In Meru, children can now smile thanks to phone app

Meru Teaching and Referral Hospital CEO Dr James Kirimi and nurse Dorothy Kinoti prepare baby Angel for her cleft lip and palate surgery recently. PHOTO | DAVID MUCHUI | NATION MEDIA GROUP

A mobile app is being used for the first time in Meru to identify patients with neglected surgical diseases (NSDs).

The aim is to reach more than 7,000 children with cleft lip and palate in the country.

Community health workers in the county have been equipped with smart phones installed with The Finders Keepers app. Through the app, those suffering from NSDs such as clefts, cataracts, clubfoot, fistula, hernia and trauma, are identified and referred for surgery.

Cleft lip and palate, a common congenital (present from birth) malformation affecting one in every 700 newborns, has been given priority. Every year, 17 million people die due to preventable, NSDs.

Last year, the county conducted a door-to-door mapping and registration of patients with NSDs. The app provides a patient’s biodata and location. “The community health volunteer takes the patient’s photo, a close-up picture of the condition, the location and other details before uploading it. The data is reviewed by a doctor, who advises on care and treatment. This is the first time the app is being used in the world,” said Patrick Mwai, a director of International Collaboration for Essential Surgery, the developers of the app.


Since the launch of the app, about 50 cleft patients have been identified in the county and have undergone free surgery at Meru Level Five Hospital.
According to Smile Train regional director, Dr Esther Njoroge-Murithi, about 1,300 babies are born with cleft lip and palate in the country every year hence the need for innovative ways of reaching out to the patients.

“The major challenge has been finding the children living with the condition and this is why we are using technology and community health volunteers. The volunteers can easily identify cases in the village,” she said.

Dr Njoroge-Murithi said despite Smile Train reaching 9,000 cleft lip and palate patients since 2002, stigma remains a hindrance to treating many children born with the condition.

“This is why for the first time we are using a mobile app and community health volunteers to identify patients in the rural areas. Once a patient’s biometrics and location is recorded, health workers are able to diagnose the condition and set a date for treatment,” she said. “The technology is a very powerful tool to link health workers with the community. Once a patient is identified, they don’t have to keep visiting hospitals looking for help.”

Lip surgery is done between the age of one and three months while palate surgery is done between six and nine months. “We recommend that palate surgery be done before a child is two years old, so that their speech is not affected,” she said, noting that cleft lip and palate also contributed to malnutrition among children as it made it difficult for a child to suckle.


Health data indicates that up to 75 per cent of children with cleft lip are moderately malnourished while 25 per cent are severely malnourished due to the condition, she added. “Other than the challenge of physical appearance, babies are also not able to latch on the breasts and create enough vacuum to suckle. The baby also takes in a lot of air, leading to a full stomach hence poor feeding. The community health volunteers are vital in educating parents on how to counter this challenge,” she said.

According to her, the nutrition status of a child may delay the corrective surgery which also affects speech development. “A three-month-old child should be at least five kilogrammes to be put on anaesthesia while older children must have appropriate weight for their age. Therefore, feeding is very important because poor feeding can prevent a child from accessing treatment,” she said.

Community health volunteers also advise mothers on how to feed their children to prevent malnutrition. Dr Njoroge-Murithi advised mothers, whose children have cleft lip, to express milk for feeding or burp the child often to remove air if they opt for suckling.

Meru Level Five Hospital will now provide free corrective surgery for cleft patients following the training of local surgeons and nurses with support from Smile Train.

To carry out the programme, the county government last year partnered with Henry Family Advised Fund, Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care (G4 Alliance), College of Surgeons of East, Central and Southern Africa (Cosecsa), Mt Kenya University and the Smile Train.

According to the G4 Alliance, about five billion people have no access to safe and affordable surgical and anaesthesia care.