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Project

mHealth Approaches in Sub- Saharan Africa and Participatory Design of mHealth app for Self-management of Diabetes

Summary The World Health Organization (WHO) defines e-Health as the use of information and communication technologies (ICTs) for health. e-Health enables public health and primary healthcare through activities such as disease surveillance, primary health data acquisition and analysis, support of community health workers, tele-consultation, tele-education, research and patient management. Managing a patient remotely using ICT is regarded as a more efficient means of delivering healthcare than transporting a patient from or a medical specialist to rural or remote locations. Sub-Saharan African countries are embracing e-Health as a means to improve accessibility to quality and equitable healthcare, especially for poor and vulnerable communities. These solutions use a variety of technological solutions, including online media, radio, fixed telephones, television and other devices for text messaging, teleconferencing, videoconferencing and sharing through e-mail. However, for most developing countries, e-Health remains a proof-of-concept activity, with only modest value demonstrated within small pilot projects. More specifically, WHO, through its global observatory report defined mHealth as ‘medical and public health practice support by mobile devices like mobile phones, smart-phones, tablets, patients monitoring devices, personal digital assistants and other wire-less devices’ [1]. The mass availability and use of mobile health (mHealth) technology provides a significant potential for such technologies to be integrated into clinical services to support quality medical care. Research has shown that the use of mHealth can result in some of the following health benefits: first, mHealth has the potential to improve the provision of quality healthcare by enhancing treatment, empowering patients, reducing medical cost and streamline the use of health resources. Several studies show that mHealth apps are useful in supporting self-management of chronic Diseases. Therefore, mHealth apps are increasingly being used in healthcare for patient communication, monitoring, education, and to facilitate adherence to chronic disease management. For the patient, mHealth apps offer the potential to overcome many of the traditional barriers within the self-management of chronic conditions, by offering care and information at home in a natural environment. Furthermore, studies have shown that having access to timely information, assessment and treatment are vital to the patient in the management of long-term conditions. Diabetes mellitus is characterized by high blood   glucose levels resulting from defects  in insulin production, insulin action, or both. Diabetes for the whole world is turned from epidemic to pandemic. According to the World Health Organization (WHO) projections, the prevalence of diabetes is likely to increase by 35% by the year 2025 [2]. Likewise, in sub-Saharan Africa (SSA), diabetes mellitus is estimated to affect 40.7 million people by 2045, up from 15.9 million people in 2017[3]. Along with the increase in the incidence of diabetes, both individual and societal expectations concerning the management of diabetes have also increased. Taking control of diabetes to improve quality of life has put the spotlight on the need for additional support and education for patients with type 2 diabetes [4], one of the most common types of diabetes. Effective management of Diabetes is in the hands of the individual patient, who must take responsibility for healthy behaviors related to increased health. Since Diabetes is a chronic disease, lifelong treatment and self-management are essential. There is no gold standard definition of self-management in the context of chronic conditions. Self-management can be defined as “the individual’s ability to manage symptoms, treatment, physical and social consequences and lifestyle changes inherent in living with a chronic condition” [5]. With the introduction of digital technology, the heath care sector has now the opportunity of automating the provision of health services, filling the gap which happens because of lack of resources such as work force and finance. Even though digital health system is of great importance, implementing this system in different countries may face barriers because of, among others, health policy, infrastructure, awareness, literacy. These problems are also very prevalent in developing countries. While the potential of e-Health for sub-Saharan Africa is significant, its uptake has been poor. A number of factors have been identified for this. These include: the excessive burden of disease in Africa; the shortage of health professionals; a rapidly growing population which is outstripping the production of health workers; the low median age of people in sub-Saharan Africa associated with poverty, results in low tax bases; unstable electric power provision; high telecommunication costs; lack of government will; and civil unrest which frequently results in damage to infrastructure. In contrast, opportunities exist as connectivity infrastructure (both internet and cellular phone based) grows and becomes cheaper, and widespread m-Health research in Africa affords the chance to leapfrog older, more expensive solutions. The global burden of non-communicable disease (NCDs) is staggering with recent reports highlighting that NCDs are responsible for 73% of deaths globally, with more than 50% of these deaths caused by four risk factors: diabetes, hypertension, obesity, and smoking [6]. Diabetes is a chronic non-communicable disease (NCD) presenting growing health and economic burdens in sub-Saharan Africa (SSA). Diabetes is unique due to its crosscutting nature, influencing multiple organ systems and increasing the risk for other communicable and non-communicable diseases. Unfortunately, the quality of care for diabetes in SSA is poor, largely due to a weak disease management framework and fragmented health systems in most sub-Saharan African countries. In sub-Saharan Africa (SSA), diabetes mellitus is estimated to affect 40.7 million people by 2045, up from 15.9 million people in 2017[7]. This burden is further exacerbated by estimates that show that more than two-thirds of individuals in SSA with diabetes are undiagnosed [8]. Given the rising demand and inadequate funding for diabetes care, the quality of care for diabetes in SSA is poor [9]. Furthermore, diabetes carries a significant “paired burden” of infectious and chronic diseases [10]. It can surge the risk of other non-communicable conditions such as cardiovascular and renal disease, as well as communicable conditions such as pneumonia and tuberculosis [11]. As a lifelong illness, diabetes is a multifaceted disease, affecting multiple organ systems and characterized by periods of acute exacerbations, requiring a comprehensive, cross-cutting, and often high-cost approach to successfully manage [12]. The overall aim of this research is to explore use of mHealth apps in SSA and employ participatory design approaches for the design and development of mHealth platform for self-management of diabetes patients. This overall aim will be further decomposed in to the following specific objectives such as to review current evidence around the use of mHealth in SSA, to identify barriers and enablers for using mHealth apps in SSA, to identify needs of people diagnosed with diabetes (gap between what the system provides and what the patient needs), to develop digital platform (mHealth) app for self-management of diabetes patients based on the identified needs. References: 1. WHO. mHealth new horizons for health through mobile technologies2011. 2. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995–2025: prevalence, estimates, and projections. Diabetes care. 1998;21(9):1414-31. 3. International Diabetes Federation. Regional fact sheet: Africa | World Diabetes Foundation. Available from: https://www.worlddiabetesfoundation.org/files/regional-fact-sheet-africa. 2017. 4. Uzoka F-ME, Barker K. Expert systems and uncertainty in medical diagnosis: a proposal for fuzzy-ANP  hybridisation. International Journal of Medical Engineering and Informatics. 2010;2(4):329-42. 5. Whitehead L., Seaton P. The Effectiveness of Self Management Mobile Phone and Tablet Apps in Longterm Condition Management: A Systematic Review. Journal of medical Internet research. 2016;18(5):e97. 6. 1GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Lond Engl. 2018;392(10159):1923–1994. doi:10.1016/S0140-6736(18)32225-6 7. International Diabetes Federation. Regional fact sheet: Africa | World Diabetes Foundation. Available from: https://www.worlddiabetesfoundation.org/files/regional-fact-sheet-africa. 2017. 8. Assah F, Mbanya JC. Diabetes in sub-Saharan Africa. In: Dagogo-Jack S, editor. Diabetes Mellitus in Developing Countries and Underserved Communities. Cham: Springer International Publishing; 2017:33–48. doi:10.1007/978-3-319-41559-8_3 9. Atun R, Davies JI, Gale EAM, et al. Diabetes in sub-Saharan Africa: from clinical care to health policy. Lancet Diabetes Endocrinol. 2017;5(8):622–667. doi:10.1016/S2213-8587(17)30181-X 10. de-Graft Aikins A, Unwin N, Agyemang C, Allotey P, Campbell C, Arhinful D. Tackling Africa’s chronic disease burden: from the local to the global. Glob Health. 2010;6:5. doi:10.1186/1744-8603-6-5 11. International Diabetes Federation - Complications. Availablefrom: https://www.idf.org/aboutdiabetes/complications.html. 12. World Health Organization. WHO Global Report on Diabetes. WHO. 2016. Available from: http://www.who.int/diabetes/global-report/en/.

Date:12 Oct 2021 →  Today
Keywords:mHealth, Sub Saharan Africa, Diabetes, Self-Management of Diabetes
Disciplines:Human health engineering
Project type:PhD project