologists, and other specialists. Hence, low skilled health professionals are responsible for screening people for ARIs and CVDs in these areas. For example, in the rural areas of the Philippines, there is only one doctor for every 10,000 people. By contrast, the United States has one doctor for every 500 Americans. Due to advances in technology, it is now possible to use a smartphone for audio recording, signal processing, and machine learning. In my thesis, I have developed an Android application named Smart Auscultation. Auscultation is a process in which physicians listen to heart and lung sounds to diagnose disorders. Cardiologists spend years mastering this skill. The Smart Auscultation application is capable of recording and classifying heart sounds, and can be used by public or clinical health workers. This application can detect abnormal heart sounds with up to 92-98% accuracy. In addition, the application can record, but not yet classify, lung sounds. This application will be able to help save thousands of lives by allowing anyone to identify abnormal heart and lung sounds.

Modern implantable and body worn medical devices leverage wireless telemetry to improve patient experience and expand therapeutic options. Wireless medical devices are subject to a unique set of regulations in which monitoring of the available frequency spectrum is a requirement. To this end, implants use software protocols to assess the in-band activity to determine which channel should be used. These software protocols take valuable processing time and possibly degrade the operational lifetime of the battery. Implantable medical devices often take advantage of a single chip transceiver as the physical layer for wireless communications. Embedding the channel assessment task in the transceiver hardware would free the limited resources of the microprocessor. This thesis proposes hardware modifications to existing transceiver architectures which would provide an automated channel assessment means for implantable medical devices. The results are applicable beyond medical device applications and could be employed to benefit any low-power, wireless, battery-operated equipment.

MHealth is an upcoming area promising to contribute benefits to health service delivery. The purpose of this study was to identify and describe the rate of mHealth utilisation as well as opportunities for mHealth and the barriers to use at one central hospital in Zimbabwe. A quantitative, descriptive, cross-sectional study was undertaken at the central hospital. Data collection was done using structured questionnaires. The entire population of medical doctors at the hospital (N=42) were the respondents of the research. The 18 mHealth activities were chosen from a possible of 101 available. The most used as well as the least used mHealth activities were identified and the reasons for use or lack of use were identified. The study revealed that 75% of the activities were currently being used and 95% had the potential of future use by medical doctors. This study highlights the potential of mHealth from medical doctors’ perspective.
Health Studies
M. A. (Public Health)

Thesis (Ph.D.)--University of the Witwatersrand, Faculty of Commerce, Law and Management, School of Economic & Business Sciences, November 2016
Community Health Workers or “CHWs” are often the only link to healthcare for millions of people in the developing world. They are the first point of contact with the formal care system, and represent the most immediate and cost effective way to save lives and improve healthcare outcomes in low-resource contexts. Mobile-health or ‘mHealth’ technologies may have potential to support CHWs at the point-of-care and enhance their performance. Yet, there is a gap in substantive empirical evidence on whether the use of mHealth tools enhances CHW performance, and how their use contributes to enhanced healthcare service delivery, especially in low-resource communities. This is a problem because a lack of such evidence would pose an obstacle to the effective large-scale implementation of mHealth-enabled CHW projects in low-resource settings. This thesis was motivated to address this problem in the Kenyan community health worker context. First, it compared the performance of CHWs using mHealth tools to those using traditional paper-based systems. Second, it developed and tested a replicable Technology-to-Performance Chain (TPC) model linking a set of CHW task and mHealth tool characteristics, to use and user performance outcomes, through four perspectives of Task-Technology Fit (TTF), namely Matching, Moderation, Mediation, and Covariation. A quasi-experimental post-test only research design was adopted to compare performance of CHWs using an mHealth tool to those using traditional paper-based systems. A primary structured questionnaire survey instrument was used to collect data from CHWs operating in the counties of Siaya, Nandi, and Kilifi, who were using an mHealth tool to perform their tasks (n = 257), and from CHWs operating in the counties of Nairobi and Nakuru using traditional paper-based systems to perform their tasks (n = 353). Results showed that CHWs using mHealth tools outperform their counterparts using paper-based systems, as they were observed to spend much less time completing their monitoring, prevention, and referral reports weekly, and report higher percentages of both timeous and complete monthly cases. In addition, mHealth tool users were found to have more positive perceptions of the effects of the technology on their performance, compared to those using traditional paper-based systems. An explanatory, predictive, research design was adopted to empirically assess the effects of a ‘fit’ between the CHW task and mHealth technology (TTF) on use of the mHealth technology and on CHW user performance. TTF was tested from the Matching, Moderation, Mediation, and Covariation ‘fit’ perspectives using the cross-sectional survey data collected from the mHealth tool users (n = 257). Results revealed that there are various unique ways in which a ‘fit’ between the task and technology can have significant impacts on use and user performance. Specifically, results showed that the paired-match of time criticality task and technology characteristics impacts use, while that of time criticality and information dependency task and technology characteristics impacts user performance. Results also showed that the cross-product interaction of mobility task and interdependence technology characteristics impacts use, and that of mobility task and interdependence and information dependency technology characteristics, impacts user performance. Similarly, the cross-product interaction of information dependency task and time criticality technology characteristics impacts user performance. Moreover, results showed that a perceived ‘fit’ between CHW task and mHealth technology characteristics partially and fully mediates the effects of user needs and tool functions on use and user performance, whereas ‘fit’ as an observed pattern of holistic configuration among these task and technology characteristics impacts use and user performance. It was also found that the perfect ‘fit’ between CHW task and mHealth tool technology characteristics leads to the highest levels of use and user performance, while a misfit leads to a decline in use and user performance. Notably, an over-fit of mHealth technology support to the CHW task leads to declining use levels, while an under-fit leads to diminishing user performance. Of the four ‘fit’ perspectives tested, the matching and cross-product interaction of task and technology characteristics offer the most dynamic insights into use and user performance impacts, whereas user-perception and holistic configuration, were also shown to be significant, thus further reinforcing these effects. Tests of a full TPC model revealed that greater mHealth tool use had a positive effect on the effectiveness, efficiency, and quality of CHW performance in the delivery of patient care. Moreover, it was found that ‘facilitating conditions’ and ‘affect toward use’ had positive effects on mHealth tool use. Furthermore, a perceptual TTF was found to have positive effects on mHealth tool use and CHW performance. Of note, this perceived TTF construct was found to be simultaneously a stronger predictor of mHealth tool use than ‘facilitating conditions’ and ‘affect toward use’, and a stronger predictor of CHW performance than mHealth tool use. Consequently, TTF was confirmed as the central construct of the TPC. The findings constitute significant empirical insights into the use of mHealth tools amongst CHWs in low resource settings and the extent to which mHealth contributes to the enhancement of their overall performance in the capture, storage, transmission, and retrieval, of health data as part of their typical workflows. This study has provided much needed evidence of the importance of a ‘fit’ between CHW task and mHealth technology characteristics for enabling mHealth impacts on CHW performance. The study also shows how these inter-linkages could improve the use of mHealth tools and the performance of CHWs in their delivery of healthcare services in low-resource settings, within the Kenyan context. Findings can inform the design of mHealth tools to render more adequate support functions for the most critical CHW user task needs in a developing world context. This study has contributed to the empowerment of CHWs at the point-of-care using mHealth technology-enabled service delivery in low-resource settings, and contributes to the proper and successful ‘scaling-up’ of implemented mHealth projects in the developing world.
MT 2018

This dissertation examines the intersecting changes of African decolonization and the post-World War II internationalization of public health by showing how Cameroonian and French health officials shaped global health programs on the ground in the 1950s and 60s. I approach this topic through the lens of two tightly interwoven developments in Cameroon: the history of colonial mobile health teams created by French military doctors and the advent of postwar global disease eradication campaigns. While colonial medicine and international health are typically treated as distinct historical subjects, I argue that global disease eradication programs in this period in Cameroon relied entirely on colonial mobile health teams and their reformulation after independence as a basis of infrastructure, personnel and knowledge. I specifically assert that Cameroonian and French health officials positioned mobile health teams as cornerstones of national health policy and regional health coordination in Central Africa and, in turn, as the basis for operations of attempted global disease eradication programs within Cameroon. As Cameroonian, French and international health officials negotiated the work of the mobile health teams through decolonization and the first decade of the independence, they were moreover charting new structures of authority and control over medicine and public health between the global and the local, and forging an international politics of public health rooted in the particular tensions of decolonization in the country. My project thus demonstrates how Africans charted new models for public health through decolonization, models that reflected both the deeply enduring impact of empire and a new post-colonial politics.

Recent developments in implantable medical devices (IMDs) have created a need for communication systems integrated directly into the implant with feedback data for various sensing systems. The need for modern communication techniques, power delivery systems, and usable interfaces for smart implants present an interesting challenge for engineers trying to provide doctors and medical professionals with the best resources available for medical research. This dissertation will cover the design of an integrated CMOS transceiver and near-field inductive link used for an IMD and the accompanying CMOS front end for the application space of neural recording in the brain of lab mice. The design process of the CMOS IC, along with thinning techniques, the nearfield inductive link, and the design of an external reading system will be discussed in detail. The various wireless power and data telemetry techniques applicable for IMDs and their strengths and weaknesses will also be described. Software techniques and implementation for real-time analysis of a high data rate communication system from the designed IMD will be covered. Finally, transceiver verification will be given for both power and data telemetry under various scenarios, with front end verification performed via controlled lab bench experiments using input sinusoidal wave forms.

The proliferation of body worn autometric devices has been enabled by advances in low-power electronics and fueled by the quantified-self movement. These devices range in complexity from pedometers to clinical vital sign measurement. They all share the same drawback, typically the most expensive and heaviest component, the battery. The future of autometric devices lies in wireless power. This work explores what is required from autometric devices and presents the results of testing both an embedded version and an application specific integrated circuit (ASIC) version of a wirelessly powered autometric device.
Graduation date: 2013

M. Tech. Business Information Systems
Field-based healthcare is the provisioning of healthcare outside a traditional healthcare facility whose location is fixed. Although healthcare is not location and time dependent, the delivery of the service is often constrained to particular location and time. That is, although data accuracy and timely access to medical information is vital, healthcare service providers are not mobile enough to provide the on-demand healthcare service to patients. With restricted mobility, mistakes, unavailability and inaccuracy of information can have life-threatening consequences. To this point, this mini-dissertation argues that Mobile Information Technology (IT) Innovation could leverage field-based healthcare. Thus Mobile IT is considered essential to reducing medical errors, enhancing patient safety and improving quality of healthcare service delivery. Mobile IT can also be leveraged to meet ICT infrastructural challenges of field-based healthcare. That is, to enhance this service delivery, Mobile IT innovation will include the use of mobile devices such as mobile phones, smart phones, pocket computers, wireless networks and other technologies such as Radio Frequency Identification, smart cards, as well as information systems accessed through these technologies. In recent years, cases of Mobile IT application in healthcare service, particularly in South Africa, suggest the use of Mobile IT for disease management, monitoring as well as evaluation of patient care activities. There is a need for an empirical study to highlight the determinant factors that influence Mobile IT innovation for field-based healthcare. In response to this need, this study captured and unraveled the complexity of Mobile IT innovation for field-based healthcare through a case study conducted at a healthcare service provider.

The aim of this study was to identify and describe the viability of using cell phones to conduct rapid assessments, pass key health messages and conduct monitoring and evaluation in complex emergencies. The study setting was in a cholera outbreak response situation in Mogadishu, the capital of war torn Somalia. Qantitative, descriptive research was conducted to determine the feasibility. Data collection was done using structured questionnaires, self-response mailed questionnaires as well as follow-up telephone interviews. Three groups of respondents participated in the study. The respondent groups included 383 internally displaced persons (IDPs), 5 water, sanitation and hygiene (WASH) specialists and 5 specialists from 5 mobile phone providers in Mogadishu. The study showed that there is good potential for an effective, cost efficient and scalable short message service (SMS) based public health education platform in Somalia. The study has also come up with recommendations on key considerations to ensure viability of the Public health education platform. It is envisaged that the recommended platform shall increase speed, access, spontaneity, coverage and reduced cost per capita, a combination of which form the hallmark of a good emergency health response. Ultimately this effort shall contribute to improved health, reduced suffering and reduced deaths in fragile humanitarian contexts.
Health Studies
M.A. (Public Health)

The aim of this study was to identify and describe the viability of using cell phones to conduct rapid assessments, pass key health messages and conduct monitoring and evaluation in complex emergencies. The study setting was in a cholera outbreak response situation in Mogadishu, the capital of war torn Somalia. Qantitative, descriptive research was conducted to determine the feasibility. Data collection was done using structured questionnaires, self-response mailed questionnaires as well as follow-up telephone interviews. Three groups of respondents participated in the study. The respondent groups included 383 internally displaced persons (IDPs), 5 water, sanitation and hygiene (WASH) specialists and 5 specialists from 5 mobile phone providers in Mogadishu. The study showed that there is good potential for an effective, cost efficient and scalable short message service (SMS) based public health education platform in Somalia. The study has also come up with recommendations on key considerations to ensure viability of the Public health education platform. It is envisaged that the recommended platform shall increase speed, access, spontaneity, coverage and reduced cost per capita, a combination of which form the hallmark of a good emergency health response. Ultimately this effort shall contribute to improved health, reduced suffering and reduced deaths in fragile humanitarian contexts.
Health Studies
M. (Public Health)