AWARrD Project 2
Dat-AUB
Heavy Menstrual Bleeding and Anemia:
The silent pandemic
Anemia is one of the four greatest causes of disability in the world and women bear the brunt with the diagnosis made at least twice as often compared to men (Reference). At least half of the anemia in the world is caused by a deficiency in iron (iron deficiency or ID), and while nutrition clearly plays a role, and for many women it is caused or contributed to by blood loss associated with pregnancy, the most common reason for the difference between women and men is the blood lost with menstruation, which, when heavy, can exceed the nutritional intake of even a well nourished woman. This "heavy menstrual bleeding", or HMB, may not be recognized by the woman, her family or her healthcare provider as being abnormal (Reference). Consequently, not only is she frequently disabled by the recurrent and cyclical bleeding and associated symptoms like pain, she experiences daily symptoms of ID or its extreme, iron deficiency anemia (IDA). Girls and women who are iron deficient, even without anemia, can have easy fatigue, impaired physical performance, and may have difficulties with cognition. Women who are anemic when pregnant have a greater risk of premature labor, reduced tolerance for episodes of heavy bleeding around delivery, and there is growing evidence that neonatal cognitive development may be impaired. All of these issues place women at a disadvantage with respect to productivity and quality of life and threaten their offspring with impaired development. This circumstance is extremely unfortunate since treatment of both HMB and ID, including IDA, are relatively simple and inexpensive in most instances. All of this begs for solutions that can be widely applied considering the spectrum of cultural and socioeconomic conditions that exist throughout Africa and elsewhere.
Can smartphones identify girls & women with HMB, ID & IDA?
There exists a spectrum of reasons why women with HMB and ID/IDA are not identified and treated. However, it appears likely that a major, if not the major reason is that the amount of menstrual blood loss is greater than the dietary intake and absorption of iron. Many women with HMB have been conditioned - by friends, family, culture or health care providers - that their heavy bleeding is normal...or even desirable. We now know that at least two thirds of Africans have access to smartphones so the opportunity exists to bypass culture, family, friends and even health care providers and directly address the victims of these two related medical issues. There are a number of app-based menstrual calendars, but virtually all are oriented to use for either contraception - or to facilitate conception. The Flo app has been designed to help women identify the amount of their menstrual blood loss, is being equipped to ask about quality of life, and already there about 2 million monthly users in Africa.
The AWARrD team has joined with Flo Health and a spectrum of internationally known and respected specialists in abnormal menstrual bleeding to create a research plan designed to test the ability of the Flo app to identify ID and IDA in African women. The name of the project is "DatAUB", which stands for Data on Abnormal Uterine Bleeding and, if approved for initiation, will start with the anonymized data already present from more than 2 million girls and women. Then, in a pair of studies called Val-IDA-te we will compare the results of women using the application with their iron levels to test the hypothesis that the system can predict those who have ID and IDA.
We are confident that the Flo app can be successfully used for this purpose. Already the data scientists from Flo have worked with investigators from the University of Adelaide in Australia to utilize the menstrual database to provide new insights into the spectrum of menstrual features experienced by 1.5 million Flo App users (Reference). These data, as well as those from other studies using menstrual applications will do much to inform us on the range of menstrual experiences and as well have provided the experience necessary to operationalize the system for the DatAUB project and val-IDA-te studies.
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