A UMMS physician working to expand his field—pediatric oncology—into the global health space has received a pair of awards from two nonprofit foundations to support his work in Kenya.
Nate Nessle, a clinical instructor in pediatrics, is the recipient of a Young Investigator Grant from the Alex’s Lemonade Stand Foundation for Childhood Cancer, as well as a Career Development Award from the Robert A. Winn Foundation, to expand his collaboration with Moi University Teaching and Referral Hospital (MTRH) in western Kenya. He and his partners, led by Dr. Festus Njuguna, head of the MTRH pediatric haemato-oncology unit, are testing wearable devices to improve fever detection among children with cancer—patients who are susceptible to infection and who too often succumb because their symptoms are not identified and treated early.
“I am very grateful to receive support from these organizations. I know they care deeply about their cause, and they recognize the need to support children suffering from cancer no matter where they are,” said Nessle, DO. “It doesn’t matter where they live—no child with cancer should die from things we can prevent, and infections are the leading cause of death.”
More than 90% of the children and adolescents in the world diagnosed with cancer live in low- and middle-income countries (LMICs), where cure rates are less than 30%, compared with 80% or higher in high-income countries. Infections contribute to poor survival rates in LMICs, with the risk of mortality rising the longer treatment is delayed.
Fever is among the first signs of infection. In previous studies, Nessle and his collaborators correlated high patient-to-nurse ratios with delays in fever detection and antibiotic treatment. Nurses, especially those on the night shift, were simply stretched too thin.
“There is a 1-to-30 nurse-to-patient ratio during the day, and an even higher ratio at night. In our study, only 1% of fevers are detected overnight—not because they aren’t occurring, but because everyone is just too busy,” Nessle said. Their proposed solution: wearable monitors that can quickly detect fevers and notify providers accordingly. Studies funded by the respective foundations will help the team survey hundreds of providers and other stakeholders about their current processes and their perceptions of wearable devices, while also running a parallel clinical trial among 45 hospitalized children.
Relatively little research has been done on the use of wearable medical devices in clinical settings in sub-Saharan Africa, and Nessle’s study is the first exploration of wearables among children with cancer.
“We have a lot of things to explore to make sure it’s a sustainable intervention, because no one that we’re aware of has looked at this approach,” Nessle said. “What is the cost? Should the device be disposable or reusable? What if the facility has spotty Wi-Fi? What if people are unwilling to use their personal cell phone data plans? Will the kids even leave the device on? All of these questions need to be answered.”
As a Global Health Equity Field Scholar, Nessle splits his time between Ann Arbor and Kenya, and his work is supported by his department and the U-M Center for Global Health Equity. The two recent awards validate his decision to join Michigan Medicine, he said.
“There are only a handful of programs doing global pediatric oncology. It’s relatively new territory, so it wasn’t easy to decide where to start my career,” Nessle said. “The support I’ve received here—not only in terms of protected research time, but also the mentorship through the Center and my Department—has been invaluable. I’ve been surrounded by great mentors who’ve given guidance and the opportunity to act on their advice. These awards would not have been possible without that support.”
