Development of a digital mental health platform in the era of COVID-19 pandemic in Kenya: findings and implications

Introduction: COVID-19 global pandemic exposed mental health gaps that have been salient among adolescents and young people. The glaring gaps include lack of information, undefined referral systems, and inadequate human resources for mental health. We aimed to develop a digital web-based platform to support young people's mental health and psychosocial needs during the COVID-19 pandemic. Methods: we adopted a mixed methods action research approach to design and pilot a digital mental health intervention for young people during the pandemic. We piloted the platform between Oct 2020 and July 2021, and recruited a sample of 150 young people through the community gathering spaces in three informal settlements in Nairobi City County using a convenient sampling method. Results: overall, participants reported that information provided to them via the platform was pertinent and beneficial, and that the self-assessments improved their mental health and psychosocial awareness and signposted them to available support and services. The support services consisted of informative weekly bulk emails and short motivational messages related to mental health, with a total of, 1343 short messages distributed through the short message service (SMS). Moreover, more than half the participants completed online self-assessments and participated in 19 online sessions. Conclusion: findings from this pilot study demonstrate that digital mental health systems are feasible and have the potential to improve access to mental health and psychosocial services. This is especially crucial during times of public health crisis, such as the COVID-19 pandemic. The realization of such systems requires swift multistakeholder partnership approach and investment.

Assessment of challenges inhibiting effective delivery of health care services among frontline Professional health workers during COVID 19 Lock down in Nigeria

This is a cross-sectional survey of challenges inhibiting health care service provision during COVID 19 lockdown. Data collected with a pretested online self-administered questionnaire included age, gender, occupation, place of practice, physical distance practices, utilization of telemedicine, income and other concerns that may have inhibited their practices during the COVID 19 lockdown. Data were analyzed using a statistical package for social sciences (SPSS) version 26.0 with the level of significance set at p<0.05. Chi square goodness of fit test was used to analyze the association between means and qualitative variables. Results: Response rate from 599 questionnaires was 481 (78%) with physiotherapists (n=108, 23%); nurses (n=106, 22%); doctors (n=86, 18%); laboratory technicians (n=87, 18%) and pharmacists (n=94, 19%); in public sector (n=318, 66%) and private practitioners (n=163, 34%). During the "lockdown" patients interacting with health professionals in private practice decreased except increases for laboratory technicians (11.91%) and pharmacists (68.35%). Social distancing was feasible by pharmacists and laboratory technicians, but interactions by nurses, physiotherapists and doctors were compromised. Telemedicine was used mostly by doctors (n=42, 48.8%), and physiotherapists (n=50, 46.3%). Health professionals experienced mental stress 428 (89%); anxiety 176 (37%); feared infection 333 (69%) and 232 (48%) of transmitting to their families; 307 (64 %) had challenges with personal protective equipment. Suggestions were: alternate accommodation or longer shifts with less working days 111 (37%); a hazard allowance 244 (51%) and counseling 238 (49%). Conclusion: Private practitioners reported a loss of income with all health professionals indicating the "lockdown" and COVID-19 compromised health delivery, health services, and individuals' health. Health professionals suggested a hazard allowance, alternate accommodation, and dedicated counseling for health professionals during the pandemic.

Evaluation of Hausa mobile health apps quality

Mobile Health (mHealth) involves the utilization of mobile communication to promote health by supporting healthcare practices. To the best of our knowledge, the quality of mobile health apps available to the 65 million Hausa speakers globally is yet to be evaluated in a study. Objective: To evaluate the quality of Hausa mobile health apps available on Google play store. Materials and Methods: This is a cross-sectional descriptive study of the quality of Hausa mobile health apps available on Google play store. A search of the Google play store for Hausa mobile health apps was conducted on 19th September, 2021. Hausa words "KiwonLafiya", "CutadaMagani" and "RashinLafiya" were utilized in the search for relevant apps. The Mobile App Rating Scale (MARS) was used to evaluate the quality of the Hausa mobile health apps found. Two of the authors separately applied the MARS which was validated by the third author. Four MARS domains (Engagement, Functionality, Aesthetics, Information) were assessed to evaluate app quality, the mean score in each domain and the overall mean were determined from the two separate quality ratings conducted. Result: Eight Hausa mobile apps were found. Majority of the apps were on women health; n = 3 (37.5%) and health education; n = 3 (37.5%). Three of the apps (37.5%) had > 10,000 downloads. Seven out of the eight apps (87.5%) were developed by an individual developer. The functionality domain had the highest mean score, followed by aesthetics and engagement domains, while the least mean score was in the information domain. The overall mean from rater one's rating was 3.18 ± 0.31 and 2.84 ± 0.60 from rater two's rating, which showed an acceptable quality. Conclusion: The reviewed apps were of an acceptable quality, however, health education features within mobile health apps needs more improvement

A review of teleradiology in Africa ­ Towards mobile teleradiology in Nigeria

eHealth is promoted as a means to strengthen health systems and facilitate universal health coverage. Sub-components (e.g. telehealth, telemedicine, mhealth) are seen as mitigators of healthcare provider shortages and poor rural and remote access. Teleradiology (including mobile teleradiology), widespread in developed nations, is uncommon in developing nations. Decision- and policy-makers require evidence to inform their decisions regarding implementation of mobile teleradiology in Nigeria and other subSaharan countries. To gather evidence, Scopus and PubMed were searched using defined search strings (September 2020). Duplicates were removed, and titles and abstracts reviewed using specified selection criteria. Full-text papers of selected resources were retrieved and reviewed against the criteria. Insight from included studies was charted for eight a priori categories of information: needs assessment, implementation, connectivity, evaluation, costing, image display, image capture and concordance. Fifty-seven articles were identified, duplicates removed and titles and abstracts of remaining articles reviewed against study criteria. Twenty-six papers remained. After review of full-texts, ten met the study criteria. These were summarised, and key insights for the eight categories were charted. Few papers have been published on teleradiology in sub-Saharan Africa. Teleradiology, including mobile teleradiology, is feasible in sub-Saharan Africa for routine X-ray support of patients and healthcare providers in rural and remote locations. Former technical issues (image quality, transmission speed, image compression) have been largely obviated through the high-speed, high-resolution digital imaging and network transmission capabilities of contemporary smartphones and mobile networks, where accessible. Comprehensive studies within the region are needed to guide the widespread introduction of mobile teleradiology.

Conceptualization and practices in digital health voices from Africa

This paper presents voices from Africa on digital health in Africa. These voices were gleaned during interviews and an online, focus group session in May 2020, during which 30 experts across Africa, among others from the South, were asked about their experiences and observations on the conceptualization of, and practices in, digital health in their respective communities and countries. Extensive input was provided, both orally and textually. The quotes gathered and presented in this paper indicate that there is a distinct need for the respectful co-development of digital health interventions in Africa. In addition, the quotes show how a one-size-fits-all solution approach does not exist, it is not a solution to Africa. Further, the community-focus, fit, and fragmentation of existing activities digital health interventions is questioned. The narratives provide a rich resource indicating capable and local agency and the need to address power-differences in international health development

The Impact of telemedicine during the COVID-19 pandemic in Nigeria: A review

Background: Telemedicine practice is a rapidly evolving aspect of medicine in developed countries, though resource-limited countries like Nigeria are yet to embrace it fully. Moreover, the COVID-19 pandemic has limited patients' visits to hospitals in addition to the social distancing measures deployed by the government. In addition, with the challenges of a limited number of doctors, among other difficulties, it has become important that a radical approach to patient care and treatment should be explored. Methods: A comprehensive literature review of original articles was done using an internet search. Words such as Telemedicine, COVID-19, Pandemic, Requirements, History, Benefits, and Challenges were searched on Google scholar, EMBASE, PubMed, Medline, Web MD, and Scopusto check for various articles published or any probable link. The references of the relevant articles were searched. Results: The practice of telemedicine has evolved over the years. Also, the global telemedicine market has grown exponentially and is expected to grow even further in the next five years. Unfortunately, this exciting narrative is not obtainable in developing countries like Nigeria. Indeed, some healthcare providers in Nigeria need to prepare for this new technological advancement, and consequently, they struggle to evolve their practice to adopt this new technology. Furthermore, there is disinterest from most of the end users, particularly the patients. Conclusion: Modifications must involve telemedicine services with a view of getting ready and well-organized in the event of any future pandemic such as COVID-19, in addition to harnessing the benefits of this service in the future.

The changing trend of teleconsultations during COVID-19 era at a tertiary facility in Tanzania

Introduction: the current COVID-19 pandemic has occasioned the increased adoption of telemedicine. This study reports the uptake and trend of a new teleconsultation service in a Tanzanian hospital. Methods: this is a retrospective observational study that profiled requests for teleconsultations and uptake of the service between April 1, 2020, and June 30, 2020. Results: two hundred and eighteen telephone inquiries were received over the 3 months. One hundred and sixteen (53.2%) individuals followed through with the teleconsultations. Paediatric (38.8%) and Internal medicine (32.8%) were the subspecialties with the highest number of teleconsultations. In a frame of 3 months, teleconsultation uptake was highest in May and lowest in June. Conclusion: there was a steady rise and a rapid fall in requests and uptake of teleconsultation services over the period under evaluation. Lack of insurance coverage for teleconsultations was a significant barrier. We propose a re-education and reiteration of the benefits of telemedicine to all stakeholders. This is important for the current era and beyond

Evaluation of the ELIMIKA Pilot Project: improving ART adherence among HIV positive youth using an eHealth intervention in Mombasa, Kenya

Adolescents and young people are arguably the most dynamic and challenging group among populations living with HIV. The adherence to anti-retroviral treatment (ART) is often low among HIV-positive youth, thus creative and context specific interventions are necessary. We aimed at evaluating the usability and effectiveness of the pilot digital peer support platform ­ ELIMIKA, implemented in Mombasa, Kenya. We applied a pre-post-test design. Data collection consisted of two parts: pre- and post-online knowledge and behavior questionnaires, and a mid-term usability survey. From 90 recruited participants, 81 completed the pre- and post-questionnaires. Overall, the participants were satisfied with the main features of the web platform and stated that they would use it again (95%). However, there was not a significant change in knowledge and behavior, but adherence intentions after 3 months intervention period have improved. This study provides valuable information on feasibility, evaluation and challenges of eHealth intervention in Kenya that supports further research in this area

A prehospital randomised controlled trial in South Africa: Challenges and lessons learnt

The incidence of cardiovascular disease and STEMI is on the rise in sub-Saharan Africa. Timely treatment is essential to reduce mortality. Internationally, prehospital 12 lead ECG telemetry has been proposed to reduce time to reperfusion. Its value in South Africa has not been established. The aim of this study was to determine the effect of prehospital 12 lead ECG telemetry on the PCI-times of STEMI patients in South Africa. A multicentre randomised controlled trial was attempted among adult patients with prehospital 12 lead ECG evidence of STEMI. Due to poor enrolment and small sample sizes, meaningful analyses could not be made. The challenges and lessons learnt from this attempt at Africa's first prehospital RCT are discussed. Challenges associated with conducting this RCT related to the healthcare landscape, resources, training of paramedics, rollout and randomisation, technology, consent and research culture. High quality evidence to guide prehospital emergency care practice is lacking both in Africa and the rest of the world. This is likely due to the difficulties with performing prehospital clinical trials. Every trial will be unique to the test intervention and setting of each study, but by considering some of the challenges and lessons learnt in the attempt at this trial, future studies might experience less difficulty. This may lead to a stronger evidence-base for prehospital emergency care

The development of ethical guidelines for telemedicine in South Africa

Telemedicine has the potential to assist in the provision of healthcare in South Africa (SA). This means of healthcare service provision involves patients, doctors and machines working together, with few constraints imposed by geography, or national or institutional boundaries. Although the practice is largely beneficial, certain legal and ethical challenges arise from the use of electronic healthcare services. Certain ethical challenges are identified as: the changing nature of the traditional doctor-patient relationship; standards of care;quality of care; privacy; confidentiality; data protection; accountability; liability; consent; record-keeping; data storage; and authentication.While various legal, regulatory and governance measures offer potential solutions and remedies for protection, ethical direction may be achieved through statutory bodies set up to promote and foster ethical compliance with normative healthcare standards. Recently, the Health Professions Council of SA (HPCSA) made an attempt to address the ethical issues by publishing a set of telemedicine guidelines.Despite this, issues around the practice of telemedicine remain unresolved. This article seeks to inform the development of a new ethical framework by addressing three distinct and relevant ethical issues: the fiduciary nature of healthcare and the changing nature of the doctor-patient relationship; privacy, confidentiality and the sensitivity of health data; and informed consent. It does so by proposing a broader and more nuanced solution to these ethical obstacles by identifying conceptual and operational difficulties within the existing HPCSA telemedicine guidelines, and advancing suggestions for reform. This speaks to a more highly integrated perspective that is culturally and contextually aware, and which affirms the need to strike a balance between individual rights protection and transformative, ethical, healthcare innovation

Orthopaedic referrals using a smartphone app: uptake, response times and outcome

Background. It is well established that South Africa (SA) suffers an immense burden of violence and injuries. The responsibility of providing care for these injuries falls mainly on public health services, resulting in overloading of the health system. Prior to a recent intervention, the large burden had been exacerbated by limitations in the traditional referral system that highlighted the need for a better referral system. Vula's smartphone app was introduced at Tygerberg Hospital in August 2016. This study evaluated the uptake, response times and outcomes using this app.Objectives. The main objectives of the study were to describe: (i) the number of referrals; (ii) referral response times; (iii) referring facilities; and (iv) referral outcomes. Secondary objectives were to: (i) evaluate whether the referral outcome pathway was appropriate; and (ii) assess professional conduct and evidence of upskilling.Methods. This retrospective, descriptive study investigated Vula app referrals to the Division of Orthopaedic Surgery at Tygerberg Hospital between 1 August 2016 and 31 March 2017. Vula was advertised to key facilities in the hospital's referral network. All referrals to the division during the study period were systematically included in the analysis of operational outcomes, although some were excluded from the subsequent referral outcome analysis. Operational outcomes included the number of referrals, referring facilities and referral response times. Referral outcome analysis included the clinical diagnosis, referral pathway, whether the referral was used for upskilling and whether it was conducted in a professional manner.Results. A total of 2 275 referrals from 39 different facilities were received during the study period from 238 individual users; 50% of referrals received a response within 11 minutes, while a small percentage received no response. Clinical and demographic characteristics of 1 985 patients included in the referral outcome analysis indicated that the majority of trauma and emergency referrals involved males, with closed fractures being the most frequent clinical presentation. Although the most common referral outcome was immediate transfer, one-third of the patients were treated at the referring hospital with advice only.Conclusions. The large volume of orthopaedic referrals received through the Vula app suggests that Vula represents a successful alternative to traditional referral methods. Referrals managed by advice only could suggest that Vula facilitates some relief for the overburdened trauma services. Future research could further explore Vula's role in strengthening the public health system, including interventions for high-volume referral areas and upskilling of referring health workers

Telemedicine and e-health in Algeria facing challenges in medical practice

The Algerian health system operates in a demographic, economic, environmental, and societal specific context to meet the challenges of epidemiological transition. Development of information and communication technologies in this atmosphere allow telemedicine and e-health emergence in the vast country of Algeria. Thus, the country may face these challenges by including them in a national telemedicine plan and making a major focus of global action for the prevention and control of prevalent diseases. The interest to adopt this tool in daily practice stems from an improvement in the quality of communication between practitioners and in the doctor­patient relationship with a possibility of quick access to care and more efficient care pathways. Thus, national goals in fight plans against diseases will be achieved. Telemedicine and e-health projects that methodologically well-defined, respecting regulations and using all means and all available resources, including WHO mobile health, are to be designed and implemented in all areas, especially in the national plan against not-communicated diseases, maternal and child health, old aging health, and mental health. This approach will integrate telemedicine in the health care system whose inevitable implementation can be done on solid foundations and will be actively supported by SATeS

Mobile health for early retention in HIV care: a qualitative study in Kenya (WelTel Retain)

Many people newly diagnosed with HIV are lost to follow-up before timely initiation of antiretroviral therapy (ART). A randomised controlled trial (RCT); WelTel Kenya1; demonstrated the effectiveness of the WelTel text messaging intervention to improve clinical outcomes among patients initiating ART. In preparation for WelTel Retain; an RCT that will evaluate the effect of the intervention to retain patients in care immediately following HIV diagnosis; we conducted an informative qualitative study with people living with HIV (n = 15) and healthcare providers (HCP) (n = 5) in October 2012. Study objectives included exploring the experiences of people living with HIV who have attempted to engage in HIV care; the use of cell phones in everyday life; and perceptions of communicating via text message with HCP. Participants were recruited through convenience sampling. Semi-structured; qualitative interviews were conducted and recorded; transcribed verbatim and analysed using NVivo software. Analysis was guided by the Theory of Reasoned Action and the Technology Acceptance Model. Results indicate that while individuals have many motivators for engaging in care after diagnosis; structural and individual barriers including poverty; depression and fear of stigma prevent them from doing so. All participants had access to a mobile phone; and most were comfortable communicating through text messages; or were willing to learn. Both people living with HIV and HCP felt that increased communication via the text messaging intervention has the potential to enable early identification of problems; leading to timely problem solving that may improve retention and engagement in care during the first year after diagnosis

Telepsychiatry in South Africa ­ present and future

The recent progress in telepsychiatry results from advancing technology and videoconferencing as an effective alternative to classic face-to-face psychiatric interaction, in terms of both results and cost-effectiveness. The wide range of applications of telepsychiatry is outlined - in particular, emergency, forensic, prison and adolescent psychiatry. Attitudes of patients and the providers of psychiatric services are discussed, and a short account is given of the place of tele-education in psychiatric teaching. The advantages of telepsychiatry are outlined and its limitations. Lastly, the limited experience and relevance of telepsychiatry in South Africa (and hence for other developing countries) are presented. The conclusion is that telepsychiatry is well established, its successes documented, and that it should be applied in planning future public health services in South Africa

Knowledge and Perception of e-Health and Telemedicine among Health Professionals in LAUTECH Teaching Hospital; Osogbo; Nigeria

Depression is a complex but treatable disorder if diagnosed appropriately. However; despite the advances in the understanding of the molecular basis of this disorder and the vast range of medication; psychotherapy and electroconvulsive therapy; very safe and effective drug to treat this disease is still being sought. Several studies suggest that St.John's wort (Hypericum perforatum L.) has phloroglucinol derivative; hyperforin; exhibiting antidepressant activity. This bioactive component can be exploited to create a major shift in the safer treatment of depression

Telemedicine Pilot Project

Telemedicine is the use of Telecommunication to provide medical and health Care at distance. This includes diagnosis; transfer of medical data; consultation; treatment; education and administration among others. The Telemedicine Pilot Project under the Minsitry of Health; Mulago National Referral Hospital and mengo Hospitals has been connected and is now operational. This project is co-ordianted by the National Telemedicine Steering Committee composed of: Dean makerere Medical School; Director Mulago Hospital; Director Development and Planning (Uganda Telecommunication Limited) UTL; Assistant Commissioner HIM/CME; Medical Superintendent Mengo Hospital and others. This Committee is to be reviewed and expanded at the end of the pilot project

Connecting people; improving health: the role of ICTs in the health sector of developing countries

This framework paper is intended to provide a 'snapshot' of the type of ICT interventions that are being used in the health sector. It draws from experience of such use in both the North and South; but pays particular attention to the applicability of such use in the South. In that sense; it is focused particularly in identifying where ICTs have real possibilities in contributing to the achievement of the health-related Millennium Development Goals (MDGs) as part of poverty reduction strategies and in order to improve the health of the most poor and vulnerable people (...)