Diarrheal disease is the second leading cause of death among children under 5 years of age globally. We are specifically interested in the diarrheal disease cholera because of the devastating impact the disease has on at-risk populations and an emerging opportunity to leverage mobile technology to overcome fundamental clinical and scientific challenges we have faced for decades in the cholera field. Despite effective treatments and advances in provider education, cholera case fatality rates remain high. Conventional methods have been unable to overcome barriers to provide patients timely access to care and fully understand the disease at the level of the household. With the emergence of high rates of cell phone penetration in areas with significant cholera associated morbidity and mortality, we feel there are new opportunities for intervention. Our research challenge is to take an unconventional approach to develop a system using mobile technology to identify cases, improve access to care, and characterize the microbial flora early in the disease state. The application's specific aims are (i) develop a system to detect cholera patients early in disease using mobile technology, (ii) validate the detection system and clinical impact of the system in an interrupted time series study with a control group, and (iii) characterize the microbial flora of cholera stool during the early disease state.
These aims will generate the following deliverables: We will show for the first time that mobile technology can be used to identify and provide ORS to diarrheal disease patients early in disease. We will show that mobile technology can be leveraged to decrease the incidence and severity of cases admitted to the hospital. Lastly, we will implement the system to characterize cholera stool using modern techniques early in disease for the first time, which may impact our fundamental understanding of correlates to disease progression and transmission.

Public Health Relevance

This project is relevant to public health because the goal is to identify cholera cases early in disease, improve access to care, and identify important factors to the progression and transmission of cholera. This project has the potential to reveal important unanticipated ways to improve clinical outcomes, stop transmission, and provide opportunities for scientific discovery.

National Institute of Health (NIH)
Office of The Director, National Institutes of Health (OD)
Early Independence Award (DP5)
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Special Emphasis Panel (ZRG1-RPHB-W (53))
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Basavappa, Ravi
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Stanford University
Schools of Medicine
United States
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Bilal, Saadiyah; Nelson, Eric; Meisner, Lars et al. (2018) Evaluation of Standard and Mobile Health-Supported Clinical Diagnostic Tools for Assessing Dehydration in Patients with Diarrhea in Rural Bangladesh. Am J Trop Med Hyg 99:171-179
Andrews, Jason R; Leung, Daniel T; Ahmed, Shahnawaz et al. (2017) Determinants of severe dehydration from diarrheal disease at hospital presentation: Evidence from 22 years of admissions in Bangladesh. PLoS Negl Trop Dis 11:e0005512
Haque, Farhana; Ball, Robyn L; Khatun, Selina et al. (2017) Evaluation of a Smartphone Decision-Support Tool for Diarrheal Disease Management in a Resource-Limited Setting. PLoS Negl Trop Dis 11:e0005290
Gruninger, Randon J; Johnson, Russell A; Das, Sumon K et al. (2017) Socioeconomic Determinants of Cipro-floxacin-Resistant Shigella Infections in Bangladeshi Children. Pathog Immun 2:89-101