Mobile health for non-communicable diseases in Sub-Saharan Africa: a systematic review of the literature and strategic framework for research

Abstract

BackgroundMobile health (mHealth) approaches for non-communicable disease (NCD) care seem particularly applicable to sub-Saharan Africa given the penetration of mobile phones in the region. The evidence to support its implementation has not been critically reviewed.MethodsWe systematically searched PubMed, Embase, Web of Science, Cochrane Central Register of Clinical Trials, a number of other databases, and grey literature for studies reported between 1992 and 2012 published in English or with an English abstract available. We extracted data using a standard form in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsOur search yielded 475 citations of which eleven were reviewed in full after applying exclusion criteria. Five of those studies met the inclusion criteria of using a mobile phone for non-communicable disease care in sub-Saharan Africa. Most studies lacked comparator arms, clinical endpoints, or were of short duration. mHealth for NCDs in sub-Saharan Africa appears feasible for follow-up and retention of patients, can support peer support networks, and uses a variety of mHealth modalities. Whether mHealth is associated with any adverse effect has not been systematically studied. Only a small number of mHealth strategies for NCDs have been studied in sub-Saharan Africa.ConclusionsThere is insufficient evidence to support the effectiveness of mHealth for NCD care in sub-Saharan Africa. We present a framework for cataloging evidence on mHealth strategies that incorporates health system challenges and stages of NCD care. This framework can guide approaches to fill evidence gaps in this area. Systematic review registration: PROSPERO CRD42014007527.

Unmet Need: Improving mHealth Evaluation Rigor to Build the Evidence Base

“…Our findings are supported by other studies that also identify that the rigor of mHealth evaluations must be improved to increase both the scientific value and programmatic utility of evaluation results (Bloomfield et al, 2014;Kumar et al, 2013;Nilsen et al, 2012;Tomlinson et al, 2013;WHO, 2011). Such evidence would be critical to balance expectations with potential, to avoid wasteful Unmet Need: Improving mHealth Evaluation duplication, and to inform and guide future programs, policies, and guidelines development.…”

Adoption of Information and communication technologies for early detection of breast and cervical cancers in low- and middle-income countries

“…30 Another looked to mHealth to address noncommunicable diseases in sub-Saharan Africa and concluded (as we have) that there is insufficient evidence in support of mHealth for noncommunicable disease prevention and control in that setting. 31 It is also worth noting that the literature suggests that ICT-supported chronic disease interventions have not been rigorously evaluated or documented in LMICs. However, there are some promising ICT-supported breast and cervical cancer prevention interventions in upper middleand high-income countries.…”

The state of mHealth development and use by palliative care services in sub-Saharan Africa: a systematic review of the literature

“…Of particular advantage in low-resource settings are the fewer requirements on infrastructure compared with health information systems, making scale-up seemingly more feasible 15. Condition-specific application of mHealth in this context has included communicable diseases, such as HIV and tuberculosis (eg, improving medication adherence16 17 18 and appointment attendance)19 20 and NCDs to a much lesser extent 21…”

“…With emerging evidence for the benefits of mHealth and the widespread use of mobile phones in SSA, the need to harness new technologies, while respecting cultural traditions, has been highlighted as one possible approach to extending the reach and provision of palliative care while maintaining quality 11. Two recent systematic reviews have documented mHealth development in SSA; one provides guidance on mHealth development informed by earlier research,28 the other provides a strategic framework to highlight evidence gaps around mHealth 21. Neither provides a focus on mHealth as part of palliative care provision in the region.…”