Mapping evidence of mobile health technologies for disease diagnosis and treatment support by health workers in sub-Saharan Africa: a scoping review

Phone-based psychosocial counseling for people living with HIV: Feasibility, acceptability and impact on uptake of psychosocial counseling services in Malawi

People living with HIV experience psychosocial needs that often are not addressed. We designed an innovative low-resource model of phone-based psychosocial counseling (P-PSC). We describe cohort characteristics, acceptability, feasibility and utilization of P-PSC at health facilities supported by Baylor Foundation Malawi. Staff were virtually oriented at 120 sites concurrently. From facility-based phones, people with new HIV diagnosis, high viral load, treatment interruption or mental health concerns were referred without identifiable personal information to 13 psychosocial counselors via a WhatsApp group. Routine program data were retrospectively analyzed using univariate approaches and regressions with interrupted time series analyses. Clients utilizing P-PSC were 63% female, 25% youth (10-24 y) and 9% children (<10 y). They were referred from all 120 supported health facilities. Main referral reasons included new HIV diagnosis (32%), ART adherence support (32%) and treatment interruption (21%). Counseling was completed for 99% of referrals. Counseling sessions per month per psychosocial counselor increased from 77 before P-PSC to 216 in month 1 (95% CI = 82, 350, p = 0.003). Total encounters increased significantly to 31,642 in year 1 from ~6,000 during the 12 prior months, an over fivefold increase. P-PSC implementation at 120 remote facilities was acceptable and feasible with immediate, increased utilization despite few psychosocial counselors in Malawi.

A scoping review protocol on integration of mobile-linked POC diagnostics in community-based healthcare: User experience

BACKGROUND

Mobile-linked point-of-care diagnostics forms an integral part of diagnostic health services for efficient communication between patients and healthcare professionals despite geographical location and time of diagnosis. The efficiency of this technology lies in the user experience which means that the interaction of the user with the implemented technology needs to be simple, convenient, and consistent. Having a well-structured user experience of these devices in community-based healthcare will aid in sustainable implementation. Herein, we propose to conduct a literature search to systematically map out evidence based on mobile-linked POC diagnostics user experience at a community level in resource-limited settings.

METHODOLOGY

The proposed scoping review will be guided by the advanced Arksey and O'Malley methodological framework and further advanced by Levac et al. A comprehensive search will be conducted to find relevant published literature from the following electronic databases: Scopus, Web of Science, EBSCOhost (Medline, CINAHL, Africa-wide, Academic Search Complete). Grey literature will also be searched, including reports from government and international organizations such as World Health Organization (WHO), Foundation for Innovative New Diagnostics (FIND), and the Food and Drug Administration (FDA). Two independent reviewers will screen the relevant studies and the degree of the agreement will be determined by calculating Cohen's kappa statistic. The quality of eligible data will also be appraised using the mixed method appraisal tool version 2018.

DISCUSSION

We anticipate that the planned scoping review will present useful evidence to inform stakeholders on the integration of mobile-linked diagnostic devices in community-based healthcare which will guide further research on the subject.

Leveraging innovation technologies to respond to malaria: a systematized literature review of emerging technologies

BACKGROUND

In 2019, an estimated 409,000 people died of malaria and most of them were young children in sub-Saharan Africa. In a bid to combat malaria epidemics, several technological innovations that have contributed significantly to malaria response have been developed across the world. This paper presents a systematized review and identifies key technological innovations that have been developed worldwide targeting different areas of the malaria response, which include surveillance, microplanning, prevention, diagnosis and management.

METHODS

A systematized literature review which involved a structured search of the malaria technological innovations followed by a quantitative and narrative description and synthesis of the innovations was carried out. The malaria technological innovations were electronically retrieved from scientific databases that include PubMed, Google Scholar, Scopus, IEEE and Science Direct. Additional innovations were found across grey sources such as the Google Play Store, Apple App Store and cooperate websites. This was done using keywords pertaining to different malaria response areas combined with the words "innovation or technology" in a search query. The search was conducted between July 2021 and December 2021. Drugs, vaccines, social programmes, and apps in non-English were excluded. The quality of technological innovations included was based on reported impact and an exclusion criterion set by the authors.

RESULTS

Out of over 1000 malaria innovations and programmes, only 650 key malaria technological innovations were considered for further review. There were web-based innovations (34%), mobile-based applications (28%), diagnostic tools and devices (25%), and drone-based technologies (13%.

DISCUSSION AND CONCLUSION

This study was undertaken to unveil impactful and contextually relevant malaria innovations that can be adapted in Africa. This was in response to the existing knowledge gap about the comprehensive technological landscape for malaria response. The paper provides information that countries and key malaria control stakeholders can leverage with regards to adopting some of these technologies as part of the malaria response in their respective countries. The paper has also highlighted key drivers including infrastructural requirements to foster development and scaling up of innovations. In order to stimulate development of innovations in Africa, countries should prioritize investment in infrastructure for information and communication technologies and also drone technologies. These should be accompanied by the right policies and incentive frameworks.

mHealth in Sub-Saharan Africa and Europe: Context of current health, healthcare status, and demographic structure

Introduction

The advent of digital systems and global mobile phone availability presents an opportunity for better healthcare access and equity. However, the disparity in the usage and availability of mHealth systems between Europe and Sub-Saharan Africa (SSA) has not been explored in relation to current health, healthcare status, and demographics.

Objective

This study aimed to compare mHealth system availability and use in SSA and Europe in the above-mentioned context.

Methods

The study analyzed health, healthcare status, and demographics in both regions. It assessed mortality, disease burden, and universal health coverage. A systematic narrative review was conducted to thoroughly assess available data on mHealth availability and use, guiding future research in the field.

Results

SSA is on the verge of stages 2 and 3 in the demographic transition with a youthful population and high birth rate. Communicable, maternal, neonatal, and nutritional diseases contribute to high mortality and disease burden, including child mortality. Europe is on the verge of stages 4 and 5 in the demographic transition with low birth and death rates. Europe's population is old, and non-communicable diseases (NCDs) pose major health challenges. The mHealth literature adequately covers cardiovascular disease/heart failure, and cancer. However, it lacks approaches for respiratory/enteric infections, malaria, and NCDs.

Conclusions

mHealth systems in SSA are underutilized than in Europe, despite alignment with the region's demographics and major health issues. Most initiatives in SSA lack implementation depth, with only pilot tests or small-scale implementations. Europe's reported cases highlight actual implementation and acceptability, indicating a strong implementation depth of mHealth systems.

Use of technology to prevent, detect, manage and control hypertension in sub-Saharan Africa: a systematic review

OBJECTIVE

To identify and assess the use of technologies, including mobile health technology, internet of things (IoT) devices and artificial intelligence (AI) in hypertension healthcare in sub-Saharan Africa (SSA).

DESIGN

Systematic review.

DATA SOURCES

Medline, Embase, Scopus and Web of Science.

ELIGIBILITY CRITERIA

Studies addressing outcomes related to the use of technologies for hypertension healthcare (all points in the healthcare cascade) in SSA.

METHODS

Databases were searched from inception to 2 August 2021. Screening, data extraction and risk of bias assessment were done in duplicate. Data were extracted on study design, setting, technology(s) employed and outcomes. Blood pressure (BP) reduction due to intervention was extracted from a subset of randomised controlled trials. Methodological quality was assessed using the Mixed Methods Appraisal Tool.

RESULTS

1717 hits were retrieved, 1206 deduplicated studies were screened and 67 full texts were assessed for eligibility. 22 studies were included, all reported on clinical investigations. Two studies were observational, and 20 evaluated technology-based interventions. Outcomes included BP reduction/control, treatment adherence, retention in care, awareness/knowledge of hypertension and completeness of medical records. All studies used mobile technology, three linked with IoT devices. Short Message Service (SMS) was the most popular method of targeting patients (n=6). Moderate BP reduction was achieved in three randomised controlled trials. Patients and healthcare providers reported positive perceptions towards the technologies. No studies using AI were identified.

CONCLUSIONS

There are a range of successful applications of key enabling technologies in SSA, including BP reduction, increased health knowledge and treatment adherence following targeted mobile technology interventions. There is evidence to support use of mobile technology for hypertension management in SSA. However, current application of technologies is highly heterogeneous and key barriers exist, limiting efficacy and uptake in SSA. More research is needed, addressing objective measures such as BP reduction in robust randomised studies.

PROSPERO REGISTRATION NUMBER

CRD42020223043.

Benefits of simulation-based education in hospital emergency departments: A systematic review

BACKGROUND

The emergency department is one of the most important parts of all hospitals. For this reason, many simulation programs are performed in this department to increase the knowledge, skills, and productivity of health-care workers. The purpose of this study was to identify the benefits of simulation in hospital emergency departments.

MATERIALS AND METHODS

In the present systematic study, using "AND" and "OR" operators, we searched for the keywords "benefits," "simulation," and "hospital emergency department" in PubMed, Web of Science, Scopus, Google Scholar as well as Persian language databases such SID, Magiran, Irandoc, and Iran Medex. Then, a three-step screening process was used to select studies relevant to simulation and hospital emergency from 2005 to 2021 using the PRISMA checklist, and finally, the obtained data were analyzed.

RESULTS

A total of three main groups, each with several subgroups, were extracted and identified as the benefits of using simulation in hospital emergency departments. They included improving the diagnosis of the disease (rapid prediction of the disease, rapid diagnosis, and patient triage), improving the treatment process (improvement of treatment results, anticipation of admission and discharge of patients, acceleration of interventions, and reduction of medical errors), and improving knowledge and skills (improvement of the speed of decision-making, staff's acquisition of knowledge and skills, simple, convenient, and low-cost training, improvement of staff's preparedness in crisis).

CONCLUSION

Based on the results of the present study, it is suggested to develop some training programs in order to help staff upgrade their knowledge and performance as well as acquire practical skills and also to improve the diagnosis and treatment process in hospital emergency departments. Virtual methods are also proposed to be applied as potential and cost-effective platforms for learning, teaching, and evaluating the staff of hospital emergency departments.

Prevalence and predictive risk factors of hypertension in patients hospitalized in Kamenge Military hospital and Kamenge University teaching hospital in 2019: A fixed effect modelling study in Burundi

INTRODUCTION

Hypertension is a major threat to public health globally. Especially in sub-Saharan African countries, this coexists with high burden of other infectious diseases, creating a complex public health situation which is difficult to address. Tackling this will require targeted public health intervention based on evidence that well defines the at risk population. In this study, using retrospective data from two referral hospitals in Burundi, we model the risk factors of hypertension in Burundi.

MATERIALS AND METHODS

Retrospective data of a sample of 353 randomly selected from a population of 4,380 patients admitted in 2019 in two referral hospitals in Burundi: Military and University teaching hospital of Kamenge. The predictive risk factors were carried out by fixed effect logistic regression. Model performance was assessed with Area under Curve (AUC) method. Model was internally validated using bootstrapping method with 2000 replications. Both data processing and data analysis were done using R software.

RESULTS

Overall, 16.7% of the patients were found to be hypertensive. This study didn't showed any significant difference of hypertension's prevalences among women (16%) and men (17.7%). After adjustment of the model for cofounding covariates, associated risk factors found were advanced age (40-59 years) and above 60 years, high education level, chronic kidney failure, high body mass index, familial history of hypertension. In absence of these highlighted risk factors, the risk of hypertension occurrence was about 2 per 1000 persons. This probability is more than 90% in patients with more than three risk factors.

CONCLUSION

The relatively high prevalence and associated risk factors of hypertension in Burundi raises a call for concern especially in this context where there exist an equally high burden of infectious diseases, other chronic diseases including chronic malnutrition. Targeting interventions based on these identified risk factors will allow judicious channel of resources and effective public health planning.

Availability and Use of Mobile Health Technology for Disease Diagnosis and Treatment Support by Health Workers in the Ashanti Region of Ghana: A Cross-Sectional Survey

Mobile health (mHealth) technologies have been identified as promising strategies for improving access to healthcare delivery and patient outcomes. However, the extent of availability and use of mHealth among healthcare professionals in Ghana is not known. The study’s main objective was to examine the availability and use of mHealth for disease diagnosis and treatment support by healthcare professionals in the Ashanti Region of Ghana. A cross-sectional survey was carried out among 285 healthcare professionals across 100 primary healthcare clinics in the Ashanti Region with an adopted survey tool. We obtained data on the participants’ background, available health infrastructure, healthcare workforce competency, ownership of a mobile wireless device, usefulness of mHealth, ease of use of mHealth, user satisfaction, and behavioural intention to use mHealth. Descriptive statistics were conducted to characterise healthcare professionals’ demographics and clinical features. Multivariate logistic regression analysis was performed to explore the influence of the demographic factors on the availability and use of mHealth for disease diagnosis and treatment support. STATA version 15 was used to complete all the statistical analyses. Out of the 285 healthcare professionals, 64.91% indicated that mHealth is available to them, while 35.08% have no access to mHealth. Of the 185 healthcare professionals who have access to mHealth, 98.4% are currently using mHealth to support healthcare delivery. Logistic regression model analysis significantly (p < 0.05) identified that factors such as the availability of mobile wireless devices, phone calls, text messages, and mobile apps are associated with HIV, TB, medication adherence, clinic appointments, and others. There is a significant association between the availability of mobile wireless devices, text messages, phone calls, mobile apps, and their use for disease diagnosis and treatment compliance from the chi-square test analysis. The findings demonstrate a low level of mHealth use for disease diagnosis and treatment support by healthcare professionals at rural clinics. We encourage policymakers to promote the implementation of mHealth in rural clinics.

Systematic Review and Meta-Analysis of the Diagnostic Accuracy of Mobile-Linked Point-of-Care Diagnostics in Sub-Saharan Africa

Mobile health devices are emerging applications that could help deliver point-of-care (POC) diagnosis, particularly in settings with limited laboratory infrastructure, such as Sub-Saharan Africa (SSA). The advent of Severe acute respiratory syndrome coronavirus 2 has resulted in an increased deployment and use of mHealth-linked POC diagnostics in SSA. We performed a systematic review and meta-analysis to evaluate the accuracy of mobile-linked point-of-care diagnostics in SSA. Our systematic review and meta-analysis were guided by the Preferred Reporting Items requirements for Systematic Reviews and Meta-Analysis. We exhaustively searched PubMed, Science Direct, Google Scholar, MEDLINE, and CINAHL with full text via EBSCOhost databases, from mHealth inception to March 2021. The statistical analyses were conducted using OpenMeta-Analyst software. All 11 included studies were considered for the meta-analysis. The included studies focused on malaria infections, Schistosoma haematobium, Schistosoma mansoni, soil-transmitted helminths, and Trichuris trichiura. The pooled summary of sensitivity and specificity estimates were moderate compared to those of the reference representing the gold standard. The overall pooled estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of mobile-linked POC diagnostic devices were as follows: 0.499 (95% CI: 0.458–0.541), 0.535 (95% CI: 0.401–0.663), 0.952 (95% CI: 0.60–1.324), 1.381 (95% CI: 0.391–4.879), and 0.944 (95% CI: 0.579–1.538), respectively. Evidence shows that the diagnostic accuracy of mobile-linked POC diagnostics in detecting infections in SSA is presently moderate. Future research is recommended to evaluate mHealth devices’ diagnostic potential using devices with excellent sensitivities and specificities for diagnosing diseases in this setting.