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The Role of Digital Health for Strengthening Health Systems in Low and Middle Income Countries

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Digital Health".

Deadline for manuscript submissions: closed (30 September 2023) | Viewed by 22636

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Special Issue Editor

Prof. Dr. Walter H. Curioso

E-Mail Website1 Website2
Guest Editor

1. Department of Biomedical Informatics & Medical Education, School of Medicine, University of Washington, Seattle, WA 98195, USA
2. Vicerrectorado de Investigación, Universidad Continental, Lima 15046, Peru
Interests: biomedical informatics; digital health; mobile health; capacity-building; telehealth; health informatics; public health informatics; health information systems

Special Issue Information

Dear Colleagues,

Healthcare challenges in low- and middle-income countries have been addressed through a wide range of digital initiatives that have focused on improving both access to and the quality of healthcare. Beyond the pilot projects, these initiatives are currently strengthening health systems through the scaling up and effective integration of health information systems involving digital health tools.

The goal of this Special Issue is to focus on the contributions of digital health for strengthening health systems in low- and middle-income countries, and to highlight the potential of digital health to positively impact health information systems and empower healthcare workers.

This Special Issue seeks contributions involving innovative approaches or relevant case studies in topics such as:

Application of digital health technologies to support health care systems in low- and middle-income countries, such as electronic medical records, telehealth, and mobile health.
Open data, data repositories, and knowledge management to improve health care systems in low- and middle-income countries.
The role of health information systems and biomedical informatics to address healthcare challenges, considering the sociotechnical issues in low- and middle-income countries.
Machine learning and artificial intelligence healthcare-related applications in low- and middle-income countries.
eLearning and continuing education in information and communication technologies for healthcare professionals in low- and middle-income countries.
Standardization and interoperability of health information systems in low- and middle-income countries.

This Special Issue welcomes original research manuscripts, reviews, and case reports considering the perspectives of different stakeholders targeting any of these topics and beyond. We would be delighted to attract a high diversity and heterogeneity of submissions, and we encourage the submission of interdisciplinary work and multi-country collaborative research.

Prof. Dr. Walter H. Curioso
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

digital health
mobile health
telehealth and telemedicine
artificial intelligence
biomedical informatics
knowledge management
health workforce development
health information systems
change management and digital health
sociotechnical issues in digital health

Published Papers (7 papers)

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Research

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29 pages, 2408 KiB

Open AccessArticle

Predicting the HIV/AIDS Knowledge among the Adolescent and Young Adult Population in Peru: Application of Quasi-Binomial Logistic Regression and Machine Learning Algorithms

by Alejandro Aybar-Flores, Alvaro Talavera and Elizabeth Espinoza-Portilla

Int. J. Environ. Res. Public Health 2023, 20(7), 5318; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20075318 - 30 Mar 2023

Viewed by 2440

Abstract

Inadequate knowledge is one of the principal obstacles for preventing HIV/AIDS spread. Worldwide, it is reported that adolescents and young people have a higher vulnerability of being infected. Thus, the need to understand youths’ knowledge towards HIV/AIDS becomes crucial. This study aimed to identify the determinants and develop a predictive model to estimate HIV/AIDS knowledge among this target population in Peru. Data from the 2019 DHS Survey were used. The software RStudio and RapidMiner were used for quasi-binomial logistic regression and computational model building, respectively. Five classification algorithms were considered for model development and their performance was assessed using accuracy, sensitivity, specificity, FPR, FNR, Cohen’s kappa, F1 score and AUC. The results revealed an association between 14 socio-demographic, economic and health factors and HIV/AIDS knowledge. The accuracy levels were estimated between 59.47 and 64.30%, with the random forest model showing the best performance (64.30%). Additionally, the best classifier showed that the gender of the respondent, area of residence, wealth index, region of residence, interviewee’s age, highest educational level, ethnic self-perception, having heard about HIV/AIDS in the past, the performance of an HIV/AIDS screening test and mass media access have a major influence on HIV/AIDS knowledge prediction. The results suggest the usefulness of the associations found and the random forest model as a predictor of knowledge of HIV/AIDS and may aid policy makers to guide and reinforce the planning and implementation of healthcare strategies. Full article

(This article belongs to the Special Issue The Role of Digital Health for Strengthening Health Systems in Low and Middle Income Countries)

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10 pages, 1047 KiB

Open AccessArticle

Use of a mHealth System to Improve Antenatal Care in Low and Lower-Middle Income Countries: Report on Patients and Healthcare Workers’ Acceptability in Tanzania

by Stefania Paduano, Federica Incerti, Lucia Borsari, Anne Caroline Benski, Alex Ernest, Ipyana Mwampagatwa, Athanase Lilungulu, Theresia Masoi, Annalisa Bargellini, Federica Stornelli, Giovanna Stancanelli, Paola Borella and Maria Angelica Rweyemamu

Int. J. Environ. Res. Public Health 2022, 19(22), 15342; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192215342 - 20 Nov 2022

Cited by 7 | Viewed by 1620

Abstract

Antenatal care (ANC) is considered a cornerstone of reproductive health programmes, but many women face difficulties in accessing these services, particularly in some sub-Saharan African countries, such as Tanzania. This study aimed to test ANC visit acceptability using mHealth system PANDA (Pregnancy And Newborn Diagnostic Assessment) in the Mufindi district (Tanzania). We investigated the ANC visit acceptability of pregnant women and healthcare workers (HCWs) in an intervention area using the PANDA system compared with a control area. An ad hoc questionnaire was administered to pregnant women in an implementation area (n = 52) and in a control area (n = 46). In the implementation area, group interviews with 50 pregnant women were conducted and five HCWs evaluated ANC visits through a questionnaire. The implementation group was significantly more satisfied with the ANC visit compared with the control group. All the 52 women and the HCWs declared that PANDA icons were useful in understanding and remembering the provided information and the PANDA app was able to improve the ANC quality and to positively influence the relationship of HCWs and pregnant women. HCWs reported that the PANDA app was “easy-to-use” and “able to improve the adherence to ANC WHO recommendations”. In underserved areas, many pregnant women could benefit from the PANDA system increasing their access to high-quality ANC and overcoming language and/or literacy barriers. Full article

(This article belongs to the Special Issue The Role of Digital Health for Strengthening Health Systems in Low and Middle Income Countries)

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20 pages, 673 KiB

Open AccessArticle

Implementation of Health Information Systems to Improve Patient Identification

by Catalin Popescu, Hani EL-Chaarani, Zouhour EL-Abiad and Iza Gigauri

Int. J. Environ. Res. Public Health 2022, 19(22), 15236; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph192215236 - 18 Nov 2022

Cited by 5 | Viewed by 4202

Abstract

Wellbeing can be ensured in society through quality healthcare, a minimum of medical errors, and the improved performance of healthcare professionals. To this end, health information systems have been implemented in hospitals, with this implementation representing progress in medicine and information technologies. As a result, life expectancy has significantly increased, standards in healthcare have been raised, and public health has improved. This progress is influenced by the process of managing healthcare organizations and information systems. While hospitals tend to adapt health information systems to reduce errors related to patient misidentification, the rise in the occurrence and recording of medical errors in Lebanon resulting from failures to correctly identify patients reveals that such measures remain insufficient due to unknown factors. This research aimed to investigate the effect of health information systems (HISs) and other factors related to work-related conditions on reductions in patient misidentification and related consequences. The empirical data were collected from 109 employees in Neioumazloum Hospital in Lebanon. The results revealed a correlation between HISs and components and the effects of other factors on patient identification. These other factors included workload, nurse fatigue, a culture of patient safety, and lack of implementation of patient identification policies. This paper provides evidence from a Lebanese hospital and paves the way for further studies aiming to explore the role of information technologies in adopting HISs for work performance and patient satisfaction. Improved care for patients can help achieve health equality, enhance healthcare delivery performance and patient safety, and decrease the numbers of medical errors. Full article

(This article belongs to the Special Issue The Role of Digital Health for Strengthening Health Systems in Low and Middle Income Countries)

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22 pages, 4782 KiB

Open AccessArticle

Social Media Tools for the Development of Pre-Service Health Sciences Researchers during COVID-19 in Pakistan

by Muhammad Zaheer Asghar, Seema Arif, Javed Iqbal and Pirita Seitamaa-Hakkarainen

Int. J. Environ. Res. Public Health 2022, 19(1), 581; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph19010581 - 05 Jan 2022

Cited by 15 | Viewed by 4142

Abstract

The development of health sciences researchers has immense significance during a pandemic to control, manage, and prevent future outbreaks of the disease. This study focused on the use of social media tools (SMT) among pre-service health sciences researchers to complement their research competencies (RCT) and research completion levels (RC) during COVID-19. This study used the Vitae research development framework (RDF) to measure research competencies as a mediator between the use of social media tools and research completion levels among post-graduate health sciences students. A cross-section survey research approach was adopted to collect data from the post-graduate students (n = 410) enrolled in health sciences departments at universities in Pakistan. The SmartPLS 3.3.8 software was used to analyze data through Partial least square structural equation modeling (PLS-SEM). The results revealed that different social media tools such as communication, information management, and multimedia have a direct influence on the research competencies of the pre-service researchers and have an indirect effect on the research completion levels. Health sciences institutions may devise social-media-based instructional strategies to develop post-graduate students’ research competencies, such as personal effectiveness, research governance, and research engagement, to help them compile their research and complete their degree program in time during an emergency. Full article

(This article belongs to the Special Issue The Role of Digital Health for Strengthening Health Systems in Low and Middle Income Countries)

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16 pages, 6495 KiB

Open AccessArticle

Predicting the 14-Day Hospital Readmission of Patients with Pneumonia Using Artificial Neural Networks (ANN)

by Shu-Farn Tey, Chung-Feng Liu, Tsair-Wei Chien, Chin-Wei Hsu, Kun-Chen Chan, Chia-Jung Chen, Tain-Junn Cheng and Wen-Shiann Wu

Int. J. Environ. Res. Public Health 2021, 18(10), 5110; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph18105110 - 12 May 2021

Cited by 9 | Viewed by 2493

Abstract

Unplanned patient readmission (UPRA) is frequent and costly in healthcare settings. No indicators during hospitalization have been suggested to clinicians as useful for identifying patients at high risk of UPRA. This study aimed to create a prediction model for the early detection of 14-day UPRA of patients with pneumonia. We downloaded the data of patients with pneumonia as the primary disease (e.g., ICD-10:J12*-J18*) at three hospitals in Taiwan from 2016 to 2018. A total of 21,892 cases (1208 (6%) for UPRA) were collected. Two models, namely, artificial neural network (ANN) and convolutional neural network (CNN), were compared using the training (n = 15,324; ≅70%) and test (n = 6568; ≅30%) sets to verify the model accuracy. An app was developed for the prediction and classification of UPRA. We observed that (i) the 17 feature variables extracted in this study yielded a high area under the receiver operating characteristic curve of 0.75 using the ANN model and that (ii) the ANN exhibited better AUC (0.73) than the CNN (0.50), and (iii) a ready and available app for predicting UHA was developed. The app could help clinicians predict UPRA of patients with pneumonia at an early stage and enable them to formulate preparedness plans near or after patient discharge from hospitalization. Full article

(This article belongs to the Special Issue The Role of Digital Health for Strengthening Health Systems in Low and Middle Income Countries)

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Review

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15 pages, 597 KiB

Open AccessReview

Digital Health Interventions to Improve Access to and Quality of Primary Health Care Services: A Scoping Review

by Daniel Erku, Resham Khatri, Aklilu Endalamaw, Eskinder Wolka, Frehiwot Nigatu, Anteneh Zewdie and Yibeltal Assefa

Int. J. Environ. Res. Public Health 2023, 20(19), 6854; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20196854 - 28 Sep 2023

Cited by 2 | Viewed by 3472

Abstract

Global digital technology advances offer the potential to enhance primary health care (PHC) quality, reach, and efficiency, driving toward universal health coverage (UHC). This scoping review explored how digital health solutions aid PHC delivery and UHC realization by examining the context, mechanisms, and outcomes of eHealth interventions. A comprehensive literature search was conducted, capturing qualitative and quantitative studies, process evaluations, and systematic or scoping reviews. Our analysis of 65 articles revealed that a well-functioning digital ecosystem—featuring adaptable, interoperable digital tools, robust Information and Communications Technology foundations, and enabling environments—is pivotal for eHealth interventions’ success. Facilities with better digital literacy, motivated staff, and adequate funding demonstrated a higher adoption of eHealth technologies, leading to improved, coordinated service delivery and higher patient satisfaction. However, eHealth’s potential is often restricted by existing socio-cultural norms, geographical inequities in technology access, and digital literacy disparities. Our review underscores the importance of considering the digital ecosystem’s readiness, user behavior, broader health system requirements, and PHC capacity for adopting digital solutions while assessing digital health interventions’ impact. Full article

(This article belongs to the Special Issue The Role of Digital Health for Strengthening Health Systems in Low and Middle Income Countries)

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17 pages, 740 KiB

Open AccessReview

Integrating Telehealth for Strengthening Health Systems in the Context of the COVID-19 Pandemic: A Perspective from Peru

by Walter H. Curioso, Lelis G. Coronel-Chucos and Milagro Henríquez-Suarez

Int. J. Environ. Res. Public Health 2023, 20(11), 5980; https://0-doi-org.brum.beds.ac.uk/10.3390/ijerph20115980 - 28 May 2023

Cited by 4 | Viewed by 2306

Abstract

The COVID-19 pandemic forced the government to rapidly modify its legal framework to adopt telemedicine and promote the implementation of telehealth services to meet the healthcare needs of patients in Peru. In this paper, we aim to review the main changes to the regulatory framework and describe selected initiatives to promote the telehealth framework that emerged in Peru during the COVID-19 pandemic. In addition, we discuss the challenges to integrate telehealth services for strengthening health systems in Peru. The Peruvian telehealth regulatory framework began in 2005, and in subsequent years, laws and regulations were established that sought to progressively implement a national telehealth network. However, mainly local initiatives were deployed. In this sense, significant challenges remain to be addressed, such as infrastructure in healthcare centers, including high-speed Internet connectivity; infostructure of health-information systems, including interoperability with electronic medical records; monitoring and evaluation of the national agenda for the health sector in 2020–2025; expanding the healthcare workforce in terms of digital health; and developing the capacities of healthcare users on health literacy, including digital aspects. In addition, there is enormous potential for telemedicine as a key strategy to deal with the COVID-19 pandemic and to improve access to rural and hard-to-reach areas and populations. There is thus an urgent need to effectively implement an integrated national telehealth system to address sociocultural issues and strengthen the competencies of human resources in telehealth and digital health in Peru. Full article

(This article belongs to the Special Issue The Role of Digital Health for Strengthening Health Systems in Low and Middle Income Countries)

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