Utilizing mobile health and community informants to collect real-time health care data in extremely low resource environments.

BACKGROUND: Mobile health provides promising opportunities to perform population surveillance in rural, impoverished, or unstable communities. The objective of this study was to test the efficacy and accuracy of data collected by community informants in extreme low-resource environments using electronic surveys and mobile phones. METHODS: We carried out a population-based, cross-sectional survey between October and November 2017 measuring access to health care and prenatal services for pregnant women in the Northern Region of Malawi. The survey was conducted by members of the community who received one day of training and volunteered to conduct a survey for each live birth that occurred within their predetermined catchment area. A study member audited less than 2% of survey responses, where community informant responses were compared to community member self-reports. RESULTS: A total of 915 survey responses were recorded by 21 community informants. These surveys recorded 621 live births and 4 cases of maternal mortality. This represents a maternal mortality rate of 0.64% (95% confidence interval (CI) = 0.2% to 1.6%), roughly equal to the United Nations Children's Fund (UNICEF) estimate from 2015 of 634 per 100 000 live births, or 0.63%. This survey captured 120 births by adolescent mothers aged 15-19 out of 673 responses about maternal age. This represents 17.8% (95% CI = 15.1% to 20.9%) of all births, slightly higher than the UNICEF estimate of 143 per 1000 live births (14.3%). Finally, 51.7% of women were recorded as attending 4 antenatal care visits (95% CI = 47.8% to 55.7%), consistent with the 2015-2016 Demographic and Health Survey (DHS) value of 51%. CONCLUSIONS: The use of cellular phones and electronic surveys by community informants allowed for the real-time capture of data in an area where access is limited by seasonally impassable roads and unreliable cell reception. The data recorded by the surveys is comparable to accepted statistics in several measures. Community reporting of health care data can provide an efficient method of monitoring extremely rural or hard to reach communities.

Stable nuclear expression of ATP8 and ATP6 genes rescues a mtDNA Complex V null mutant.

We explore the possibility of re-engineering mitochondrial genes and expressing them from the nucleus as an approach to rescue defects arising from mitochondrial DNA mutations. We have used a patient cybrid cell line with a single point mutation in the overlap region of the ATP8 and ATP6 genes of the human mitochondrial genome. These cells are null for the ATP8 protein, have significantly lowered ATP6 protein levels and no Complex V function. Nuclear expression of only the ATP8 gene with the ATP5G1 mitochondrial targeting sequence appended restored viability on Krebs cycle substrates and ATP synthesis capabilities but, failed to restore ATP hydrolysis and was insensitive to various inhibitors of oxidative phosphorylation. Co-expressing both ATP8 and ATP6 genes under similar conditions resulted in stable protein expression leading to successful integration into Complex V of the oxidative phosphorylation machinery. Tests for ATP hydrolysis / synthesis, oxygen consumption, glycolytic metabolism and viability all indicate a significant functional rescue of the mutant phenotype (including re-assembly of Complex V) following stable co-expression of ATP8 and ATP6 Thus, we report the stable allotopic expression, import and function of two mitochondria encoded genes, ATP8 and ATP6, resulting in simultaneous rescue of the loss of both mitochondrial proteins.