Lack of ownership of mobile phones could hinder the rollout of mHealth interventions in Africa

Elife. 2022 Oct 18:11:e79615. doi: 10.7554/eLife.79615.

Abstract

Mobile health (mHealth) interventions, which require ownership of mobile phones, are being investigated throughout Africa. We estimate the percentage of individuals who own mobile phones in 33 African countries, identify a relationship between ownership and proximity to a health clinic (HC), and quantify inequities in ownership. We investigate basic mobile phones (BPs) and smartphones (SPs): SPs can connect to the internet, BPs cannot. We use nationally representative data collected in 2017-2018 from 44,224 individuals in Round 7 of the Afrobarometer surveys. We use Bayesian multilevel logistic regression models for our analyses. We find 82% of individuals in 33 countries own mobile phones: 42% BPs and 40% SPs. Individuals who live close to an HC have higher odds of ownership than those who do not (aOR: 1.31, Bayesian 95% highest posterior density [HPD] region: 1.24-1.39). Men, compared with women, have over twice the odds of ownership (aOR: 2.37, 95% HPD region: 1.96-2.84). Urban residents, compared with rural residents, have almost three times the odds (aOR: 2.66, 95% HPD region: 2.22-3.18) and, amongst mobile phone owners, nearly three times the odds of owning an SP (aOR: 2.67, 95% HPD region: 2.33-3.10). Ownership increases with age, peaks in 26-40 year olds, then decreases. Individuals under 30 are more likely to own an SP than a BP, older individuals more likely to own a BP than an SP. Probability of ownership decreases with the Lived Poverty Index; however, some of the poorest individuals own SPs. If the digital devices needed for mHealth interventions are not equally available within the population (which we have found is the current situation), rolling out mHealth interventions in Africa is likely to propagate already existing inequities in access to healthcare.

Keywords: Africa; epidemiology; global health; human; inequities; mHealth; medicine; mobile phones; smartphones; telemedicine.

Plain language summary

Many healthcare systems in African countries are under-resourced. As a result, people, particularly those living in rural areas, often have to travel large distances to access the medical care they need. Mobile phone-based interventions (also known as mHealth) could make a substantial difference. In Africa, mHealth is already used to diagnose and treat diseases, increase adolescents’ use of sexual and reproductive health services, boost HIV prevention and treatment, and improve maternal and child healthcare. However, using mHealth services requires owning a basic mobile phone or, in some cases, a smartphone that can access the internet. While mobile phone ownership in Africa is increasing rapidly, data on who has them and what types of phones they have are limited. If geographic, income, or gender-based inequities exist, mHealth interventions may not be able to reach those who would benefit the most. To close this knowledge gap, Okano et al. analyzed data on the mobile phone ownership of people living in 33 of the 54 countries in Africa. They used mathematical models and data collected from 44,224 people in Afrobarometer, a continent-wide survey conducted between 2017 and 2018. Okano et al. estimated that 80% of African adults in these 33 countries owned a mobile phone, and half of these devices were smartphones. Although ownership levels varied between the 33 countries, there were substantial inequities that appeared across all of them. More men than women owned a mobile phone. Residents in urban areas and wealthy individuals were also more likely to have a mobile phone than people living in rural areas and poorer individuals, respectively. However, in some countries, the least wealthy were also found to sometimes own smartphones. Okano et al. also found that people living closer to a health clinic were more likely to have a mobile phone than those living further away. Mobile phone ownership was also higher between 26 to 40 year olds, and then decreased with age. In addition, people under 30 were more likely to have a smartphone, whereas older individuals were more likely to own a mobile phone that does not connect to the internet. These findings suggest that there are large inequities in mobile phone ownership. If these are not addressed, rolling out mHealth interventions could worsen existing health disparities in African countries. Efforts need to be made across the continent to expand access to phone devices and reduce substantial internet costs. This will ensure that mHealth interventions benefit everyone across Africa, particularly those who need them most.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Bayes Theorem
  • Cell Phone*
  • Female
  • Humans
  • Male
  • Ownership
  • Smartphone
  • Telemedicine*