Diagnosis & Disruption

Why malaria diagnosis needs to move into the 21st century.

« Great companies start because the founders want to change the world… not make a fast buck. » – Guy Kawasaki

The term « disruption » often conjures a negative image. A disease disrupts the ordinary process of things on both a micro and a macro level; individuals experience disruption in their lives through losing their ability to work or attend school and through the medical costs that come with disease. On a larger scale, businesses, governments and entire societies suffer the inevitable interference that comes with being placed in a disease endemic area. The direct cost of malaria has been estimated to be the equivalent of $12 billion per year, with damage to economic growth projected to be far more.

In the business and innovation community, the term has a more positive spin. « Disruption » is the lifeblood of start-up business. Interfering with the status quo by offering different solutions to old problems is often the pillar upon which young companies rest. It may be that disruptive companies have a part to play in shaking up the current techniques of malaria diagnosis; disrupting the disruption could be the way forward.

Prompt diagnosis and effective treatment are the cornerstones of malaria case management. Patients who are diagnosed early recover quickly and require less anti-malarials to treat. However, if the disease is not correctly diagnosed or the diagnosis is delayed the disease can quickly progress, increasing the severity of symptoms and the risk of death. The current methods leave too much room for error and logistical complication both from an individual and disease control perspective.

« The main problem with malaria detection is that dipsticks are unreliable, they’ve got poor shelf life and they’re quite expensive » – Professor David Mendels, xRapid inventor

It is also vital that malaria diagnosis is extremely accurate. Any tool used as a diagnostic needs to be consistently reliable. Avoiding misdiagnosis and uncertainty has several positive ramifications. Because malaria symptoms cross over with several other diseases, there have been instances of people being treated for malaria when they have contracted something else. For this reason, only an accurate test can truly diagnose malaria. The overtreating caused by symptomatic diagnosis and unreliable testing not only misplaces the supply of antimalarials, but also skews the picture of an outbreak.

Reliable data for malaria outbreaks can only be created and used as a method of control if the diagnostic tool is incredibly consistent and reported quickly. Diagnostic tests already play a large role in malaria surveillance activities, but one issue with current rapid diagnostic tests is that they rely on accurate outbreak statistics in order to be used at the sensitivity needed for pin point diagnosis. This creates a cycle of inconsistency.

Besides speed and accuracy, the main obstacle current diagnostic technology presents is cost. Malaria does most of its damage within the developing world, particularly in rural areas with little access to healthcare and less access to the money needed for transport and medicine. Rapid diagnostic tests in their current form are a step forward in this regard. The labour costs of employing a microscopist to analyse thousands of samples combined with the logistics of collecting and transporting them are heavy. However, current RDTs have financial drawbacks due to the sheer volume they are required in, and the costs of storing them. Children in sub-saharan Africa can be infected almost one thousand times per year, and it takes roughly three years to build an immunity. That is a lot of testing. RDTs also need to be stored below 30 degrees centigrade, which in almost all endemic zones requires expensive refrigeration.

A key fact to consider is that under the status quo, malaria deaths and cases have dropped. Malaria deaths peaked in 2004, with over 1,817,000 casualties globally. In 2013, the figure had reduced to 584,000. The question is, is this good enough?

Dr. Nick White says that the disease will persist even if 99% of the parasites that carry malaria are wiped out. – Wall Street Journal – 09/02/2015

Considering the threats that drug resistance bring, fighting malaria harder than ever is vastly important for the state of global public health. Alongside research into new treatments, improving the speed, accuracy and cost of diagnosis is of paramount importance.

Something as innocuous as the phone in your pocket may hold the key. The advances in smartphone technology over the last decade mean that we all carry computers that have similar processing power to the advanced workstations of ten years ago. Using smartphones to diagnose malaria has shown an astounding improvement on accuracy and speed. The xRapid algorithm has managed to achieve 98% accuracy consistently, whilst also being able to detect the level of infection to a precise extent.

Furthermore, diagnosis on a smartphone increases the speed in which patients can be diagnosed and the transmission of important outbreak data. xRapid can diagnose a patient within 3 seconds of analysis, whilst a full procedure takes under five minutes. With access to such rapid diagnosis, severe disease progression and death can be avoided because patients can be treated within that critical 48 hour window with certainty.

There are also several reasons why smartphone diagnosis can reduce cost. The digital nature of the testing cuts out the labour costs of the microscopist, and the material cost of traditional RDTs. Using facial recognition software, smartphones can cut the disintermediary and bureaucratic costs for rural areas with little access to medical records. The portability and interconnectivity of smartphone devices not only cut transport costs, but can relay information quickly to central databases, helping create a real time picture of any outbreak. Access to a rapid, accurate diagnosis for malaria also reduces the amount of antimalarials needed to treat the disease, avoiding overtreatment and reducing the risk of drug resistance whilst simultaneously saving large amounts of money.

The xRapid app incorporates all of these improvements, and can help carve a new path for malaria case management. The efforts to combat malaria over the past ten years have been highly successful, but a new gear is needed if the disease is ever to be eradicated. Moving forward starts with revolutionising diagnosis, and the tools that 21st century technology has provided us with can take us there.

 

 

Is Data the Cure?

The significance of simplifying malaria diagnosis with technology.

Written by Fergus Knight

 

Everything should be made as simple as possible, but no simpler – Albert Einstein

Solving a problem, scratching an itch, relieving the pain. These phrases are often used as a template for any innovation. When applied to disease control they take on a more literal meaning. Malaria is one of the worlds biggest killers. Nearly half the population of the world are at risk of the disease. Efforts to eradicate the illness worldwide are stepping up, but an initiative of such magnitude is fraught with complexity. When it comes to malaria, the devil is in the detail.

 

The global push to fight malaria receives a considerable amount of attention, funding and research and this has lead to some real victories. Internationally, malaria deaths have dropped 47% since the year 2000. Additionally, cases in sub-saharan Africa, one of the most heavily endemic regions in the world, have dropped by 50 million, despite a 43% population increase in the area*.

The success of a disease eradication initiative, like any public health programme, is largely dependent on the level of societal and political commitment to it from the beginning to the end, considering the potentially enormous cost of failure. – The Dahlem Workshop: 1999

The bad news is that there is still a long way to go. New obstacles are constantly being thrown up to hamper our progress in defeating a disease that still causes a child to die every minute. In a recent piece from the Wall Street Journal , Dr. Nick White of the Mahidol-Oxford Tropical Medicine Research Unit in Bangkok explains that whilst malaria cases have dropped by nearly 50% in recent years, it is not nearly enough. Even if 99% of the parasite is eliminated, the disease will survive because it is so adaptable.

The malaria parasite has also been growing in resistance to antimalarials, and the worries that this will affect the spread and scope of epidemics is at the forefront of the media at the moment. To move towards the goal of eradication problems like drug resistance require innovative solutions, and tools are being developed to provide them.

« Successful elimination means eliminating the parasites, not the mosquitoes » – Dr. Nick White

Whilst research into new treatments remains a difficult and expensive initiative, a significant amount of the complexity surrounding the disease lies in the access to information. The first principle in disease eradication is control, and in order to gain that control health services need access to outbreak data. Dr. White suggests that the official number of cases does not accurately account for the amount of people who are carrying the parasite. This means that for real eradication control even those not exhibiting symptoms need to be diagnosed and treated. Also, even with rapid diagnosis on a widespread scale such as this, the information needs to be relayed into a central database as quickly as possible in order for it to paint a picture of an outbreak. If technology allows us to simplify these complications then not only could outbreaks of drug resistant malaria be tracked and tackled, the way we approach the eradication of the disease in general could be revolutionised.

This is a risk map: an amalgamation of various types of data to calculate the location and transience of outbreaks

There are many ways in which data is already being used to simplify malaria eradication initiatives. Researchers in Kenya used non health data in order to map human migration patterns. They took anonymised mobile phone usage data and used it to track migration patterns. They combined these with existing malaria incidence data and came up with some very informative results. They were able to pinpoint tea plantations in the western highlands as a hub through which malaria is spread. Because thousands of workers came from Lake Victoria to work there, the mosquitoes in the highlands have picked up the parasite. Infected workers who come from elsewhere spread the parasite originating in the Lake Victoria region throughout the country. Access to simple information like this informs the measures that can be taken against the disease. But this is only the tip of the iceberg of what mobile technology can do for disease eradication.

Data-driven insights can help direct resources and interventions to make the malaria fight more effective. For example, eliminating malaria in the Lake Zone might cut off the source of infections in the highlands – even if you didn’t run a large-scale elimination program in the highlands themselves. – Malarianomore.org

In April 2014, Global Health Sciences released a paper on what a global data and surveillance system for elimination should include. The first point they make is that the reporting of data should be rapid and complete.

The surveillance system collects data at the lowest level and in the most direct manner possible. It captures the data in a rapid, feasible, locally appropriate, and sustainable way. – Global Health Sciences

Reporting from the low level means data needs to be collected in real time, from front line locations such as communities, health posts, district health units, environmental health programs and national malaria control programs. With the comprehensive data collected from all of these locations, eradication initiatives have a simple picture of what needs to be done in order to eradicate the parasite in the region.

Imagine if there was a tool that incorporated solutions to all of these problems. A device that could diagnose malaria quickly and cheaply from an unlimited number of locations, simultaneously. Something with the functionality to collect and relay data through strong mobile networks in malaria endemic zones. With a rapid, accurate, portable, independant diagnostic system, initiatives and governments can track outbreaks and take anti-parasitic measures whilst simultaneously treating those infected. Furthermore, if those infected are diagnosed and treated within 48 hours of being bitten, the parasite requires significantly less antimalarial to kill. Using less antimalarial could potentially slow the development of drug resistant parasites. Finally, even those without symptoms could be diagnosed in an endemic zone, creating a precise map of an outbreak, and enabling eradication.

Dr. David Mendels may have created such a piece of technology in xRapid. Using the camera on an iPhone, a microscope attachment and and some custom built software, we can bring together all the functionality and potential that mobile technology has to map outbreaks with real time rapid diagnosis. If used on a large scale, the technology can simplify eradication initiatives so that the only thing frontline health services will have to do is provide treatment in order to eradicate one of the worlds biggest killers.

« A step forward in the battle against malaria »

Our CEO Jean Viry-Babel talks to Reuters journalists about the significance of xRapid in the fight against malaria.

On the 4th of December 2014 IanXen was celebrated by the Nominet Trust 100, a global list of inspiring ventures focused on solving some of the worlds biggest problems through technology.

The nomination has seen xRapid receive some significant attention from the media. Top of the billing is xRapid CEO Jean-Viry Babel, who was interviewed by Reuters about xRapid as part of a report on social innovations supported by Nominet.

After a brief introduction, Jean spoke about xRapid and its potential to save a significant amount of lives worldwide.

During the interview, Jean gave a demonstration of how xRapid works and explained just how simple it is to use the app to diagnose malaria.

« There is just one button, it is called diagnose. You put (xRapid) on the dry blood, you press diagnose and it tells you: yes or no. »

The report concluded with a positive message about the influence xRapid can have on global public health, pointing toward our plans to adapt xRapid to diagnose tuberculosis and Lyme disease alongside its growing stance as a valuable weapon against malaria.

« The world might have it’s eyes on the battle against Ebola, but if xRapid works the way Jean Viry-Babel hopes, the war against malaria may have just taken a step forward. »

The story was re-run several times by news outlets across the world including the New York Times, MSN and BBC Africa.

Elsewhere in the press, xRapid earned a mention in New Scientist magazine‘s « One Percent » section on their website, using the tagline below.

Your phone knows if you’re sick.

They briefly explained the process xRapid uses to diagnose disease whilst also mentioning that xRapid have just started accepting pre-orders.

Press from the Reuters Interview:
New York Times , Science Daily, MSN, Yahoo, AOL, Tech Investor News , WHIO, BBC News Africa