Ariel Yang, M.D. 2021, Renaissance School of Medicine at Stony Brook University

Coauthors: Nahid Bakhtari, Simon Grandjean Lapierre, Patricia Rakotomanga, Armand Rafalimanantsoa, Juan De Dios Santos, Inès Vigan-Womas, Astrid M. Knoblauch, Luis Marcos

Kankanet: An Artificial Neural Network-Based Smartphone Application as a Point-of-Care Diagnostic Aid for Soil-Transmitted Helminthiases:

A Pilot Study in Rural Madagascar

Soil-transmitted helminthiases (STH):endemic in rural areas,diagnosed in urban areas

How are STH diagnosed?

How prevalent are STH in rural

villages of Ranomafana?

Ascaris lumbricoides 69.0%

Trichuris trichiura 87.6%

Hookworm (Ancylostoma spp.,

Necatur americanus) 3.5%

July 2018 sample of population in

Ambinanindranofotaka and Mangevo (n=113)

How rural is rural?

Our goals:What features did we want our solution to have?

Point-of-care Inexpensive Low-resource User-friendly

Our solution: Kankanet

Kankana, Malagasy for “worm” + net, short for convolutional neural network

Kankanet Microscope Stage Android phone

How do convolutional networks like

Kankanet work?Raccoon!

RACCOON[87.6]

Here’s a demo.

How well did the microscope work?

Species Intensity Sensitivity Specificity Kappa

ascaris

lumbricoides

0 97.10% 0.715

1 60.60% p=0.000

2 97.60%

3 100.00%

total 82.30% 97.10%

trichuris trichiura 0 97.10% 0.715

1 60.60% p=0.000

2 97.60%

3 100.00%

total 82.30% 97.10%

Hookworm 50.00% 69.70% 0.082

How well did Kankanet work?

Evaluation set Species Se Sp PPV NPV

microscope

images only

AL 85.70% 87.50% 85.70% 87.50%

TT 100% 100% 100% 100%

H 66.7% 100.0% 100.0% 80.0%

UVC images only AL 68.5% 40.0% 92.5% 10.5%

TT 8.3% 96.9% 50.0% 73.8%

H - - - -

All images AL 69.6% 61.1% 92.0% 23.9%

TT 15.4% 97.8% 66.7% 80.0%

H 71.4% 100.0% 100.0% 96.2%

Cost Benefit

Where can we go from here?

Kankanet

Developed from Tensorflow, an

open-source library

Improve hardware and softwareIncrease microscope resolution

Add more images to Kankanet database

Empower local health workersTo train or aid human diagnosis

To develop similar point-of-care diagnostic tools

Questions?Email: ariel.yang@stonybrookmedicine.edu

Picture acknowledgements: Dat Tran, Luciana Ybarnegaray, CDC DPDx