This grant proposal aims to address malnutrition in Mali by developing a smartphone application to help community health workers (CHWs) more effectively monitor child growth and nutrition. Undernutrition accounts for over a third of child deaths under age 5 in Mali. CHWs play a key role in growth monitoring but face challenges with low literacy, inaccurate data collection, and inability to provide timely counseling. The proposed app would use speech recognition and touchscreen technology to help CHWs collect and interpret growth data, provide counseling, and share information. It would also allow aggregated anonymized data to be accessed by the Ministry of Health to guide nutrition programs. The goal is to ultimately reduce infant mortality, hunger, and improve maternal health through more effective CHW services

1. Stars in Global Health Grant Proposal (Round 4 Phase I):
Title to be put on the website (Swiss-knife for community health worker?)
1. Describe and quantify the global health problem you will address.
The World Bank warns that malnutrition continues to be the world’s most serious health
problem and the single biggest contributor to child mortality. Under-nutrition accounts for more
than a third of all deaths in children under 5 years-old. Regular growth monitoring of children
under five provides early detection of under-nourished children, enabling prompt nutritional
intervention before the age of 2 and the irreversible consequences of stunting.
In Mali, Community Health Workers (CHWs) play a vital role in monitoring community
health and providing individual and groups with counselling, and Behavior Change
Communication (BCC). BCC centers on women’s nutrition as well as infant and young child
feeding. Effective BCC on this theme requires trained CHWs to identify all pregnant women and
counsel them at critical stages until the infant is at least 2 years old. Regular growth monitoring
of young children provides early detection of malnourishment which will give CHWs the
opportunity to provide counselling and feedback to the families. However, majority of CHWs’
literacy level and educational attainment negatively affect their ability to capture accurate growth
monitoring data and to provide appropriate counselling. For adequate analysis and targeted
assistance, accurate and timely data collection is indispensable. Moreover, growth monitoring
must be shared first and foremost with the mother at point of collection and used for follow up of
the child. At the district level, collected data can be used to guide planning of nutrition
interventions and programming. At the National Ministry of Health (MOH) offices, collected
data can be used to support nutrition surveillance and contribute to the national nutrition strategy.
There are two more challenges with community-based Growth Monitoring & Promotion
(GMP). The first is that the focus is often primarily on the measurement of children and not on
the interpretation of results which delays the actions of CHWs. The second is that while
extensive data on child growth is collected through GMP programs, much of this data is never
collated, analyzed or reported up to higher levels in the Ministry of Health to allow for
monitoring and targeting of initiatives at the population level.

2. We believe there is an opportunity to equip CHWs with affordable and appropriate
smartphone technology in order to help them track, interpret, collate and report child growth
data. Furthermore, the smartphone platform can also act as a local hub for information
dissemination, which empowers the community with up-to-date knowledge. On a macro-level,
data collected would also help the Ministry of Health to access quality information which could
be used to support planning, track health interventions, and ultimately improve quality and
consistency of care for children under 5.
2. Indicate in one or two sentences the essence of your idea. (Please note that this
description will be used for public use through our website.)
The essence of this smartphone application software (app) is to help community health
workers to increase the effectiveness of their service and ultimately reduce infant mortality rate,
reduce extreme hunger, and improve maternal health in Mali. This app will help CHWs to
circumvent barriers of: unreliable and untimely data collection; CHWs not possessing correct
tools or literacy level; inappropriate/untimely intervention and consultation; not having
visual/multimedia aid; inability to transfer health related data inter/intraprofessionally.
The application software will integrate touch screen technology and speech recognition
technology; it will function with limited cell network coverage and has the ability to create and
maintain patient record. The application will have a graphic interface with speech recognition
system to aid the CHWs to enter growth data and other relevant information. It will streamline
the data gathered and put them into growth-chart specific to individual family, and whenever a
trend is below the national average, the software will redirect CHWs to algorithms of steps to
take (the algorithms will also be presented in graphic and audio form). There will also be other
functionality beyond data collection such as calendar, event notifier, and local maps. This is to
ensure the compactness and resourcefulness of the application. We want to make sure that
CHWs will have the relevant tools and information they need by using this application. Finally,
all the data will be collected and sorted by time, location and other variables, then put into open-
source data base such as GapMinder for government organization or NGO to access. (this section
need to be modified if it were to be put on Grand Challenge Website)

3. 3. How will your proposed idea significantly improve the outcomes of the problem you
identified (Where possible, use quantitative estimates)?
Malnutrition and infant mortality had been a persistent issue in developing nations. There
were many attempts and programs that tried to ameliorate these issues, for example (insert
example). The problems seem to lay in that the top-down approach towards social/health issues
are not as effective as a grass-root approach where population health and community health were
taken into consideration. Moreover, recent researches had shown that (increase women’s rights,
make the target population part of the solution) increases community participation and makes the
solutions long lasting. The zeitgeist of modern Africa had been a boom in telecommunication
and personal mobile equipment, and this is a valuable opportunity to achieve that bottom-up
approach to population health. With mobile equipment, critical clinical data can be recorded, and
health information and up-to-date clinical guidelines can be spread around in remote villages.
However, barriers such as language and illiteracy block the successful adoption of mobile
technology in developing nations.
Our solution of an interactive, compact and user-friendly speech recognition system fully
utilize the potential of smart phone technology. Our application circumvents the language and
literacy barriers by providing full audio playback for all its content, and speech recognition will
facilitate data entry. Furthermore, we are using existing infrastructure to base our application
(mobile/smart phone), therefore creating a cost-effective ecosystem. Also, there will be two
versions of the application (iPhone, and Android OS) to ensure accessibility. By giving this
powerful and portable tool to community health workers, we will (hope to?) increase health
promotion, address determinants of health (access to and distribution of food; food safety; facts
about nutrition), and improve maternal and infant health (by timely consultation and
intervention). Growth data can be shared in the community or between CHWs, therefore
increasing visibility and ownership. Lastly, since the app is service based and not hardware
based, it will have the advantage of flexibility, sustainability and upgradeability.