TITLE: A Model for Early Identification of Potentially Malignant and Malignant Lesions Using a Mobile-Based Application by Community Health Workers.

Intro: Oral cancer rates in South Asia, particularly in India, are among the highest globally, with India alone bearing 7.8 percent of the worldwide cancer burden. Nearly half of oral cancer cases are detected in advanced stages due to limited healthcare access and patient neglect, leading to high mortality rates. Early detection is essential, as over 80 percent of cases develop from precancerous lesions, which are detectable with proper screening. mHealth and teledentistry offer promising solutions, utilizing mobile technology for remote diagnosis and specialist support. These digital health innovations enable Community Health Workers  to conduct cost-effective screenings, breaking down geographical and financial barriers. The  app is designed to empower CHWs in identifying, assessing, and referring oral lesions, addressing India’s low dentist-to-population ratio. Beyond detection, the app facilitates data collection for predictive modeling and risk assessment, enhancing data-driven decision-making for better oral health outcomes in underserved areas.

Objective:

     I.         Training of CHW for awareness, identification and counselling of tobacco users and presence/absence of oral lesions using a mobile based application

   II.         Use of HCW in identification and presence/ absence of tobacco related Pre-Malignant Lesions and malignant lesions.

 III.         To establish a path for early diagnosis, counselling , referral and treatment for the inaccessible  masses using existing health care system.

Methodology

The sample was calculated to be 294 and rounded off to 300. Patients will be screened for presence of OPMLs and MLs by CHWS from the villages of Khordha block until the desired sample size is achieved.

Data Collection-

All the Community Health Workers of the included villages will be trained at the tertiary centre by two specialists using power point presentation and dental models that will include:

         Information on harms of tobacco consumption, oral cancer burden, prevention, habit cessation.

        Oral cavity and parts of the mouth and it’s clinical examination

      Toluidine Blue  staining protocol to identify tobacco-associated mucosal lesions.

All participants aged more than 15 years residing in the selected villages regardless of habit history will be invited to participate from their homes, but those who refuse consent will be excluded.

The mobile application-based questionnaire using modified Fagestrom Questionnaire will be administered by the CHW using a  mApp for android and iOS mobile phones which will categorise the individual based on severity of tobacco consumption based on the Fagerstrom Test for Nicotine Dependence . FTND is a standard instrument for assessing the intensity of person’s physical addiction to nicotine. Those categorised as high risk having scored more than 5 in FTND will be indicated for a clinical picture to be captured by the CHW with autofocus and auto-flash mode using the mobile phone camera, of buccal and labial mucosa, palate, dorsal and ventral surface of tongue. The clinical pictures which are deemed as suspicious , red/white patch or ulcers by an oral health expert, will be notified through the app to the health care worker as in need of TB staining.

Pictures of the stained lesions will be uploaded by the CHW through the app for further diagnosis by the expert. The images will be uploaded in real-time, remote specialist will serially review the images. The results will be communicated to the CHW via the app under the following categories:

1.No Lesion,

2. Lesion.

Patient with lesions will be referred to tertiary care using specially designed referral slips to for histo pathological examination and further treatment.

After a brief counselling by CHW for all participants with a habit history, they will be referred them to the ‘Institution Tobacco Control Cell’, to seek further help to quit.

IMPLICATIONS

Odisha has long been endemic to malignant and malignant lesions of oral cavity due to various reasons like social acceptance of chewing tobacco, low awareness and low accessibility to specialists. The mortality of oral cancer is high primarily due to late diagnosis , as patients are usually unaware of a lesion developing in their oral cavity and only report when there is precipitation of symptoms. With “SAH-AI’ we aim to  screen , diagnose and treatment at the earliest level to reduce  mortality, and reduce incidence by awareness and counselling.