App could predict viral diarrhea in children

A new mobile health app for doctors could predict viral diarrhea in children, according to findings from a study presented recently at the American Society of Tropical Medicine & Hygiene Annual Meeting.

Stephanie Garbern, MD, MPH, an assistant professor of emergency medicine at Brown University Alpert Medical School, told Healio that the researchers were interested in how smartphone tools or mobile health apps could improve care for patients in low- and middle-income countries. The study was conducted in Bangladesh and Mali.

“Apps would be useful in places that are resource limited, that often don't have other advanced laboratory diagnostics and tests that you would have in more high-income country settings,” Garbern said. “Health care professionals don't usually have the tests they need, like stool testing or lab tests that will allow people to tell if they have a bacterial or viral cause of diarrhea. A lot of people ended up just getting antibiotics, because they're not sure what's causing the diarrhea.”

Garbern said the issue results antibiotic overuse becoming a “huge” problem in these countries.

“A lot of parents will often use antibiotics without prescriptions or without guidance from health care professionals because they're not sure what's causing the diarrhea,” Garbern said. “So, by giving people a tool that's very easy to use, like a mobile health app, we can give people a better way to predict whether this is from a virus and that they don't need antibiotics.”

The observational study was conducted from late 2019 to the beginning of 2020 in Dhaka, Bangladesh, and Bamako, Mali. The researchers enrolled more than 300 children aged younger than 5 years.

Doctors at both sites were given the app, and they noted factors like the patient’s age, the presence of bloody stool or vomiting, if the child was breastfed, and a measurement of malnutrition. External factors like weather and seasonal change were also noted.

Ultimately, Garbern said, the researchers found that the app performed differently at both sites.

“The causes of diarrhea vary greatly between and within countries,” Garbern said. “We found that, for instance, in Bangladesh, there was a huge amount of rotavirus, which is one of the most common causes of diarrhea in children. We found a huge amount of rotavirus when we did the data collection, compared to Mali, where there wasn't very much rotavirus.

“The app, surprisingly, actually did better in Mali, where there were more of a mix of viruses and bacteria compared to Bangladesh, where there was this surge of rotavirus cases. We thought that could possibly just be because there were so much rotavirus that it may have dominated all the other data and made it harder to distinguish viral vs. nonviral causes.”

Garbern said the authors are wrapping up a pilot randomized control trial, also in Bangladesh, to further test the app’s validity.

“We're hoping eventually that could be used throughout the world,” Garbern said. “But you know, this was a still a small pilot study. Before this app could be used in other places, it's important that we validate it in other settings, because different parts of the world are so different in terms of epidemiology of diarrhea. We're hoping that we'll be able to validate it in other countries and other groups of patients.”