Creation of a teledermatology service

— Mali —

BACKGROUND

The prevalence of skin diseases in Mali is very high, with a rate nearing 30%. The principal afflictions are infectious dermatoses, such as impetigo, eczema and scabies. They are minor ailments, but with sometimes disastrous consequences. Impetigo, for example, can cause heart-valve disease or kidney failure in children. Unfortunately, with less than one dermatologist per million inhabitants, the country is facing a shortage of specialists and low skill levels in staff working in peripheral health facilities.

Nevertheless, those working at these centres readily seek advice from specialists via mobile phone, a technology that is expanding exponentially on the continent. Based on this observation, Professor Ousmane Faye, head of the dermatology department at the Centre for Disease Control (Centre National d’Appui à la lutte contre la Maladie, or CNAM), decided to assess telemedicine’s feasibility and impact on treating skin diseases.  As dermatology essentially involves visual observation, ICT can be put to particularly effective use in diagnosis and monitoring. The Fondation Pierre Fabre has supported this project since early 2015.

This 18-month study covered the regions of Koulikoro, Sikasso and Mopti. Twenty doctors and nurses received training in common dermatoses that do not require a dermatologist’s assessment, so that the project may remain focused on complex cases. These professionals were then trained in digital tools and the use of the Bogou telediagnosis platform (bougou means “mutual aid” in Bamanankan), operated by the RAFT*, in sending data (text, audio, video). This platform is used to obtain diagnoses from dermatologists on complex cases. In parallel, the 10 pilot health centres were equipped with digital cameras and Internet connections.

Of the 3,000 ailments recorded during the period, 175 were shared on the platform. These were cases in which healthcare workers needed a dermatologist’s input. This number surpassed projections, as the project objectives had planned on 150 such cases. Telediagnosistic requests were typically processed the same day. An evaluation phase will make it possible to measure the telediagnostics’ compliance with a physical examination of the patients.

The results of the teledermatology pilot programme, established in Mali by Professor Ousmane Faye with the Fondation Pierre Fabre’s support, has demonstrated how new technologies help improve skin health through remote diagnosis for those populations having access to such innovations. Based on the results of the pilot, the project is currently being extended nationwide. In 2020, the programme will cover 80% of Mali’s peripheral health centres (Kayes, Koulikoro, Sikasso, Segou, Mopti, Gao, Timbuktu, Kidal…), thanks to the training of 160 health workers. The study also resulted in a scientific publication :Faye O., Bagayoko C.O., Dicko A., Ciseé L., Berthé S., Traoré B., Fofana Y., Niang M., Traoré S.T., Karabinta Y., et al. A teledermatology pilot programme for the management of skin diseases in primary health care centres: Experiences from a Resource-Limited Country (Mali, West Africa) Trop. Med. Infect. Dis. 2018;3:88. doi: 10.3390/tropicalmed3030088https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6161172/

To present this work, the Fondation Pierre Fabre, in conjunction with Bamako’s National Centre for Disease Control (CNAM) and the Faculty of Medicine and Odontostomatology, held the First African Teledermatology Conference (Assises de Télédermatologie Africaines) on 1 June 2017 in Bamako.

This gathering, chaired by Mali’s Health Minister, drew specialists from eight countries of the sub-region (Mali, Burkina Faso, Guinea-Conakry, Mauritania, Senegal, Togo, Benin, Côte d’Ivoire) who all presented their research.

As part of this event, the Fondation Pierre Fabre put out a call for projects open to health structures in other African countries interested in receiving support to begin similar initiatives. After studying the proposals received, the Foundation chose to support two projects, one put forth by the Mauritanian Dermatology Society (SMD) and the other by the Togolese Society of Dermatology and Sexually Transmitted Infections (SOTODERM):

Mauritania – Taking skin-disease treatment into the desert.

With only 13 dermatologists (12 of whom are based in the capital) for a population of four million spread over this vast desert territory, quality care options remain very limited. Over a two-year period, the project selected intends to create twelve consultation units in three regions of Mauritania in the north and south, relying on existing departmental or communal health structures.

The local referring professionals at these health centres will be in contact with the eight expert dermatologists based in Nouakchott via the National Telemedicine Programme’s computer network. A diagnosis and treatment protocol will be returned in 24-48 hours. The long-term objective is to train 24 referring professionals who can handle 300 patients per month (3,600 a year) in the three targeted regions.

This project is supported by the Mauritanian Dermatology Society in partnership with the National Telemedicine Programme of Mauritania.

Togo – Train 100 health workers in five years.

To improve dermatological expertise among health workers in four of Togo’s five regions, the Togolese Society of Dermatology and Sexually Transmitted Infections (SOTODERM) plans to train 100 health workers across 50 healthcare facilities.

Diagnoses for complex cases will be accessible through remote data transmission to expert dermatologists based in Lomé. This project, which took five years to implement, replicates the Malian teledermatology model created by Professor Faye and will rely on the Réseau en Afrique Francophone pour la Télémédecine (RAFT).

Following the production of a National Guide for the Management of Common Dermatoses, and the training of 40 peripheral health workers, the pilot phase of the project was launched on 20 May 2019. For a period of 2 years, it will be continued with a generalization phase including 100 health workers, in order to improve the diagnosis and management of skin diseases in 50 peripheral health centres.

* Réseau en Afrique Francophone pour la Télémédecine, a network of more than 1,000 health professionals, 200 hospitals and health facilities in 20 African countries.

KEY FACTS
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Priority
Tropical dermatology

Programme
Since 2015

Type of involvement
Distributor

Actions

  • Funding of the entire programme: communications equipment, training, operating costs, etc.

Université de Bamako, Faculté de Médecine
BP 1805
Bamako – MALI

Our project is based on both quality of care and training capacity. For the quality of care, we can count on the specialists from the CNAM, which is home to the country’s largest dermatological reference center. For the training capacity, the Faculty of Medicine and Odontostomatology is highly relevant: it trains the most senior healthcare managers in Mali. Furthermore, it already has a telemedicine platform in place. This proven tool will make possible the exchange of information between the dermatologists and health workers in the nine pilot centres.”

Pr. Ousmane Faye
Dermatologist, teaching staff member and vice dean of the Bamako Faculty of medicine, Head of the Bamako Dermatology Hospital.

ACHIEVEMENTS AND PERSPECTIVES

Achievements

1000+ 
cases sent via the Bogou teletransmission platform

69
health centres involved

120+
 health workers trained in common dermatoses and the use of digital tools

Perspectives

The objective for the next two years is to cover 80% of peripheral health centres in Mali, starting in the north. Nearly 200 health workers will be trained and networked.

PARTNERS

  • National Centre for Disease Control (Centre National d’Appui à la lutte contre la Maladie or CNAM, formerly the Institut Marchoux), Secretariat General of the Ministry of Health
  • RAFT (Réseau en Afrique Francophone pour la Télémédecine)
  • Faculty of Medicine, Pharmacy and Odontostomatology (FMPOS) of Bamako
  • CERTES (Centre d’Expertise et de Recherche en Télédermatologie et en e-Santé)

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