The UOC's commitment to the WHO in the fight against neglected tropical diseases bears its first fruits

This year sees another edition of World Neglected Tropical Diseases Day (NTD), dedicated to a series of diseases affecting over a billion people worldwide. The Universitat Oberta de Catalunya (UOC), through the eHealth Lab research group, is fully committed to helping the World Health Organization (WHO) in this fight. This collaboration has resulted in the recent publication of "Assessing the Quality of the World Health Organization's Skin NTDs App as a Training Tool in Ghana and Kenya: Protocol for a Cross-sectional Study".

Neglected tropical diseases are bacteria-, virus-, protozoa- and helminth-induced infectious diseases that afflict people in African, Asian and American low- and middle-income tropical areas. "They include diseases such as Guinea worm disease, leprosy, dengue fever, leishmaniasis, Pian's disease and Chagas disease," explained Marta Aymerich, UOC Vice President for Strategic Planning and Research. "The WHO has made a list of 20 diseases, and sadly what they all share is precisely the reason for having a World Day dedicated to them: the fact that we don't pay enough attention to them. Little scientific research and insufficient effort worldwide are devoted to addressing the issue that could eradicate them: poverty."

"The UOC is doing its bit by collaborating with the WHO, and we plan to continue carrying out research and providing training in order to achieve one of the milestones of Goal 3 of the UN 2030 Agenda: to put an end to NTD epidemics," she said. The research carried out has led to the recent publication of a protocol by the team led by Carme Carrion, from the UOC's Faculty of Health Sciences and scientific coordinator of the eHealth Center. This is part of a much larger study to assess the mobile app Skin NTDs, which is being developed with Mireia Cano of the eHealth Lab research group, who is leading the fieldwork. The app aims to help healthcare professionals working in the field. This would help improve our knowledge of these neglected diseases, which would in turn improve their diagnosis, as well as the possibilities for treatment and prevention.

As to the current study, Carrion explained that "the assessment involves asking 50 professionals from Ghana and Kenya to take part. After using the app for a few days, they will have to answer a number of questions based on a standardized tool called uMARS." In the assessment, the protocol detailed in 'Assessing the Quality of the World Health Organization's Skin NTDs App as a Training Tool in Ghana and Kenya: Protocol for a Cross-sectional Study' will determine the parameters to be used to ensure it runs as accurately and efficiently as possible. "Online focus groups are being established with some of these 50 professionals to try to understand what lies behind the figures arising from the assessment as well as, above all, to identify areas for improvement," she said.

"Little is known about neglected tropical diseases, and there is little investment, both in terms of research and their diagnosis, handling and prevention," said Carrion. "Mobile health tools such as the Skin NTDs app provide exciting opportunities for supplementing and assisting in the work carried out by professionals to raise awareness of these diseases and improve their diagnosis. The WHO has long been committed to digital health as a tool for ensuring that health and the management of disease reach every part of the world, regardless of how isolated they may be."

"The Skin NTDs app is already in its third version and, as is often the case with mobile applications regardless of the field they relate to, each new version is better than the previous one and contains new features. We're currently working on adding artificial intelligence elements in order to achieve a better differential diagnosis. We're doing this based on the images of skin lesions obtained by professionals in the field," explained Carrion.

The researcher highlighted an important detail: a large proportion of the population affected have a different skin colour from the predominant tones of high-income countries. "We have few images of people with diverse skin colours. This is why it's so important to feed the algorithms with images of the people who are more likely to suffer from these diseases. Acquiring these photographs is key when it comes to improving the quality of the app," she said.

She also explained that, although the project is making rapid progress, there are still many barriers to overcome. "Some diseases appear to be extremely rare or not to be endemic to certain regions until professionals in the area are trained and start actively looking for cases. The number of cases then skyrockets not because the disease has become more prevalent but as a result of better knowledge. Digital tools can be key to obtaining better results both for prevention and for investment in research. Another very important aspect is the stigma of neglected tropical skin diseases, such as leprosy, due to the lesions being very visible. This can result in sufferers being ostracized at school, professionally and socially. The most affected and stigmatized are often the poorest women," said Carrion.

"The UOC has been a WHO Collaborating Centre on Digital Health since 2018," said Aymerich. "Regarding neglected tropical diseases in particular, our collaboration with the WHO is carried out through the eHealth Lab and involves various research and training initiatives. For example, the UOC-WHO course on how to handle NTDs, taught in English and French, has been run several times now."

"As to research", she continued, "the current Skin NTDs app assessment project follows two other projects carried out in collaboration with the World Health Organization. The first of these aimed to propose a design model for neglected tropical disease management apps. The second one, Leishguide, focused on one of these diseases – cutaneous leishmaniasis – and involved studying the impact on the management of cutaneous leishmaniasis of implementing the WHO's clinical practice guidelines in Morocco."

The research is always carried out globally, internationally. This can be seen, for example, in the role played by the research teams. "We always generate knowledge based on that already generated – anywhere in the world," said Aymerich. "Collaborating with a global organization such as the WHO makes all that knowledge available to us and enables us to carry out research, provide training and disseminate knowledge in order to continue to increase it in the hope that, one day, no one will die from preventable diseases. In order to see this, and as often asserted by the organization's director-general, we must work to protect a fundamental human right, which is the right to health for everyone, everywhere."

Skin NTDs is just one of the projects carried out by the UOC's eHealth Lab research group. The lab's activities focus on the design, implementation and assessment of digital solutions for both healthcare professionals and the general public to improve the efficacy, effectiveness and efficiency of different interventions. In addition to the assessment project for the Skin NTDs mobile app developed by the WHO, the researchers have taken this opportunity to highlight other significant projects.

●      EVALAPPS: a project to design and validate a tool to assess the efficacy and safety of mobile apps to manage overweight and obesity.

●      DARWeb: a project to design a web app to manage recurrent abdominal pain in children.

●      Psicodem: a project to design a web app to choose the most suitable psychosocial intervention for dementia based on the amount of scientific evidence and the severity of the disease and concomitant illness.

●      AUTAPP: a project to design an app (TEApp – currently under development) to help people with autism spectrum disorder (ASD) and their families communicate with health professionals.

●      eTRAMS: a project to identify the best strategies and design a web app that implements them for a more efficient application of clinical practice guidelines to the target population (based on scientific evidence).

This UOC research backs Sustainable Development Goal (SDG) 3: Ensure healthy lives and promote well-being for all at all ages