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 covers 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.

Watch the AFP report on the Teledermatology programme in Mali:

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.

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).

* 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.