Designing for Neglected Tropical Diseases: Co-creating digital diagnostic devices for Low-Resource Settings

Abstract

Neglected Tropical Diseases (NTDs) affect more than two billion people worldwide and cause significant morbidity and mortality. Despite their impact, these diseases receive limited attention in the development of diagnostics, medicines, and vaccines. For many parasitic NTDs, microscopy remains the primary diagnostic tool, yet it is often unavailable or requires expertise that is lacking in primary healthcare settings. Digital optical diagnostics could provide affordable, user-friendly alternatives that support diagnosis, treatment, and monitoring. However, designing such devices requires a strong understanding of the social and healthcare context in which they will be used, as well as close collaboration with stakeholders. The main objective of this thesis is to investigate how smart optical diagnostics for NTDs can be developed for endemic countries by integrating local knowledge and experience to support local adoption.

The thesis shows that the use context of digital diagnostics is complex and involves interactions between physical, social, cultural, and organizational factors. Healthcare policies, workflows, resources, and users all shape how a diagnostic device can be used. Social factors influence awareness of diseases, interest in prevention and treatment, and the availability, accessibility, affordability, and acceptability of diagnostic resources. Collaboration among stakeholders—including healthcare workers, communities, policymakers, and organizations—is therefore essential for successful device design and implementation.

To support this, the thesis presents a five-step iterative design process consisting of empathizing, defining, ideating, prototyping, and testing. Co-creation with stakeholders plays a central role throughout this process, helping to build shared understanding of disease challenges and opportunities for innovation. Methods such as stakeholder mapping, social network analysis, document reviews, interviews, and Q-methodology can be used to identify and involve relevant stakeholders in the design process.

The diagnostic device design itself also requires iterative collaboration. Five key design components are identified: the overall device concept and evaluation, the software system, the hardware system, the structural composition and style of the device, and the product documentation. Through this process, two categories of product specifications emerge: broad-based and context-based specifications. Broad-based specifications include technical, regulatory, and business requirements. Technical specifications cover manufacturing aspects and performance requirements such as sensitivity, specificity, and speed. Regulatory specifications involve compliance with standards from organizations such as ISO and WHO, while business specifications address financing and cost considerations. Context-based specifications relate to factors affecting usability, user experience, and acceptability within the local healthcare setting.

The interaction between these specifications leads to different product use scenarios for NTD diagnostics. In the Nigerian context, three potential scenarios are identified: screening programs, monitoring and evaluation of interventions, and point-of-care testing.

Finally, the thesis highlights that adopting new NTD diagnostics is a complex, multi-stage process involving research, training, implementation, monitoring, maintenance, and scale-up. Adoption can be hindered by limited resources, infrastructure gaps, political instability, and cultural differences. Successful implementation therefore requires early needs assessment, stakeholder involvement, regulatory alignment, training of healthcare workers, and continuous monitoring.

Overall, the thesis demonstrates that developing and implementing digital diagnostics for NTDs requires a systemic design approach that integrates context, stakeholder collaboration, and technological development to ensure that new diagnostic tools are usable, acceptable, and effective in endemic settings.