Temporal Logic-Based Fuzzy Decision Support System for Rheumatic Fever and Heart Disease in Nepal

Overview
Nepal is a landlocked Mountainous Country covering the area of 147,181 sq km on the world’s map. Its neighbouring countries are China to North and India which covers East, West and South. Nepal is one of the least developed countries with per capita income approximated at $195. According to the HDR Report 2004 of UNDP, nearly 42% of Nepal’s people live below the poverty datum line. In terms of GDP development index Nepal is ranked 140th among 177 countries. According to the 2000 census, the total population was pegged at approximately 23 million. The country is divided into three regions Himalayan/Mountain (all northern part), Hilly (Middle Part) and Terai (Southern Part) with agriculture the main occupation. Nepal is also divided into 14 Zones and 75 Districts out of which most districts are still untouched by modern developments in the field of transport and communication.

Rheumatic Fever and Rheumatic Heart Disease is Nepal's major problem in comparison to other diseases. Where this scourge has been almost eradicated in developed countries, it remains a problem in most developing Countries. In Nepal, according to Shahid Gangalal National Heart Centre report of 2004, a total of 1441 patients were admitted in one year; among them 856 (59%) were male and 585 (41%) were female. Coronary Artery Disease (CAD) was the commonest cause for admission (39%) followed by Rheumatic Heart Disease (26%) and Essential Hypertension (9.1%) respectively. According to Shahid Gangalal National Heart Centre report of 2007, Rheumatic Heart Disease (RHD) cases were second highest number 430 (20.99%), 591 patients were admitted in Medical Intensive Care Unit (MICU) where RHD was the leading cause of admission. RHD cases involved 58 male and 87 female (24.5%). From these figures the mortality figures recorded showed 14 males and 11 females.

The WHO technical report of 2001 on  Rheumatic Fever (RF) and Rheumatic Heart Diseases (RHD) states and we quote “RF and RHD are nonsuppurative complications of Group A streptococcal pharyngitis due to a delayed immune response. Although RF and RHD are rare in developed countries, they are still major public health problems among children and young adults in developing countries (1–6)”. According to WHO, approximately 18.1 million people are currently suffering from a serious Group A Streptococcal Diseases (GAS), 1.78 million new case occur each year and 0.5 million death each year. The same report states 15.6 million people have RHD.

According to Nepal Heart Foundation Report of 2007, 75,000 children were suffering from rheumatic heart diseases in Nepal. Poverty was cited as the major cause of RF and RHD in Nepal. Poor economic conditions, poor sanitation, over-crowding, lack of balanced diet, lack of education are the causes of RF. RF/RHD can be diagnosed in people  up to 20 years.  RF is a type of sickness caused by a reaction due to a bacterial infection. RF is a precursor to RHD. Untreated RF could lead to permanent damage to the valves of the heart which leads to RHD. The consequences of RHD could be heart failure, stroke and sometimes sudden death. RHD is one of the reasons of mortality in young people in Nepal. The treatment of RHD could be for long periods and sometimes requires surgical treatment of patients although successful treatment is not always guaranteed.

Due to high poverty levels in Nepal, most rural dwellers can hardly access good medical care as fully equipped Hospitals with experienced specialists for treating RF and RHD can only be found in urban areas. Efforts are being to explore the use of expert systems in the form of Decision Support Systems to help inexperienced doctors in the diagnosis of RF and RHD. Decision support systems are currently in use in various sectors of medical sciences in most developed countries. Unfortunately for countries such as Nepal, these technologies are still not available.  Although the country has invested in Information and Communications Technologies (ICTs), the use of Decision Support Systems in medical diagnosis has not been explored at all. There are no information systems designed to support medical diagnostics. Our proposed research aims at exploring the use of DSSs in the diagnosis of RF and RHD. Our goal is to employ WHO together with the guidelines from the Nepal Heart Foundation to design and implement a DSS for use in the diagnosis of RF and RHD. Our goal is to extend rule-based reasoning which employs the guidelines for diagnosing RF and RHD into a temporal and fuzzy logical model to ascertain the precision of such diagnosis. Such a system would also incorporate a subsystem for capturing knowledge from experts in order to support inexperienced medical practitioners.

Thus, the main objective of this research is to explore the extent to which these ICTs could be used in the diagnosis of rheumatic fever and rheumatic heart diseases in order to support doctors and rural health workers caring for such patients in remote areas of Nepal and other developing countries. Our goal is to design and implement a suitable and possibly affordable DSS system for use in countries such as Nepal and other developing countries

Thus, our proposed “Temporal Logic-Based Fuzzy Decision Support System for Rheumatic Fever and Heart Disease‘ is intended to be a  DSS  which inexperienced doctors and other rural Health workers can utilise in the diagnosis and treatment of patients suffering from RF/RHD. Consequently, it may help Doctors and other Health workers to perform their duties effectively and efficiently by minimising chances of human error.