Cervical cancer in sub-Saharan Africa: an urgent call for improving accessibility and use of preventive services.

Sub-Saharan Africa has the highest rates of cervical cancer in the world, largely attributed to low cervical cancer screening coverage. Cervical cancer is the most common cause of death among women in 21 of the 48 countries in sub-Saharan Africa. Close to 100% of all cases of cervical cancer are attributable to Human papillomavirus (HPV). HPV types 16 and 18 cause at least 70% of all cervical cancers globally, while types 31, 33, 45, 52, and 58 cause a further 20% of the cases. Women living with HIV are six times more likely to develop cervical cancer than those without HIV. Considering that sub-Saharan Africa carries the greatest burden of cervical cancer, ways to increase accessibility and use of preventive services are urgently required. With this review, we discuss the preventive measures required to reduce the burden of cervical cancer in sub-Saharan Africa, the challenges to improving accessibility and use of the preventive services, and the recommendations to address these challenges.

Risk Factors for COVID-19 Infection Among Healthcare Workers. A First Report From a Living Systematic Review and meta-Analysis.

Health care workers (HCWs) are more than ten times more likely to be infected with coronavirus infectious disease 2019 (COVID-19) than the general population, thus demonstrating the burden of COVID-19 among HCWs. Factors that expose HCWs to a differentially high-risk of COVID-19 acquisition are important to elucidate, enable appropriate public health interventions to mitigate against high risk and reduce adverse outcomes from the infection. We conducted a systematic review and meta-analysis to summarize and critically analyze the existing evidence on SARS-CoV-2 risk factors among HCWs. With no geographical limitation, we included studies, in any country, that reported (i) the PCR laboratory diagnosis of COVID-19 as an independent variable (ii) one or more COVID-19 risk factors among HCWs with risk estimates (relative risk, odds ratio, or hazard ratio) (iii) original, quantitative study design, and published in English or Mandarian. Our initial search resulted in 470 articles overall, however, only 10 studies met the inclusion criteria for this review. Out of the 10 studies included in the review, inadequate/lack of protective personal equipment, performing tracheal intubation, and gender were the most common risk factors of COVID-19. Based on the random effects adjusted pooled relative risk, HCWs who reported the use of protective personal equipment were 29% (95% CI: 16% to 41%) less likely to test positive for COVID-19. The study also revealed that HCWs who performed tracheal intubations were 34% (95% CI: 14% to 57%) more likely to test positive for COVID-19. Interestingly, this study showed that female HCWs are at 11% higher risk (RR 1.11 95% CI 1.01-1.21) of COVID-19 than their male counterparts. This article presents initial findings from a living systematic review and meta-analysis, therefore, did not yield many studies; however, it revealed a significant insight into better understanding COVID-19 risk factors among HCWs; insights important for devising preventive strategies that protect them from this infection. PROSPERO registration number: CRD42020193508 available for public comments via the link below https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193508).

Virtual healthcare services and digital health technologies deployed during coronavirus disease 2019 (COVID-19) pandemic in South Africa: a systematic review.

Aims: To identify virtual healthcare services and digital health technologies deployed in South Africa during coronavirus disease 2019 (COVID-19) and the challenges associated with their use. Methods: To determine the status of digital health utilization during COVID-19 in South Africa, the preferred reporting items for systematic reviews and meta-analyses model was used to perform a systematic and in-depth critical analysis of previously published studies in well-known and trusted online electronic databases using specific search keywords words that are relevant to this study. We selected published peer-reviewed articles available from the onset of COVID-19 to July 2021. Results: Total of 24 articles were included into this study. This study revealed that South Africa adopted digital technologies such as SMS-based solutions, mobile health applications, telemedicine and telehealth, WhatsApp-based systems, artificial intelligence and chatbots and robotics to provide healthcare services during COVID-19 pandemic. These innovative technologies have been used for various purposes including screening infectious and non-infectious diseases, disease surveillance and monitoring, medication and treatment compliance, creating awareness and communication. The study also revealed that teleconsultation and e-prescription, telelaboratory and telepharmacy, teleeducation and teletraining, teledermatology, teleradiology, telecardiology, teleophthalmology, teleneurology, telerehabilitation, teleoncology and telepsychiatry are among virtual healthcare services delivered through digital health technologies during COVID-19 in South Africa. However, these smart digital health technologies face several impediments such as infrastructural and technological barriers, organization and financial barriers, policy and regulatory barriers as well as cultural barriers. Conclusion: Although COVID-19 has invigorated the use of digital health technologies, there are still some shortcomings. The outbreak of pandemics like COVID-19 in the future is not inevitable. Therefore, we recommend increasing community networks in rural areas to bridge the digital divide and the modification of mHealth policy to advocate for the effective use of innovative technologies in healthcare and the development of sustainable strategies for resources mobilization through private-public partnerships as well as joining available international initiatives advocating for smart digital health.

Non-invasive smart implants in healthcare: Redefining healthcare services delivery through sensors and emerging digital health technologies

The adoption of non-invasive smart implants is inevitable due to recent technological advancements in smart implants and the increasing demand to provide pervasive and personalized care. The integration of non-invasive smart implants presents unprecedented opportunities for effective disease prevention, real-time health data collection, early detection of diseases, real-time monitoring of chronic diseases, virtual patient care, patient-tailored treatment, and minimally invasive management of diseases. Even though the research work in this area is nascent, this study presents the potential benefits and use of non-invasive smart implants in healthcare while reflecting on the potential challenges and limitations of their utilization. With current technological advancements, the adoption of non-invasive smart implants is regaining momentum in managing chronic conditions and diseases such as cancer, cardiovascular diseases, cognitive impairment;orthopedic surgery, dental surgery;and managing and remotely monitoring infectious diseases such as the novel coronavirus disease 2019 (COVID-19). However, the full adoption and utilization of non-invasive smart implants still encounter barriers such as lack of policies and frameworks regulating their use, limited memory space, health consequences and implants' failure, clinical challenges, health hazards imposed by non-invasive smart implants, health data security, and privacy risks. Therefore, there is a need for robust security and privacy measures as well as the formulation of policies guiding the development and use of non-invasive smart implants. With the gained experience from smart implants, the next generation of non-invasive smart implants may include sophisticated modern computational techniques that can analyze health data and suggest adequate therapeutic actions.

COVID-19 Prevalence among Healthcare Workers. A Systematic Review and Meta-Analysis.

Understanding the burden of SARS-CoV-2 infections among healthcare workers is a critical component to inform occupational health policy and strategy. We conducted a systematic review and meta-analysis to map and analayse the available global evidence on the prevalence of SARS-CoV-2 infections among healthcare workers. The random-effects adjusted pooled prevalence of COVID-19 among those studies that conducted the test using the antibody (Ab) method was 7% [95% CI: 3 to 17%]. The random-effects adjusted pooled prevalence of COVID-19 among those studies that conducted the test using the PCR method was 11% [95% CI: 7 to 16%]. We found the burden of COVID-19 among healthcare workers to be quite significant and therefore a cause for global health concern. Furthermore, COVID-19 infections among healthcare workers affect service delivery through workers' sick leave, the isolation of confirmed cases and quarantine of contacts, all of which place significant strain on an already shrunken health workforce.

Utility of telemedicine in sub‐Saharan Africa during the COVID‐19 pandemic. A rapid review

Telemedicine is the use of technology to achieve remote care. This review looks at the utility of telemedicine during the pandemic, period March 2020 to February 2021. Eleven articles met inclusion criteria. There was moderate use of telemedicine in sub‐Sahara Africa during the pandemic, however, there were also some limitations. Benefits of telemedicine include continuing medical service provision, connecting relatives with loved ones in quarantine, education, and awareness of mental health issues, and toxicovigilance and infection control. Challenges to the implementation of telemedicine on the continent were lack of supporting telemedicine framework and policies, digital barriers, and patient and healthcare personnel biases. To address these challenges, this article proposes the development of policy frameworks that fosters telemedicine use by all stakeholders, including medical insurance organizations, the introduction of telemedicine training of medical workers, educational awareness programs for the public, and improvement of digital platforms access and affordability.

Are we there yet? Unbundling the potential adoption and integration of telemedicine to improve virtual healthcare services in African health systems.

Since the outbreak of COVID-19, the attention has now shifted towards universal vaccination to gracefully lift strict COVID-19 restrictions previously imposed to contain the spread of the disease. Sub-Saharan Africa is experiencing an exponential increase of infections and deaths coupled with vaccines shortages, personal protective equipment, weak health systems and COVID-19 emerging variants. Some developed countries integrated telemedicine to reduce the impacts of the shortage of healthcare professionals and potentially reduce the risk of exposure, ensuring easy delivery of quality health services while limiting regular physical contact and direct hospitalization. However, the adoption of telemedicine and telehealth is still nascent in many sub-Saharan Africa countries. Therefore, this study reflects on progress made towards the use of telemedicine, virtual health care services, challenges encountered, and proffers ways to address them. We conducted a systematic literature review to synthesise literature on telemedicine in sub-Saharan Africa. The study revealed that telemedicine provides unprecedented benefits such as improving efficiency, effective utilization of healthcare resources, forward triaging, prevention of medical personnel infection, aiding medical students' clinical observation and participation, and assurance of social support for patients. However, the absence of policy on virtual care and political will, cost of sustenance of virtual health care services, inadequate funding, technological and infrastructural barriers, patient and healthcare personnel bias on virtual care and cultural barriers are identified as limiting factors to the adoption of virtual health care in many African health systems. To alleviate some of these barriers, we recommend the development of robust policies and frameworks for virtual health care, the inclusion of virtual care in the medical school curriculum, supporting virtual care research and development, increasing health funding, removing monopolisation of telecommunication services, developing of virtual health solutions that address eccentricities of African health systems.

Application of intelligence-based computational techniques for classification and early differential diagnosis of COVID-19 disease

Clinical methods are used for diagnosing COVID-19 infected patients, but reports posit that, several people who were initially tested positive of COVID-19, and who had some underlying diseases, turned out having negative results, after further tests. Therefore, the performance of clinical methods is not always guaranteed. Moreover, chest X-ray image data of COVID-19 infected patients are mostly used in the computational models for COVI-19 diagnosis while the use of common symptoms such as “Fever, Cough, Fatigue, Muscle aches, Headache etc”, in computational models is not yet reported. In this study, we employ seven classification algorithms to empirically test and verify their efficacy when applied to diagnose COVID-19 using the aforementioned symptoms. We experimented with logistic regression (LR), support vector machine (SVM), naïve Byes (NB), decision tree (DT), multilayer perceptron (MLP), fuzzy cognitive map (FCM) and Deep neural network (DNN) algorithms. The techniques were subjected to random under-sampling and over-sampling. Our results showed that with class imbalance, MLP and DNN outperform others but without class imbalance MLP, FCM and DNN outperform others with the use of random under-sampling but DNN has the best performance with the use random oversampling. This study identified MLP, FCM and DNN as better classifiers over LR, NB, DT and SVM, that healthcare software system developers can adopt to develop intelligence-based expert systems which both medical personnel and patients can use for differential diagnosis of COVID-19 based on the aforementioned symptoms however, the test of performance must not be limited to the traditional performance metrics.

Unbundling the Significance of Cognitive Robots and Drones deployed to tackle COVID-19 pandemic: A rapid review to unpack emerging opportunities to improve healthcare in sub-Saharan Africa

The emergence of COVID-19 brought unprecedented opportunities to deploy emerging digital technologies such as robotics and drones to provide contactless services. Robots and drones transformed initial approaches to tackle COVID-19 and have proven to be effective in curbing the risk of COVID-19 in developed countries. Despite the significant impact of robots and drones in reducing the burden of frontline healthcare professionals, there is still limited literature on their utilization to fight the pandemic in sub-Saharan Africa. Therefore, this rapid review provides significant capabilities of robots and drones while introspecting at the challenges and barriers that may hinder their implementation in developing countries. The study revealed that robots and drones have been used for disinfection, delivery of medical supplies, surveillance, consultation and screening and diagnosis. The study revealed that adopting robots and drones face challenges such as infrastructural, financial, technological barriers, security and privacy issues, lack of policies and frameworks regulating the use of robots and drones in healthcare. We, therefore, propose a collaborative approach to mobile resources and invest in infrastructure and bridge the digital divide among the various nations on the continent coordinated efforts to craft policies and frameworks for effectively integrating robots and drones in healthcare. There is a need to include robotics in the medical education and training of health workers and develop indigenous knowledge and encourage international collaboration. Partnership with civil aviation authorities to license and monitor drones to improve monitoring and security of drone activities. Robots and drones should guarantee superior safety features since it either directly interacts with human or works in a densely populated environment. However, future work should focus on the long term consequences of robots and drones on human behaviour and interaction as well as in healthcare.

Towards Emotive Sensory Web in Virtual Health Care: Trends, Technologies, Challenges and Ethical issues

With fast-paced technological advancements coupled with increasing demands for virtual health care especially during the pandemic, health systems globally are on the cusp of transforming healthcare through emerging technologies. Such paradigm shift in digital healthcare requires effective integration of information, computing, communication, and connectivity technologies sharing health data through the web. The current technologies deployed in healthcare service delivery lack emotional competencies despite the growing demands for capturing and monitoring patients’ affections, feelings and emotions. The importance of the emotive Sensory web has been gaining relevance in healthcare and society to remotely monitor patients’ emotional competencies during the pandemic like COVID-19 to minimize infections. In this respect, this paper discusses the significant benefits, trends, technologies, perceived challenges, and ethical issues of the emotive sensory Web in virtual health care. The study revealed that emerging technologies such as artificial intelligence, Internet of Things, Internet of Medical Things, 5G technology, Industry 5.0, big data, cloud computing are paramount in the development and implementation of sensory emotive Web in virtual health care. However, the standardization and synchronization of communication protocols, as well as devices interoperability issues, threatens the integration of these technologies. While the need for emotive sensory Web in virtual health care continues to increase, there are social, technological, infrastructural, economic barriers, security and ethical issues that hinder its implementation. Therefore, there is a need for developing technological infrastructure that supports the integration of appropriate technologies;crafting regional and international legal and regulatory policy through WHO;and standardization and interoperability of sensory devices.

Digital technologies and COVID-19: reconsidering lockdown exit strategies for Africa.

Widespread vaccination provides a means for countries to lift strict COVID-19 restrictions previously imposed to contain the spread of the disease. However, to date, Africa has secured enough COVID-19 vaccine doses for less than 5% of its population. With widespread vaccination not on the horizon for Africa, there is a strong emphasis on non-pharmaceutical interventions which include movement restrictions (lockdowns). This general COVID-19 pandemic response of imposing lockdowns, however, neglects to factor in non-fatal consequences leading to disruption socio-economic wellbeing of the society at large. The economy in most African countries can no longer sustain lockdown restrictions. Some studies have indicated that a hard lockdown statistical value of the extra lives saved would be dwarfed by its long-term cost. At the same time not responding to the threat of the pandemic will cost lives and disrupts the social fabric. This paper proffers ways to mitigate the both and advocate for better policymaking that addresses specific challenges in defined communities thus yield higher population welfare.

Application of Deep Learning and Machine Learning Models to Detect COVID-19 Face Masks - A Review

The continuous COVID-19 upsurge and emerging variants present unprecedented challenges in many health systems. Many regulatory authorities have instituted the mandatory use of face masks especially in public places where massive contact of people is frequent and inevitable, particularly inside public transport facilities, sports arenas, shopping malls and workplaces. However, compliance and adherence to proper wearing of face masks have been difficult due to various reasons including diversified mask types, different degrees of obstructions, various variations, balancing various model detection accuracy or errors and deployment requirements, angle of view, deployment of detection model on computers with limited processing power, low-resolution images, facial expression, and lack of real-world dataset. Therefore, this study aimed at providing a comprehensive review of artificial intelligence models that have been used to detect face masks. The study revealed that deep learning models such as the Inceptionv3 convolutional neural network achieved 99.9% accuracy in detecting COVID-19 face masks. We deducted that most of the datasets used to detect face masks are created artificially, do not represent the real-world environments which ultimately affect the precision accuracy of the model when deployed in the real world. Hence there is a need for sharing real-world COVID-19 face mask images for modelling deep learning techniques. The study also revealed that deeper and wider deep learning architectures with increased training parameters, such as inception-v4, Mask R-CNN, Faster R-CNN, YOLOv3, Xception, and DenseNet are not yet implemented to detect face masks.

Ethics for integrating emerging technologies to contain COVID-19 in Zimbabwe.

Zimbabwe is among the countries affected with the coronavirus disease (COVID-19) and implemented several infection control and measures such as social distancing, contact tracing, regular temperature checking in strategic entry and exit points, face masking among others. The country also implemented recursive national lockdowns and curfews to reduce the virus transmission rate and its catastrophic impact. These large-scale measures are not easy to implement, adhere to and subsequently difficult to practice and maintain which lead to imperfect public compliance, especially if there is a significant impact on social and political norms, economy, and psychological wellbeing of the affected population. Also, emerging COVID-19 variants, porous borders, regular movement of informal traders and sale of fake vaccination certificates continue to threaten impressive progress made towards virus containment. Therefore, several emerging technologies have been adopted to strengthen the health system and health services delivery, improve compliance, adherence and maintain social distancing. These technologies use health data, symptoms monitoring, mobility, location and proximity data for contact tracing, self-isolation, and quarantine compliance. However, the use of emerging technologies has been debatable and contentious because of the potential violation of ethical values such as security and privacy, data format and management, synchronization, over-tracking, over-surveillance and lack of proper development and implementation guidelines which impact their efficacy, adoption and ultimately influence public trust. Therefore, the study proposes ethical framework for using emerging technologies to contain the COVID-19 pandemic. The framework is centered on ethical practices such as security, privacy, justice, human dignity, autonomy, solidarity, beneficence, and non-maleficence.

Is malaria elimination a distant dream? Reconsidering malaria elimination strategies in Zimbabwe.

Malaria remains a public health problem decimating vulnerable populace especially in resource-constrained areas in Zimbabwe. Significant progress towards malaria elimination has beenik made in the previous decades through intensified and improved malaria control measures such as indoor residual spraying (IRS), distribution of long-lasting insecticidal nets (LLIN), artemisinin-based combination therapy and administration of intermittent preventive treatment in pregnancy. However, the outbreak of pandemics like coronavirus disease (COVID-19), cyclones and tropical storms, lack of funding, porous political environment, dearth of resources for vector control, changes in vector behaviour, vector resistance to insecticides, community behavioural change and lack of feasible and sustainable digital technologies for managing malaria control interventions retards progress made towards malaria elimination. Also, arbitrary political environment and unstable economic situation often interfere with health programmes which subsequently lead to malaria outbreaks. Most recently, the country recorded a sharp increase in malaria incidences in malaria-endemic areas especially during the pandemic due to some factors such as movement restrictions, temporary cancellation of IRS activities, delayed delivery of IRS chemicals and recursive lockdown. Therefore, we propose ways to mitigate future malaria outbreaks and advocate for reconsidering malaria elimination strategies to addresses emerging challenges in eradicating malaria in Zimbabwe.

Integrating emerging technologies into COVID-19 contact tracing: Opportunities, challenges and pitfalls.

BACKGROUND AND AIMS: With no approved vaccines for treating COVID-19 as of August 2020, many health systems and governments rely on contact tracing as one of the prevention and containment methods. However, there have been instances when the infected person forgets his/her contact-persons and does not have their contact details. Therefore, this study aimed at analyzing possible opportunities and challenges of integrating emerging technologies into COVID-19 contact tracing. METHODS: The study applied literature search from Google Scholar, Science Direct, PubMed, Web of Science, IEEE and WHO COVID-19 reports and guidelines analyzed. RESULTS: While the integration of technology-based contact tracing applications to combat COVID-19 and break transmission chains promise to yield better results, these technologies face challenges such as technical limitations, dealing with asymptomatic individuals, lack of supporting ICT infrastructure and electronic health policy, socio-economic inequalities, deactivation of mobile devices' WIFI, GPS services, interoperability and standardization issues, security risks, privacy issues, political and structural responses, ethical and legal risks, consent and voluntariness, abuse of contact tracing apps, and discrimination. CONCLUSION: Integrating emerging technologies into COVID-19 contact tracing is seen as a viable option that policymakers, health practitioners and IT technocrats need to seriously consider in mitigating the spread of coronavirus. Further research is also required on how best to improve efficiency and effectiveness in the utilisation of emerging technologies in contact tracing while observing the security and privacy of people in fighting the COVID-19 pandemic.

Effects of COVID-19 in South African health system and society: An explanatory study.

BACKGROUND AND AIMS: The underestimation of the severity of COVID-19 by the South African government resulted in delayed action against the pandemic. Ever since WHO declared COVID-19 a pandemic preventive action was comprehensively upgraded worldwide. This prompted South African authorities to implement physical distancing, self-isolation, closure of non-essential services, schools, travelling restrictions and recursive national lockdowns to mitigate the impact of COVID-19. This explanatory study sought to review the effects of COVID-19 in the South African health system and society. METHODS: The study applied literature research of COVID-19 reports, policies from the National Department of Health, WHO, Africa CDC, and articles from Google Scholar, Science Direct, Web of Science, Scopus and PubMed. RESULTS: The South African health system is affected by the lack of PPEs, increased mortality rates, mental health problems, substance abuse, resurgent of NCDs. The closure of international borders, global demand meltdown, supply disruptions, dramatic scaling down of human and industrial activities during lockdown cause socio-economic problems. The prolonged effects of lockdown on psychosocial support services resulted in the outbursts of uncertainties, acute panic, fear, depression, obsessive behaviours, social unrests, stigmatization, anxiety, increased gender-based violence cases and discrimination in the distribution of relief food aid. CONCLUSION: To slow down the spread of COVID-19, massive testing must be adopted, contact tracing, isolation, and home quarantine guidelines for asymptomatic cases which promote behavioural change and reviewing of policy on food relief.

A critical review of emerging technologies for tackling COVID-19 pandemic.

COVID-19 pandemic affects people in various ways and continues to spread globally. Researches are ongoing to develop vaccines and traditional methods of Medicine and Biology have been applied in diagnosis and treatment. Though there are success stories of recovered cases as of November 10, 2020, there are no approved treatments and vaccines for COVID-19. As the pandemic continues to spread, current measures rely on prevention, surveillance, and containment. In light of this, emerging technologies for tackling COVID-19 become inevitable. Emerging technologies including geospatial technology, artificial intelligence (AI), big data, telemedicine, blockchain, 5G technology, smart applications, Internet of Medical Things (IoMT), robotics, and additive manufacturing are substantially important for COVID-19 detecting, monitoring, diagnosing, screening, surveillance, mapping, tracking, and creating awareness. Therefore, this study aimed at providing a comprehensive review of these technologies for tackling COVID-19 with emphasis on the features, challenges, and country of domiciliation. Our results show that performance of the emerging technologies is not yet stable due to nonavailability of enough COVID-19 dataset, inconsistency in some of the dataset available, nonaggregation of the dataset due to contrasting data format, missing data, and noise. Moreover, the security and privacy of people's health information is not totally guaranteed. Thus, further research is required to strengthen the current technologies and there is a strong need for the emergence of a robust computationally intelligent model for early differential diagnosis of COVID-19.