The potential use of digital health technologies in the african context: a systematic review of evidence from ethiopia

Manyazewal, Tsegahun; Woldeamanuel, Yimtubezinash; Blumberg, Henry M.; Fekadu, Abebaw; Marconi, Vincent C.

doi:10.1038/s41746-021-00487-4

Cited by 178Mobile Health and mHealth ApplicationsTelemedicine and Telehealth ImplementationICT in Developing Communities

The potential use of digital health technologies in the african context: a systematic review of evidence from ethiopia

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Manyazewal, Tsegahun, Woldeamanuel, Yimtubezinash, Blumberg, Henry M., Fekadu, Abebaw, Marconi, Vincent C.·2021·npj Digital Medicine

DOI 10.1038/s41746-021-00487-4PMC PMC8371011

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Abstract

The World Health Organization (WHO) recently put forth a Global Strategy on Digital Health 2020–2025 with several countries having already achieved key milestones. We aimed to understand whether and how digital health technologies (DHTs) are absorbed in Africa, tracking Ethiopia as a key node. We conducted a systematic review, searching PubMed-MEDLINE, Embase, ScienceDirect, African Journals Online, Cochrane Central Registry of Controlled Trials, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform databases from inception to 02 February 2021 for studies of any design that investigated the potential of DHTs in clinical or public health practices in Ethiopia. This review was registered with PROSPERO ( CRD42021240645 ) and it was designed to inform our ongoing DHT-enabled randomized controlled trial (RCT) (ClinicalTrials.gov ID: NCT04216420 ). We found 27,493 potentially relevant citations, among which 52 studies met the inclusion criteria, comprising a total of 596,128 patients, healthy individuals, and healthcare professionals. The studies involved six DHTs: mHealth (29 studies, 574,649 participants); electronic health records (13 studies, 4534 participants); telemedicine (4 studies, 465 participants); cloud-based application (2 studies, 2382 participants); information communication technology (3 studies, 681 participants), and artificial intelligence (1 study, 13,417 participants). The studies targeted six health conditions: maternal and child health (15), infectious diseases (14), non-communicable diseases (3), dermatitis (1), surgery (4), and general health conditions (15). The outcomes of interest were feasibility, usability, willingness or readiness, effectiveness, quality improvement, and knowledge or attitude toward DHTs. Five studies involved RCTs. The analysis showed that although DHTs are a relatively recent phenomenon in Ethiopia, their potential harnessing clinical and public health practices are highly visible. Their adoption and implementation in full capacity require more training, access to better devices such as smartphones, and infrastructure. DHTs hold much promise tackling major clinical and public health backlogs and strengthening the healthcare ecosystem in Ethiopia. More RCTs are needed on emerging DHTs including artificial intelligence, big data, cloud, cybersecurity, telemedicine, and wearable devices to provide robust evidence of their potential use in such settings and to materialize the WHO’s Global Strategy on Digital Health.

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The infrastructure gap hinders development and deployment of practical systems such as health chatbot applications in resource-constrained regions like Ethiopia.
“This infrastructure gap hinders the development and deployment of practical systems such as health chatbot applications in resource-constrained regions like Ethiopia, despite their strong potential to reduce pressure on overstretched services and lower operational costs (Manyazewal et al., 2021;Bank, 2023).”
From Improving Amharic Information Retrieval with Translative and Multi-Agent Debate Retrieval Augmented Generation (2026) · cites this paper as Manyazewal et al., 2021
The Discussion (page not available) says infrastructure challenges hinder the full adoption and implementation of digital health solutions in Ethiopia. It does not identify health chatbots as an example or establish that they would reduce pressure on services or lower operational costs. (LLM, conf=0.86)
Experimental — accuracy not yet measured
People living in LMICs are at high risk of many health conditions compared to those living in high-income countries while having the most limited access to health innovations such as digital health intervention.
“People living in LMICs, such as many countries in Africa, are at high risk of many health conditions compared to those living in high-income countries while having the most limited access to health innovations such as digital health intervention.”
From Effectiveness of digital health interventions on blood pressure control, lifestyle behaviours and adherence to medication in patients with hypertension in low-income and middle-income countries: a systematic review and meta-analysis of randomised controlled trials (2024) · cites this paper as [20]
The Introduction says people in low-income countries, including many in Africa, face high risks of many health conditions and have the most limited access to health innovations. It also gives African health-outcome comparisons with high-income countries and identifies digital health technologies as health innovations. The cited passage does not extend the access claim to all low- and middle-income countries or specifically establish limited access to digital health interventions. (LLM, conf=0.84)
Experimental — accuracy not yet measured

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[29]United Nations Conference on Trade and Development (UNCTED). Selected sustainable development trends in the least developed countries—2019. https://unctad.org/en/PublicationsLibrary/aldc2019d1_en.pdf (Geneva, 2019).
[35]United Nations Conference on Trade and Development (UNCTED). Technology and innovation report—2018: Harnessing Frontier Technologies for Sustainable Development. https://unctad.org/en/PublicationsLibrary/tir2018_en.pdf (Geneve, 2018).

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Authors: Manyazewal, T., Woldeamanuel, Y., Blumberg, H. M., Fekadu, A., & Marconi, V. C.
Affiliations: Addis Ababa University (ET)
Emory University (US)
Corresponding author: Manyazewal, Tsegahun
ORCID: Manyazewal, Tsegahun
Woldeamanuel, Yimtubezinash
Blumberg, Henry M.
Fekadu, Abebaw
Marconi, Vincent C.
Venue: npj Digital Medicine
Publisher: Springer Science and Business Media LLC
Published: 2021-08-17
Volume: 4
Issue: 1
Pages: 125-125
ISSN: 2398-6352 (ISSN-L)
DOI: 10.1038/s41746-021-00487-4
PMC: PMC8371011
OpenAlex: W3194185186
Cited by: 177
References: 112
Citations by year: 2026: 33 · 2025: 43 · 2024: 42 · 2023: 27 · 2022: 28 · 2021: 4
FWCI: 5.22
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0 (tdm)
creativecommons.org/licenses/by/4.0 (vor)
Locations: npj Digital Medicine (publishedVersion, cc-by)
medRxiv (acceptedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Figshare (submittedVersion, cc-by)
Funders: U.S. Department of Health & Human Services | NIH | Fogarty International Center (D43TW009127)
Emory University | Center for AIDS Research, Emory University (P30 AI050409)
Topics: Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
Physical Sciences › Computer Science › Information Systems › ICT in Developing Communities
Keywords: digital health technologies, Ethiopia, mobile health, electronic health records, telemedicine, cloud applications, information and communication technologies, artificial intelligence in healthcare, maternal and child health, infectious diseases, non-communicable diseases, technology adoption, feasibility and usability, health infrastructure, digital health implementation, smartphone access

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The potential use of digital health technologies in the african context: a systematic review of evidence from ethiopia

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