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

Abstract

Background: Mobile 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.

Methods: We 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.

Results: Our 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.

Conclusions: There 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.

Figure 1

Reasons for exclusion of studies. Legend. Schematic diagram of the studies identified by the literature search showing the number of studies excluded for various reasons. Five studies met final inclusion and exclusion criteria.

Figure 2

Results of the systematic review embedded in the mHealth strategies framework to address health systems challenges to non-communicable disease care. Legend. The chronic disease continuum includes healthy people with no apparent disease through patients with complications of non-communicable diseases (NCDs). Health System Challenges (HSC) one through six are shown alongside examples of specific barriers as they relate to NCDs. The mHealth programs found in the literature search are displayed where these programs intersect HSCs at points along the chronic disease continuum. There remain many opportunities for implementation of mHealth for non-communicable diseases (NCDs) in sub-Saharan Africa and other LMIC regions broadly.