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  • Field Based Application of AutomatedImage Processing Using Windows Phone Guided Application in Diagnosis of Malaria A paper Presented to The Faculty of the Graduate School University of the East Ramon Magsaysay Memorial Medical Center In Partial Fulfillment Of the Requirements for the Course Epidemiology and Control of Vector Borne Diseases By: Melvin B. Marzan RN MSc Tropical Medicine II
  • INTRODUCTION Malaria is a serious mosquito-borne disease that has already been eradicatedfrom North America, Europe and Russia, but still prevalent in Africa, Central and SouthAmerica, the Middle East, the Indian subcontinent, and Southeast Asia including thePhilippines. Experts estimate that one to three million people die from malaria everyyear and that more than 500 million people are affected by it. Malaria is still a major health problem in the Philippines although the number ofreported cases has been decreasing since 1990. The World Health Organization (WHO)figures show that in 1990 more than 86,200 new cases of the disease were reportedcompared to only 37,005 in 2002 and 43,644 in 2003. The improvement can beattributed to the anti-malarial program of the government that has been receivingsupport from international agencies. The common method of malarial diagnosis in third world countries is bydetection of malarial parasite either by morphologic analysis or detection inidentification of antigens products in the blood of the patient by direct microscopy orusing the Rapid Diagnostic Test. When executed properly, 60 to 70% of all adults withmalaria can be identified using the Rapid Diagnostic Test Procedure, followed bymicroscopic examination. However, in areas of endemicity, laboratories are oftenoverloaded with samples for smear examination. It is also a common scenario that mostareas with malaria-affected population do not have laboratory or laboratory personnelto man the contemporary diagnostic procedure. Therefore, there is an urge for a newsimple and rapid diagnostic that should alternatively or totally replace microscopy notcompromising the high specificity and sensitivity. In the past, research was mainlyamplified on the development of either antibody/antigen for histidine-rich protein-2 of2|Page
  • P. falcifarum or a parasite-specific lactate dehydrogenase detection assays or thedevelopment of nucleic acid amplification reactions. Against this background, the current technology (Lifelens) investigated thefeasibility of a simple windows phone and a specialized lens to detect malarial species insamples of blood. With the (LifeLens) application and a tiny lens attachment, an aidworker with very little training could perform a finger prick blood sample, and take apicture of the blood cells at 350x zoom. The app then utilizes edge detection to count thecells in the image, and identify any discolored cells to count the cells in the image, andidentify any discolored cells that would suggest the presence of Malaria, ultimatelyresulting in immediate diagnosis. Current global malaria control relies on the diagnosis of cases, followed byadequate treatment. The available laboratory methods for the detection of malaria donot fully meet the need in environments with high malaria prevalences. The complexityof the procedures would sometimes make the end users reluctant to follow theprescribed protocol, thus causing discrepancies on case finding reports. Abovementioned scenarios would likely cause spontaneous and perennial problems of malariacases in the country. The main aim of the study is to conduct community and field-basedwide scale research to test the efficacy, sensitivity and reliability of the new application.Currently, the innovators have tested the device in purely clinical setting and haveachieved stunning 94.4% level of accuracy. Lifelens diagnosis and treatment also offereda cost effective way of managing malaria, it just cause an average of only $0.56, versus$3.40 using current methods. Empirical therapy of malaria is vital to avoid adverse and virulent effects, tomitigate or totally stop resistance, and to save cost on alternative drugs. Precise and3|Page
  • absolute diagnosis is the requisite of effective empirical therapy. Confirmatory diagnosisbefore treatment initiation recently regained attention, partly influenced by the spreadof drug resistance and thus the requirement of more expensive drugs unaffordable toresource-poor countries. This research aims to focus on the accuracy of the Smartphoneapplication (Lifelens), the malaria diagnostic that shows potential to have the largestimpact on malaria control today. Thus the research hopes to fill in the gaps regardingthe current diagnosis and the new diagnosis to yield recommendations on the effectiveuse of the Lifelens in community and field settings.PURPOSE The paper discussed to substantially identify the sensitivity and specificity of thenew diagnostic device (Lifelens) in the diagnosis of malaria. The research warrantsaddressing also the practicality and stability of the innovated device. A comparativeanalysis will be performed to find out if the (Lifelens) device could perform betteragainst the existing diagnostic methods use in the malarial infection management suchas the Microscopy and Rapid Diagnostic testing to develop a ground for the extensiveuse of (Lifelens) device in community and filed based settings.OBJECTIVES: This paper scrutinizes a prospect of lifelens device (a windows phone guided malarialdetection device) and image analysis studies aiming at automated and fast diagnosis orscreening of malaria infection in thin blood film smears. In addition, a general patternrecognition framework to perform diagnosis, which includes image acquisition, pre-processing, segmentation, and pattern classification components, will be described . The4|Page
  • open problems will be addressed and a perspective of the future work for realization ofautomated diagnosis of malarial parasite with lifelens device will be provided. The main objective of the study is to determine the sensitivity and accuracy of thenew and simple diagnostic tool in the diagnosis of malaria in community and field-based settings. the present study hopes to assess the reliability and accuracy of(Lifelens) in a field based setting of the Philippines, where health workers have limitedtraining and compromised knowledge of basic microscopy and support diagnosis andcompares it with the existing Rapid Diagnostic Testing and Microscopy. The studyendures to adhere with the following objectives in the course of study: 1.) Measure and assess the sensitivity and specificity of the device. 2.) probe the practicality, cost effectiveness, and accuracy of the proposed diagnostic tool (Lifelens) and the its abilty to perform the actual diagnostic task in community and field based settingsCURRENT STATE OF MALARIAL DIAGNOSIS/MALARIAL DIAGNOSTICRESEARCH Rapid diagnostic tests (RDTs) are frequently used as an adjunct to microscopy inthe diagnosis of malaria [Wongsrichanalai 2007] and even as a point-of-carediagnostic tool [Wiese L, Bruun B 2006]. In settings where high quality microscopyis not available, the detection of Plasmodium infections is often based on RDTs alone[Chilton D, Malik AN, Armstrong M et. Al 2006]. World Health Organization (WHO)recommends the use of RDTs as part of parasite-based diagnosis and supports the broadimplementation of RDTs for malaria diagnosis in areas where malaria isprevalent [World Health Organization: World Malaria Report 2009. Geneva; 2009].5|Page
  • Although fast and simple in concept, RDT performance in practice requires well-trainedoperators that are able to interpret results correctly and record them properly. Atpresent, there is no widely accepted way of assessing the quality of RDTs at the end-userlevel and both microscopy and PCR could be used as reference method [Bell D,Wongsrichanalai 2006] The PATH Organizations 2010 Report reveals that malaria diagnosis,particularly in remote areas lacking laboratory support, frequently relies on the patientssymptoms. The first symptoms of malaria (fever, chills, sweats, headaches, musclepains, nausea, and vomiting) are not specific to malaria. While clinical diagnosis isinexpensive and can be effective, clinicians often misdiagnose malarial infection.Misdiagnosis often leads to the unnecessary prescription of malaria medications whichare becoming increasingly expensive as drug resistance grows globally and newmedicines are required for effective treatment. Thus, increasing the accuracy of malariadiagnosis is becoming more important and will continue to be so in the future[]. Clinical diagnosis is imprecise but remains the basis of therapeutic care for themajority of febrile patients in malaria endemic areas, where laboratory support is oftenout of reach. Scientific quantification or interpretation of the effects of malariamisdiagnosis on the treatment decision, epidemiologic records, or clinical studies hasnot been adequately investigated. Despite an obvious need for improvement, malariadiagnosis is the most neglected area of malaria research, accounting for less than 0.25%($700,000) of the U.S.$323 million investment in research and development in 2004.Establishing and maintaining an accurate and reliab