Category: Research

Juliet Sekandi and the case of the treatable yet rapidly spreading disease

Tuberculosis is rampant in Uganda, where nearly 80,000 people develop the disease every year. While practicing there as the attending physician in charge of the public hospital’s TB clinic, Dr. Juliet Sekandi, assistant professor in the UGA College of Public Health, noticed that when people with TB came to her clinic, they often had been suffering for months from the painful breathing, extreme and persistent coughing, fatigue, and fever. Moreover, after the patients went home with their treatment, they would soon return with a household member (or two) who now also had TB.

TB is a highly contagious disease that spreads when the bacteria are ejected from a person’s lungs when they cough or even just speak. So, in a household of four or more people, it was unlikely that it would infect only one person. What’s more, the longer someone remains undetected, the further they spread the disease. What was it, Sekandi wondered, that was keeping people from seeking treatment, helping TB spread like wildfire? That question led her on an ongoing 15-year quest to understand the factors underlying people’s resistance to seeking help, and has spurred a solution using cell phones and artificial intelligence.

At the time, she was trained as an M.D., a field that focuses on finding and treating patients. But that approach wasn’t solving the larger issue of TB spreading throughout the community. For that, she knew she would need to use a public health perspective, which could both seek to prevent the disease from spreading and get care to people who didn’t have good access to it.

Using an exercise called active case finding, she went door to door in one of the capital city of Kampala’s poorest slums, asking people about their cough and to give her samples of their spit. She found that, of those who’d had a chronic cough for at least two weeks, 20% tested positive for TB. She also tested people for HIV and discovered that 30% of those found to have TB also had HIV—most of them unaware they were positive.

“Now, we have very effective medicine to treat TB,” said Sekandi. “So, if one in five is not showing up for treatment, it was clear we needed to find a way to improve our case detection.”

TB causes disease by attacking the body’s CD4 immune cells. As it turns out, so does the human-immunodeficiency virus (HIV), which can lead to AIDS. People with HIV/AIDS are more susceptible to catching TB because their CD4 cells are already depleted.

What was going on that led people to avoid medical treatment for two diseases that, either alone or together, can be fatal when left untreated, yet can be well-controlled if they are medicated properly? The answer was twofold: avoiding the health clinic and not finishing their medication.

patient signing in with nurse at clinic
A nurse enrolls a study volunteer in the DOT Selfie system, which is used to monitor TB patients as they take months-long courses of medication. Patients often stop taking their medicine when they feel better, leading to recurrent illness and drug-resistant strains of TB. With DOT Selfie, patients use their smartphones to record videos as evidence that they’ve taken their medication. (Photo courtesy of Juliet Sekandi)

Mobile Phone Charging Station in Mobile Phone Charging Station in Kabale, Uganda

UGA study using ‘selfies’ to encourage tuberculosis treatment

Researchers from the University of Georgia and Makerere University in Uganda have launched a project leveraging the popularity of selfies to promote tuberculosis (TB) treatment.

The intervention, dubbed DOT Selfie, is one of thirteen mobile health research projects funded by the National Institutes of Health and The Fogarty Center to improve health outcomes, health care services and health research in low- and middle- income countries.

TB is one of the world’s deadliest infectious diseases, and though the disease is treatable, almost one-third of TB patients do not follow prescribed treatment plans.

Non-adherence is a major obstacle to TB control in low- and middle-income countries, says Juliet Sekandi, an assistant professor in the Global Health Institute at UGA’s College of Public Health and lead investigator for DOT Selfie.

But many TB patients in these countries face their own barriers to treatment, she added.

“Major barriers to medication adherence include patient-related factors, such as stigma and lack of overall knowledge about TB, and they include systemic factors, such as the cost of travel to health clinics or long waiting times at health facilities due to high patient to health worker ratios,” said Sekandi.

Adherence challenges are particularly acute in sub-Saharan Africa, where TB rates can be as high as 800 per 100,000 and resources for delivery of health care are limited.

Directly observed therapy (DOT) is acknowledged as the best way to monitor and ensure TB treatment adherence, but this approach proves difficult in areas where there are health care gaps.

In recent years, mobile health tools, including the added video function of a smartphones, have helped overcome some of these barriers to adherence. But there is limited evidence describing the best ways to utilize mobile technologies.

Sekandi’s team is piloting the DOT Selfie project with around 150 TB patients in the Uganda, a country that is estimated to have 45,000 new cases of TB per year. It will be among the first trials to evaluate video DOT in an African setting.

DOT Selfie patients will use their smartphones to record and send time-stamped videos of their daily medication intake. In return, they receive a weekly reward for following their medication regime.

“The need for frequent travel to health facilities is eliminated, which is a big deal,” said Sekandi. “It also offers autonomy to take medications anywhere, anytime, perhaps in a location with more privacy.

Sekandi says she and her team are most excited about the potential impacts of this project to propel health care delivery forward in Uganda and the rest of Africa.

“The successful use of mobile technology will address some critical systemic barriers that persistently lead to poor health outcomes in Africa,” said Sekandi.

UGA GHI receives two NIH grants to fight global TB

The National Institutes of Health (NIH) recently awarded the Global Health Institute (GHI) at the University of Georgia two grants for research projects aimed at decreasing the global burden of tuberculosis.

The first NIH grant, awarded over five years, will study the transmission of M. tuberculosis in an African city. GHI director Dr. Christopher Whalen and associate director Dr. Julie Sekandi, along with their research team at UGA, will collaborate with colleagues at Makerere University and Case Western Reserve University to determine the geographic ‘hotspots’ for transmission in Kampala, Uganda. With this knowledge, public health professionals can design community interventions to reduce transmission of tuberculosis and control the epidemic.

Dr. Sekandi was also awarded a two-year grant from the NIH Fogarty International Center to address the problem of non-adherence with treatment of tuberculosis. Non-adherence is a major obstacle to tuberculosis control because it reduces cure rates, prolongs infectiousness, and promotes drug-resistance. This study will evaluate the benefit of using smartphones to perform video-directed observed therapy – meaning a video selfie to record taking pills – to improve overall adherence and outcomes in treating tuberculosis.

José F. Cordero honored by Puerto Rico Public Health Trust

The Puerto Rico Public Health Trust recently honored University of Georgia College of Public Health professor José F. Cordero by establishing an award in his name aimed at recognizing professionals in public health whose trajectories have a positive impact on institutions and citizens of the Island of Puerto Rico.

The new Dr. José Cordero Award was unveiled during “Caribbean Strong: Building Resistance with Equity” held Feb. 27 to March 1, 2019 in San Juan, Puerto Rico. The three-day summit, focused on disaster preparedness in the Caribbean region, was sponsored by the Puerto Rico Science, Technology & Research Trust and the Society for Disaster Medicine and Public Health, Inc.

“I am humbled by such recognition, particularly coming from a premier institution from Puerto Rico,” said Cordero.

Dr. Richard Besser, president and CEO of the Robert Wood Johnson Foundation and summit keynote speaker, presented the honor at an award ceremony held February 28.

“We highlight the excellent professional career of Dr. Cordero,” Besser said. “[His] contributions to the Puerto Rico Science, Technology and Research Trust have led to the creation of programs such as the Brain Trust for Tropical Diseases Research & Prevention, the P.R. Vector Control Unit, and the Puerto Rico Public Health Trust.”

A native of Puerto Rico, Cordero is the Gordhan and Jinx Patel Distinguished Professor of Public Health and head of the department of epidemiology and biostatistics in the College of Public Health, where he mentors graduate researchers in infectious disease studies and infant and maternal health. His own work is focused on improving maternal and infant health in Puerto Rico.

Cordero currently co-directs the Puerto Rico Test site for Exploring Contamination Threats (PROTECT) Center as well as the Center for Research on Early Childhood Exposure and Development (CRECE), both of which examine how exposure to environmental contaminants contributes to the high rate of preterm birth in Puerto Rico.

At the advent of the Zika epidemic in 2015, the PROTECT Center was poised to assist the CDC with Zika surveillance and prevention efforts in Puerto Rico. Cordero quickly became an expert on the risks Zika posed to expectant mothers and a key voice in advocating for Zika prevention education and funding.

In addition to his research and clinical work, Cordero serves as the executive director of the Puerto Rico Brain Trust for Tropical Diseases Research and Prevention, a group that seeks to facilitate and speed up the development of rapid tests, vaccines, vector control, and prevention strategies for diseases like Zika, Dengue, Chikungunya and others.

Cordero earned his medical degree from the University of Puerto Rico before moving to the mainland to expand his training in genetics and, later, epidemiology. His many contributions to public health include identifying nutritional deficiencies of infant formula, advocating for nutrient fortification in corn and flour to prevent neural tube defects in Hispanic children, promoting child immunizations in the U.S. to eliminate measles, mumps and rubella, and championing early diagnosis for children with autism.

For 27 years, Cordero served at the Centers for Disease Control and Prevention, where he focused on improving the health of mothers and children, and in 2006, Cordero returned to the island to lead the newly formed University of Puerto Rico Graduate School of Public Health.

“This award is the latest evidence of Cordero’s indelible impact on Puerto Rican communities, and will live on for those following in his footsteps doing great public health work,” said Marsha Davis, interim dean of the UGA College of Public Health. “This is a wonderful way to honor José whose commitment to the communities he serves has always been paramount.”


UGA epidemiologist tracks tuberculosis using cellphone records

Tuberculosis is the ninth leading cause of death worldwide, and though the World Health Organization has said the average global burden of disease is on the decline, some areas of the world continue to feel its impact.

Researchers at the University of Georgia have received a $2.6 million grant from the National Institutes of Health to understand the local epidemiology of TB in African urban settings and help these communities develop targeted interventions to reduce transmission.

Led by physician and epidemiologist Christopher Whalen at UGA’s College of Public Health, the team will estimate where TB is being transmitted by combining information about patient movement with genetic information from the bacteria itself. Understanding where transmission is happening is the key to effective control, said Whalen.

The standard approach to tuberculosis control today relies on detection and treatment of tuberculosis disease, but this approach doesn’t work in areas where the disease burden is high.

“By the time a case is diagnosed and treated, the next generation of cases has already been newly infected,” he said.

Whalen has been working with colleagues in Makarere University in Kampala, Uganda, for years trying to discover better ways to limit TB transmission.

From 2012 to 2017, Whalen conducted a study to track how TB moves within communities, but his findings were perplexing. The infection didn’t seem to spread within known social networks. That begged the question, where is transmission occurring?

“Then it dawned on me,” said Whalen. “Everyone is carrying a cellphone. By using archived cellphone records, we would be able to map where TB cases move and measure how much time they spent in different places.”

Whalen’s team collected preliminary data using cellphone records from 15 TB patients, and they found that these patients tended to go to the same spots.

“There are hot spots, or places where TB patients spend a lot of time. With this information, you can target areas with the usual community control strategies, such as TB screening, active case finding, and education. If you collect this cellphone information going forward, you’ll be able to see if your control strategies worked,” explained Whalen.

The new project will expand Whalen’s previous work to include genomic information about the organisms that will reveal the order and timing of TB infection among the cases. When this information is combined with the mobility data, the team will be able map where transmission is occurring at different levels within Kampala.

Whalen hopes this approach will provide an actionable prevention tool for tuberculosis control programs in communities facing a high disease burden.

Child bearing expectations can hinder family planning in rural Uganda

The rate of infant and child deaths is very high in many developing countries, and Uganda is no exception. Some of the issues contributing to this problem are poor child spacing and unplanned pregnancies that occur within the first twelve months after child birth. Though low cost, effective family planning options are widely available, only eight percent of women living in rural Uganda are using them.

A recent study from the University of Georgia sought to identify factors that may discourage women living in rural areas from using one such option, long acting reversible contraceptives (LARC).

Most Ugandans live in rural communities where the culture surrounding family and child bearing is rooted in the land.

“Cultural norms in general surround numbers,” said Juliet Sekandi, an assistant professor in the Global Health Institute at UGA’s College of Public Health, who lead the study. “Strength in numbers,’ they always say, because a large family can cultivate a larger piece of land.”

Family members are part of the labor support for the family in a country that is up to 80 percent agricultural, says Sekandi, so the size of the family directly impacts their economic stability. Having more family members also means the extended family clan can wield more political power in the community.

However, mothers can put their health and the health of their unborn child at risk if they become pregnant again within a year of giving birth. Medical standards recommend a time span of twelve to 24 months for a woman to fully recover from pregnancy.

“There are nutritional gains to make after having a child,” said Sekandi. “If the baby in utero has poor nutritional supply because the mother’s nutrient banks are still depleted, you’re going to see poor growth, which we know is typically an indicator of poor child outcomes.”

The researchers surveyed 400 women from 30 villages, asking a range of questions about their feelings on family planning and using LARCs, as well as demographic variables such as previous childbirths and previous pregnancies.

Overall, LARC use mirrored Uganda’s national average, but they found that many women who reported using LARCs had five or more children.

“Once women reach a certain number of children, they are ready for what’s going to give them the most reliable outcome,” said Sekandi. “I’m beginning to speculate, but it may speak to the fact that the accumulation of wisdom from the many experiences of child bearing brings women to this important decision point.”

Interestingly, most of the respondents said they were willing to use modern contraceptives. Sekandi says their willingness to use contraceptives likely comes from 15 to 20 years of public health messaging and education campaigns surrounding the benefits of family planning.

“The education has been there so that women know they can make choices despite the cultural influences around them,” she said. “They know their lives are at risk.”

The dissonance between desire and use could be explained by another cultural norm. In the rural areas, the husband usually has the control over the finances, which can create challenges for woman seeking contraceptives.

A husband may be less likely to allow his wife to use contraceptives if the couple is still planning to have more children. Sekandi posits that this economic barrier may be a substantial one, which highlights the need for more male participation in family planning education.

“Men need to be at the table,” she said. “If they fully understand the dangers of poor spacing, when decision time comes, it can be a joint decision where the person who’s going to provide the funds will be on board well convinced that this a priority for our family.”

The paper, “High parity predicts use of long-acting reversible contraceptives in the extended postpartum period among women in rural Uganda” was published in Contraception and Reproductive Medicine. It is available online at:

Co-authors include Ronald Anguzu and Hassard Sempeera of Makerere University in Kampala, Uganda.

Test for Latent Tuberculosis Still Accurate in High Burden Communities, UGA Study Finds

Though tuberculosis (TB) is an old disease, with cases dating back 5,000 years, it remains a major global health threat. Accurately detecting latent TB infections, when the disease is still dormant and not actively making a person sick, is key to public health efforts to eliminate TB.

New research from the University of Georgia is the first population-level study to examine whether the primary diagnostic tool for latent TB, a tuberculin skin test, could misidentify individuals as new cases of latent TB in areas where the disease burden is very high.

Dr. Juliet Sekandi

The proper identification of new cases using the tuberculin skin test has implications for who is treated, says Juliet Sekandi, an assistant professor in the Global Health Institute at UGA’s College of Public Health and lead author on the study.

Sekandi and colleague Chris Whalen were leading a research team gathering survey data in Kampala, Uganda, when they noticed an unusually high rate of reported latent TB, over 50 percent of the population.

“That’s what triggered this study,” said Sekandi, to determine whether there could be a flaw in the skin test.

Tuberculin skin tests can be susceptible to ‘boosting,’ which can occur when the test triggers an immune response from past exposure to TB bacteria, rather than recent exposure. That can lead to a false positive.

“We don’t want to falsely diagnose latent TB because, by policy, it is supposed to be treated,” said Sekandi. “You treat for six to nine months, so if you’re going to give somebody treatment for nothing when it’s just a boosted reaction, that’s not good.”

In addition to protecting the patient from unnecessary side effects, it can be costly to treat people who don’t need it. It’s estimated that one-third of the world’s population have latent TB infections, but resources to treat it are limited. Public health programs can’t afford to treat a large number of misidentified patients.

Researchers recruited volunteers in Kampala, who agreed to receive two skin tests. If the initial test came back negative for latent TB, a second skin test was performed. Of the 99 participants, only two showed a boosted response.

These findings, says Sekandi, are important to public health prevention programs going forward.

“We can be confident we aren’t doing too much harm,” she said. “The takeaway point here is that in high burden settings like Uganda, most of the people that test positive with a skin test are actual cases of latent TB, not just false positives.”

The study “Low Prevalence of Tuberculin Skin Test Boosting among Community Residents in Uganda” was published in the American Journal of Tropical Medicine and Hygiene. It is available online at

Co-authors include Allan Nkwata, Leo Martinez, Robert Kakaire, Jane Mutanga and Christopher Whalen, with UGA’s College of Public Health; Sarah Zalwango with Makerere University in Kampala, Uganda, and the Department of Health Services; and Noah Kiwanuka with Makerere University.

GHI researchers receive seed funding for mobile phone-based TB treatment monitoring

Athens, Ga. — Six collaborative, international research projects housed at the University of Georgia have received seed funding under UGA’s Global Research Collaboration Grant program.

The program funds a range of early-stage projects with significant global impact. Each initiative received between $4,000 and $8,000 to cover initial project costs.

“Some of the most important challenges facing researchers today are global in nature,” said Brian Watkins, director of international partnerships at the Office of International Education. “Solving them requires international engagement. By providing initial support to promising projects, UGA can enhance its global reach and reputation.”

Funding is provided twice a year by the Office of International Education and the Office of Research, matched by academic departments.

“These types of seed grants showcase the depth and breadth of the international research collaborations being carried out by UGA faculty with partners in the top universities around the world,” said Noel Fallows, associate provost for international education. “Our facilitation further positions the Office of International Education as the nexus for international teaching and research initiatives at UGA.”

Juliet Sekandi, a faculty member in the epidemiology and biostatistics department, and Christopher Whalen, Ernest Corn Professor of Infectious Disease Epidemiology, both from the College of Public Health, are collaborating with Esther Buregyeya, Lynn Atuyambe and Frederick Makumbi from the Makerere University School of Public Health in Uganda on mobile phone-based treatment monitoring for tuberculosis patients. The project will develop a pilot mobile app and test the feasibility of remote observation by heath workers to ensure patients are complying with their treatment regimens.

James Beasley, a faculty member at the Savannah River Ecology Laboratory and the Warnell School of Forestry and Natural Resources, is collaborating with Thomas Hinton of Fukushima University in Japan to study the effects of low dose radiation exposure on wildlife inhabiting the Fukushima Exclusion Zone. The two researchers recently collaborated on similar research in the Chernobyl Exclusion Zone.

In this study, they will collect pilot data on the distribution of wildlife species in the zone and will fit several wild boar with GPS-dosimetry collars to collect location and radiation exposure data on the animals. The project’s goal is to provide a picture of the ecological consequences of energy production and potential accidents, using a systems approach to assess radiation effects on wildlife at molecular, individual, population and community levels.

Nicole Gottdenker, a faculty member in the College of Veterinary Medicine’s pathology department, John Drake and John Paul Schmidt from the Odum School of Ecology and Travis Glenn from the College of Public Health’s environmental health sciences department, are collaborating with Azael Saldana and Jose Calzada from the Instituto Conmemorativo Gogas de Estudios de la Salud in Panama and Jennifer Peterson from the Universidad Peruana Cayetabo Heredia in Peru on the relationship between the spread of palm oil plantations and the transmission of Chagas disease.

David Okech from the School of Social Work, Nathan Hansen from the health promotion and behavior department in the College of Public Health and Jody Clay-Warner from the sociology department in the Franklin College of Arts and Sciences are collaborating with John Anarfi from the University of Ghana on giving survivors of human trafficking a voice in developing effective reintegration services.

The first phase of their collaboration has produced research on the psychological, social and economic consequences of trafficking. The seed grant will fund the next phase, which includes interviewing survivors and identifying service gaps in existing reintegration programs.

Javad M. Velni, Changying “Charlie” Li and WenZhan Song of the College of Engineering are collaborating with Herbert Warner from Germany’s Hamburg University of Technology to develop tools to help maintain communications and avoid data bottlenecks among complex systems of robots when they’re performing joint tasks in harsh environments that may interfere with normal communication methods. The portion of the work funded by the grant will focus on developing a system model and a communication method that cuts down on the amount of data that must be transferred among robots.

Nina Wurzburger from the School of Ecology is collaborating with Michael P. Oatham from the University of the West Indies in Trinidad and Jack Brookshire from Montana State University to study the interaction of various soil nutrients on a forest’s ability to absorb carbon dioxide from the atmosphere. Using new field studies and taking advantage of more than 30 years of tropical forest data from the Victoria-Mayaro Forest Reserve in Trinidad, the team seeks to understand how these forests respond to global changes in the environment, and eventually to develop a model for sustainable forestry in tropical regions.

“This program is a vital component of our ongoing efforts to increase international collaborations, help solve the planet’s grand challenges and secure additional funding for the world-class research conducted at UGA,” said UGA Vice President for Research David Lee.

Applications are due Oct. 10 for the fourth round of Global Research Collaboration Grant funding. Details can be found at

This story originally appear in UGA’s Columns magazine.

UGA graduate student receives Schlumberger Fellowship to study tuberculosis transmission

Athens, Ga. – University of Georgia doctoral student María Eugenia Castellanos has been awarded a 2016-2017 Schlumberger Foundation Faculty for the Future Fellowship to fund her research on tuberculosis transmission in Guatemala.

Castellanos, a doctoral student studying epidemiology in the UGA College of Public Health, will work to identify the risk factors associated with TB and spread of with TB—especially in HIV patients. The one-year, renewable Schlumberger Foundation grant provides women scientists from developing and emerging countries up to $50,000 to pursue advanced degrees in a science, technology, engineering or mathematics field.

“The leading causes of death in Guatemala are preventable and treatable infectious diseases,” Castellanos said. “Tuberculosis, in particular, is an illness that affects the most vulnerable people and one that we have not been able to reduce the prevalence of in the last 10 years.”

For her project, Castellanos will analyze isolates of the bacteria that cause mycobacterium tuberculosis from patients at Clínica Familiar “Luis Angel García,” an HIV specialty clinic within Guatemala City’s General Hospital.

HIV-positive people are at particular risk for TB infection. Her research will identify the strains of TB more prevalent in this particularly vulnerable population and also look at the clinical and epidemiological risk factors that might increase a patient’s chance of having a recent transmission of this disease.

“If we understand the main risk factors that lead a patient to have a particular strain of TB, we can create interventions that will allow health policymakers in Guatemala to direct targeted TB control measures at high-risk populations,” she said. “Over the last 20 years, there have only been a handful of papers published about tuberculosis in Guatemala. Not many people are able to do any type of research, often because of lack of funding and lack of resources, so I think this is going to be very important work.”

Castellanos received her bachelor’s degree in chemical biology from the Universidad de San Carlos de Guatemala in 2005 and, with the support of a Joint Japan-Inter-American Development Bank Scholarship, traveled to England to study tuberculosis at University of Liverpool School of Tropical Medicine. She completed a master’s degree in medical microbiology there in 2008.

Returning to her hometown of Guatemala City, Castellanos accepted a position at the Universidad del Valle de Guatemala teaching and working as a research assistant in the Malaria and Vector Biology Unit of the university’s Center for Health Studies.

In 2014, she came to the U.S. supported by a Fulbright fellowship and a desire to pursue a doctoral degree under the mentorship of Dr. Christopher Whalen, Ernest Corn Professor of Infectious Disease Epidemiology at the UGA College of Public Health.

“Dr. Whalen is one of the leading TB researchers in the world with over 25 years working on TB in low-income, international settings; and he is the main reason I chose UGA for my graduate studies,” Castellanos said. “I feel proud to be doing something, in collaboration both with Dr. Whalen and a great group of talented Guatemalan researchers, that we, the people of Guatemala, can do to help our country. The only way that we will be able to advance is if we start shaping our fate.”

Recognizing the link between science, technology and socioeconomic development, as well as the role of education in realizing individual potential, the Schlumberger Foundation established its flagship program, Faculty for the Future, in 2004. Since then, 600 women from 78 emerging countries have received Faculty for the Future fellowships to pursue advanced graduate studies at top universities abroad.

Castellanos is the second doctoral student from the college’s department of epidemiology and biostatistics to receive the international award. Dr. Jane Mutanga-Mutembo, whose fellowship was renewed for a second year, is developing mobile technology in Zambia to help people living with HIV maintain adherence to the lifelong medication regimens needed to keep the virus suppressed.

“Guatemala is definitely a country where machismo is still very prevalent,” Castellanos said. “And combined with lack of financial resources, women in my country don’t tend to be able to advance at the graduate level and earn a master’s or Ph.D. degree. I feel as more women are able achieve this level of success, we can do more for the women who come after.”

After the completion of her degree, Castellanos plans to return to Universidad del Valle de Guatemala to build her own research program in tuberculosis and ultimately, she hopes, participate in the establishment of a leading research center for infectious diseases in the Central American region.

“There is still a lot to do in the study of the epidemiology of tuberculosis and other infectious diseases in Guatemala and Central America,” Castellanos said. “My dream is that my Ph.D. program will permit me to better participate in their control and management, as it can be a doorway to the improvement in the lives of many Guatemalan people. That’s big, but, yeah, that is my dream.”

This story originally appeared on UGA Today.

Faculty Spotlight: Juliet Sekandi

You may not realize it, but that Health application on your iPhone is good for a lot more than just counting the number of steps you take each day. It contains valuable information, tracking and personalized advice on health topics from nutrition and body measurements to vitals and reproductive health. There’s even an option to enter a “Medical ID,” which can provide your medical information to someone else in case of emergencies. This application is constantly updating and improving and is part of a much larger initiative emerging in public health called mobile health, or mHealth.

mHealth is a relatively new concept; so new, in fact, that no standardized definition exists. One description, from The Global Observatory for eHealth, defines mHealth as medical and public health practice supported by mobile devices, through the use of communication through calls and text messages as well as features such as GPS, Bluetooth technology, and 3 and 4G systems. Projects span from appointment reminders and patient monitoring to emergency calling lines and raising awareness over health issues.

Though the advanced nature of these technological services may only appear applicable to high-income countries, mHealth is actually seen as an opportunity to bridge the huge gap between healthcare needs and service delivery in lower-income countries. The World Health Organization claims that mHealth “has the potential to transform the face of health service delivery across the globe.”

The unique advantage of mHealth is its ability to capitalize on existing resources rather than needing to develop new ones altogether. There are over 5 billion wireless subscribers to mobile cellular networks in the world, and 65 percent of these subscribers live in low- and middle-income countries. Even in remote areas of low-income countries where medical infrastructure is lacking, many people have access to mobile phones. This presents healthcare workers with a valuable opportunity to wield existing technology and resources for providing underserved populations with information on how, when and where to seek care.

The Ministry of Health and Family Welfare of Bangladesh, for example, has taken advantage of the country’s increasing number of mobile phone users to improve the health of its citizens. In 2007, the Ministry launched a project to encourage citizens to get their children on National Immunization Day by sending SMS text messages to all mobile phone numbers in the country. After noticing a positive response from the campaign, the Ministry extended this project to raise awareness of other health campaigns, such as National Safe Motherhood Day and National Breastfeeding Week. By 2010, pregnant women in rural areas of the country could register to receive prenatal advice by gestation age.

The WHO and United Nations see mHealth as a catalyst for reaching the Millennium Development Goals—the UN’s targets for addressing extreme poverty and human rights—particularly those aimed at improving maternal and child health and reducing the burden of diseases such as HIV/AIDS, tuberculosis and malaria. Governments across the globe are taking part, with 83 percent of UN Member States reporting the use of at least one mHealth initiative. Some of the most common initiatives reported were health call centers and toll-free emergency calling lines, though many states also reported the use of initiatives like community mobilization and appointment reminders.

The Harvard School of Public Health is taking a leading role in this new field, with professors launching programs focused on improving maternal and child health and tracking and preventing the spread of disease. One assistant professor, for example, developed a text message application that allows nurses in rural Kenya to alert a main blood bank about shortages before the situation becomes an emergency.

Students and faculty at the University of Georgia are also getting involved. Dr. Juliet Sekandi, a Ugandan native, physician and UGA professor of Global Health, has taken a strong interest in the field of mHealth. She was inspired to take action after visiting her home country three years ago: “I noticed that a lot more people in the population owned personal mobile phones even when they didn’t have access to basic needs like potable water and electricity,” she says.

Dr. Sekandi is particularly passionate about using mobile technology to improve maternal health in rural Uganda, a serious issue in the area. Between 2011 and 2015, Uganda experienced 343 deaths by pregnancy-related causes per 100,000 live births, a staggering maternal mortality rate compared to 14 per 100,000 in the U.S. In the same time period, Uganda’s rate of neonatal mortality, or number of infants dying before 28 days of age, was 19 per 1,000 live births, once again unacceptably high compared with four per 100,000 in the U.S.

According to Dr. Sekandi, these high rates have a lot to do with the lack of information and awareness of what to do or where to go when health issues arise. Because of the limited availability of healthcare services and poor infrastructure, women in rural areas of Uganda must be extraordinarily proactive in their search for healthcare, especially during pregnancy.

Dr. Sekandi hopes to use mHealth to empower pregnant women with vital information such as where to go for prenatal care and birth assistance from trained health workers, early warning signs for problems associated with pregnancy, and where and when to take their babies for immunizations.

Along with a team of students, which she hopes to expand in the future, Dr. Sekandi plans to launch a pilot program in Uganda this summer. This team, a new club called MobileHealth at UGA, is currently focused on collecting old phones, developing a text messaging application containing educational information related to maternal health, and fundraising for the future.

Dr. Sekandi, although very hopeful, believes that the project’s greatest barriers will be in bringing the effort to scale and making it sustainable. Proper funding, she says, will be necessary to keep up with demands for the services this project can provide.

According to the second global survey on eHealth, many WHO Member States are still in the experimentation phase of implementing mHealth projects. There is a need for further information and evaluation of the effectiveness of certain mHealth applications. If mHealth initiatives are to become priorities, they must be properly evaluated and proven a worthwhile use of scarce resources, especially in lower-income countries.

But the potential for success is evident. As mobile technology constantly improves and the reach of subscribers expands, mHealth seems to be an inevitable and promising next step in improving healthcare around the world. And while developers continue to create technology for high-income markets – like the iPhone Health app and a new smartwatch device that reminds users to take medications when they eat – Dr. Sekandi’s project shows that mHealth can capitalize on existing resources to reach underserved populations with the greatest need for healthcare improvements.

Original article in Georgia Politial Review, February 8, 2016