Teledermatology and AD in Sub-Saharan Africa

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Teledermatology procedures

Teleconsultation

• Live Video
• Telemonitoring, teleassistance, medical regulation

Teleexpertise

• Store and Forward
• Pictures/asynchronous

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Teledermatology Programs
/projects in Africa

Multiple countries

• RAFT: 20 countries
• Africa Teledermatology Project: 12 countries

National Initiatives

• Ghana
• Mali: TelederMali©
• Mauritania
• South Africa
• Tanzania
• Togo

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RAFT : Réseau en Afrique Francophone pour la Télémédecine

• French speaking african countries network in telemedicine
• « Supporting care professionals where they are most needed »
  • Dudal (E- learning): Low-bandwidth distance education
    • Interactive webcasting, 20-30 kbps bandwidth
  • Bogou (Web/mobile based platform)
• founded by the university of Geneva,
• 1000 health practitioners
  • Cardiology (electrocardiograms), gynecology (discussing difficult cases)
  • Teleechography, teleradiology, dermatology

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Africa Teledermatology Project (ATP)

• 12 countries : Uganda, Botswana, Malawi, Swaziland, Burkina Faso, Lesotho, Kenya, South Africa, Eritrea, Liberia, Mozambique, Nigeria, South Africa, Tanzania
  • 1229 patients (2007-2013)
  • Secure website or mobile phone 13%
  • Response 1 week
• Online archive of tropical skin conditions
• Internet source of educational material for training and updating of medical specialists and health personnel.
• Secure an active channel and platform for dermatological research collaboration

JAAD 2015 Lipoff et al.

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TelederMali :
Pilot project in Mali, 2015-2016

• Subsaharan Africa (West Africa)
• 10 Primary health care center
• Modality: web based platform (Bogou), picture with camera then connection to a computer
• 180 patients
• Response of dermatologists delay 32h:
  diagnosis and recommandations
• Eczema: 13 % of all skin diseases

Faye O et al Trop Med Infect Dis. 2018

Frequency skin disease teledermatology

Skin disease in reference center of dermatology 2015

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Ghana, Mauritania, South Africa, Tanzania and Togo

Web based platform

• Togo, Bogou
• Mauritania, National program of telemedicine
• South Africa,
• Ghana, Mobile platform, ClickDoc and ATP

Teleconferencing/mailing

• Tanzania (RDTC) and Switzerland (Zurich)

Osei-tutu A. JAAD 2013

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AD in Africa, Current difficulties

Difficulties of diagnosis

• Access to dermatologist in primary health care/distance/lack of dermatologists: 1/ 500,000 to 1 million (ideal ratio of dermatologist 1:30,000*)
• Difficulty of diagnosis of non dermatologist: delay in diagnosis
• Allergic test not available

Difficulties of access to treatment

• Access to emollients and corticosteroids : quality? Financial accessibility? Pharmacy avaibility
• Not available: calcineurine inhibitors, immunosuppressants, biotherapy
• Compliance: anaphalbetism, incorrect application of the cream (quantity, duration, adverse effects)

Difficulties of follow up:

• Long term follow up: chronic disease
• Lost to follow up patient
• No therapeutic patient education
• Impact of traditional medicine in chronic dermatosis
• Religious/social mysticism for chronic dermatosis

*Gaffney R (2015) Global teledermatology

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Geneva Workshop roadmap

• AD:
  • one of the most common inflammatory dermatological diseases in primary, secondary and especially tertiary care in SSA.
  • significant emerging public health problem in SSA.
    
• International health organizations, Foundations, international learned societies (WHO, IFD, ISAD) should encourage and support studies on AD in Africa for better recognition.
  
• Participants agreed:
  • difficulties in diagnosis and treatment of AD, lack of medical infrastructure, in particular, trained primary care workers and certified dermatologists.
  • need to develop telemedicine in order to compensate for the low number and uneven distribution of dermatologists.

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Tele-AD

Connecting Derm specialist and primary health workers

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E-Learning

• Prerequisites:
  survey on AD in Cameroon (Kouotou BMC Dermato 2017) and Togo
  
• Methods:
  • Initial and in-service training programme oriented towards AD.
  • Describe the diagnostic criteria of the disease, the procedure for using the digital tools of the programme.
  • Produce a normative good clinical practice guide.
  • Collaboration with CYBERDERM
    
• Expected outcome
  • Trained health professionals will be able to recognize and manage AD.

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Store & Forward Teledermatology

• Method:
  tele-expertise platform (clinical history + photography)
  
• Expected results:
  • Definition of simple diagnostic criteria adapted to the primary care setting.
  • Epidemiology of AD (morbidity, mortality) and defined severity spectrum.
  • Diagnostic time will be shortened and quality of care increased.

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Telemonitoring

• Prerequisites:
  training in the use of PO SCORAD (Eczema Foundation)
  
• Methods:
  • Self-assessment of AD under the guidance of professionals in charge of long-term follow-up.
  • Simple cases handled in primary structures and complex cases included in a system of referral and sorting of requests by tele-expertise.
    
• Expected results:
  • Better follow-up of AD patients
  • Long journeys avoided

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Therapeutic Patient Education

• Prerequisite:
  development of contents in different languages by local experts (sensibilization messages).
  
• Methods:
  • YouTube channel / field animations,
  • Field visits with mobile teams,
  • SMS phone alerts.
    
• Expected results:
  • Improving compliance and quality of life
  • Therapeutic success in patients

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Where are we now?

• Writing a comprehensive guide for AD in SSA
• ATOPY TV for TPE
• Bogou in use
• Dudal in use, collaboration with CYBERDERM (Peter SCHMID)
• PO SCORAD: adaptation, online training with Eczema Foundation is developed

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Conclusion

• Increase access to quality care services for patients in any situation in which there is a barrier to receiving treatment.
• Project threats:
  • Access: cost of equipment, quality of internet
  • Resources (finance), stakeholders engagement

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Ask questions to Garba MAHAMADOU:

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Conflict of interest : none