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In low and middle income countries, infectious diseases continue to have a significant impact, particularly amongst the poorest in society. Tetanus and hand foot and mouth disease (HFMD) are two such diseases and, in both, death is associated with autonomic nervous system dysfunction (ANSD). Currently, photoplethysmogram or electrocardiogram monitoring is used to detect deterioration in these patients, however expensive clinical monitors are often required. In this study, we employ low-cost and mobile wearable devices to collect patient vital signs unobtrusively; and we develop machine learning algorithms for automatic and rapid triage of patients that provide efficient use of clinical resources. Existing methods are mainly dependent on the prior detection of clinical features with limited exploitation of multi-modal physiological data. Moreover, the latest developments in deep learning (e.g. cross-domain transfer learning) have not been sufficiently applied for infectious disease diagnosis. In this paper, we present a fusion of multi-modal physiological data to predict the severity of ANSD with a hierarchy of resource-aware decision making. First, an on-site triage process is performed using a simple classifier. Second, personalised longitudinal modelling is employed that takes the previous states of the patient into consideration. We have also employed a spectrogram representation of the physiological waveforms to exploit existing networks for cross-domain transfer learning, which avoids the laborious and data intensive process of training a network from scratch. Results show that the proposed framework has promising potential in supporting severity grading of infectious diseases in low-resources settings, such as in the developing world.

Original publication





IEEE journal of biomedical and health informatics

Publication Date





2131 - 2141


Humans, Tetanus, Communicable Diseases, Hand, Foot and Mouth Disease, Diagnosis, Computer-Assisted, Electrocardiography, Photoplethysmography, Monitoring, Physiologic, Models, Statistical, Algorithms, Developing Countries, Adult, Child, Preschool, Infant, Vital Signs, Wearable Electronic Devices, Deep Learning