Precision Global Health - The case of Ebola: a scoping review

Ethical implications related to processing of personal data and artificial intelligence in humanitarian crises: a scoping review

BACKGROUND

Humanitarian organizations are rapidly expanding their use of data in the pursuit of operational gains in effectiveness and efficiency. Ethical risks, particularly from artificial intelligence (AI) data processing, are increasingly recognized yet inadequately addressed by current humanitarian data protection guidelines. This study reports on a scoping review that maps the range of ethical issues that have been raised in the academic literature regarding data processing of people affected by humanitarian crises.

METHODS

We systematically searched databases to identify peer-reviewed studies published since 2010. Data and findings were standardized, grouping ethical issues into the value categories of autonomy, beneficence, non-maleficence, and justice. The study protocol followed Arksey and O'Malley's approach and PRISMA reporting guidelines.

RESULTS

We identified 16,200 unique records and retained 218 relevant studies. Nearly one in three (n = 66) discussed technologies related to AI. Seventeen studies included an author from a lower-middle income country while four included an author from a low-income country. We identified 22 ethical issues which were then grouped along the four ethical value categories of autonomy, beneficence, non-maleficence, and justice. Slightly over half of included studies (n = 113) identified ethical issues based on real-world examples. The most-cited ethical issue (n = 134) was a concern for privacy in cases where personal or sensitive data might be inadvertently shared with third parties. Aside from AI, the technologies most frequently discussed in these studies included social media, crowdsourcing, and mapping tools.

CONCLUSIONS

Studies highlight significant concerns that data processing in humanitarian contexts can cause additional harm, may not provide direct benefits, may limit affected populations' autonomy, and can lead to the unfair distribution of scarce resources. The increase in AI tool deployment for humanitarian assistance amplifies these concerns. Urgent development of specific, comprehensive guidelines, training, and auditing methods is required to address these ethical challenges. Moreover, empirical research from low and middle-income countries, disproportionally affected by humanitarian crises, is vital to ensure inclusive and diverse perspectives. This research should focus on the ethical implications of both emerging AI systems, as well as established humanitarian data management practices.

TRIAL REGISTRATION

Not applicable.

Role of digital technology in epidemic control: a scoping review on COVID-19 and Ebola

OBJECTIVE

To synthesise the role of digital technologies in epidemic control and prevention, focussing on Ebola and COVID-19.

DESIGN

A scoping review.

DATA SOURCES

A systematic search was done on PubMed, HINARI, Web of Science, Google Scholar and a direct Google search until 10 September 2024.

ELIGIBILITY CRITERIA

We included all qualitative and quantitative studies, conference papers or abstracts, anonymous reports, editorial reports and viewpoints published in English.

DATA EXTRACTION AND SYNTHESIS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews checklist was used to select the included study. Data analysis was performed using Gale's framework thematic analysis method, resulting in the identification of key themes.

RESULTS

A total of 64 articles that examined the role of digital technology in the Ebola and COVID-19 pandemics were included in the final review. Five main themes emerged: digital epidemiological surveillance (using data visualisation tools and online sources for early disease detection), rapid case identification, community transmission prevention (via digital contact tracing and assessing interventions with mobility data), public education messages and clinical care. The identified barriers encompassed legal, ethical and privacy concerns, as well as organisational and workforce challenges.

CONCLUSION

Digital technologies have proven good for disease prevention and control during pandemics. While the adoption of these technologies has lagged in public health compared with other sectors, tools such as artificial intelligence, telehealth, wearable devices and data analytics offer significant potential to enhance epidemic responses. However, barriers to widespread implementation remain, and investments in digital infrastructure, training and strong data protection are needed to build trust among users. Future efforts should focus on integrating digital solutions into health systems, ensuring equitable access and addressing ethical concerns. As public health increasingly embraces digital innovations, collaboration among stakeholders will be crucial for effective pandemic preparedness and management.

Enhanced event-based surveillance: Epidemic Intelligence from Open Sources (EIOS) during FIFA World Cup 2022 Qatar

BACKGROUND

Public health threats can significantly impact mass gatherings and enhancing surveillance systems would thus be crucial. Epidemic Intelligence from Open Sources (EIOS) was introduced to Qatar to complement the existing surveillance measures in preparation to the FIFA World Cup Qatar 2022 (FWC22). This study estimated the empirical probability of EIOS detecting signals of public health relevance. It also looked at the factors responsible for discerning a moderate-high risk signal during a mass gathering event.

METHODS

This cross-sectional descriptive study used data collected between November 8th and December 25th, 2022, through an EIOS dashboard that filtered open-source articles using specific keywords. Triage criteria and scoring scheme were developed to capture signals and these were maintained in MS Excel. EIOS' contribution to epidemic intelligence was assessed by the empirical probability estimation of relevant public health signals. Chi-squared tests of independence were performed to check for associations between various hazard categories and other independent variables. A multivariate logistic regression evaluated the predictors of moderate-high risk signals that required prompt action.

RESULTS

The probability of EIOS capturing a signal relevant to public health was estimated at 0.85 % (95 % confidence interval (CI) [0.82 %-0.88 %]) with three signals requiring a national response. The hazard category of the signal had significant association to the region of occurrence (χ2 (5, N = 2543) = 1021.6, p < .001). The hazard category also showed significant association to its detection during matchdays of the tournament (χ2 (5, N = 2543) = 11.2, p < .05). The triage criteria developed was able to discern between low and moderate-high risk signals with an acceptable discrimination (Area Under the Curve=0.79).

CONCLUSION

EIOS proved useful in the early warning of public health threats.

"It's what we perceive as different": an interpretative phenomenological analysis of Nigerian women's characterization of their health during the COVID-19 pandemic

BACKGROUND

Health has historically been adversely affected by social, economic, and political pandemics. In parallel with the spread of diseases, so do the risks of comorbidity and death associated with their consequences. As a result of the current pandemic, shifting resources and services in resource-poor settings without adequate preparation has intensified negative consequences, which global service interruptions have exacerbated. Pregnant women are especially vulnerable during infectious disease outbreaks, and the current pandemic has significantly impacted them.

METHODS

This study used an interpretive phenomenological analysis study with a feminist lens to investigate how women obtained healthcare in Ebonyi, Ogun, and Sokoto states Nigeria during the COVID-19 pandemic. We specifically investigated whether the epidemic influenced women's decisions to seek or avoid healthcare and whether their experiences differed from those outside of it.

RESULTS

We identified three superordinate themes: (1) the adoption of new personal health behaviour in response to the pandemic; (2) the pandemic as a temporal equalizer for marginalized individuals; (3) the impacts of the COVID-19 pandemic on maternal health care. In Nigeria, pregnant women were affected in a variety of ways by the COVID-19 epidemic. Women, particularly those socially identified as disabled, had to cross norms of disadvantage and discrimination to seek healthcare because of the pandemic's impact on prescribed healthcare practices, the healthcare system, and the everyday landscapes defined by norms of disadvantage and discrimination.

CONCLUSION

It is clear from the current pandemic that stakeholders must begin to strategize and develop plans to limit the effects of future pandemics on maternal healthcare, particularly for low-income women.

Learning from digital health investments during COVID-19 vaccine program implementation: a research collaboration and theory of change

Responses to recent epidemics provide critical lessons on how the use of digital technologies and data systems can support timely and evidence-driven responses to public health emergencies. The arrival of COVID-19 and, subsequently, the COVID-19 vaccine, compelled many countries to attempt to create digitized, individual-level records on a large scale and quickly. In 2022, the United States Agency for International Development (USAID) brought together four global USAID-funded projects to explore whether and how USAID's COVID-19 vaccine data and digital health investments supporting the emergency response strengthened the digital health enabling environment and, by extension, contributed to broader health system strengthening. Each project designed and implemented individual learning activities aligned to their specific USAID-funded COVID-19 vaccine response activities. The group collaboratively developed a theory of change to explore the potential relationship between COVID-19 vaccine-related digital and data investments and their immediate COVID-19 response, as well as two intermediate- and longer-term impact pathways: one focused on COVID-19-specific outcomes and impact, and a second focused on strengthening the digital health enabling environment and broader health system. The focus of this supplement is primarily to explore the theory of change associated with this latter pathway. Recognizing that health emergencies triggered by shocks due to disease outbreaks, climate change and conflict are likely to continue to characterize the environment in which health programs are delivered, this research seeks to contribute to a better understanding of how digital technologies and data systems can be most effectively leveraged to meet immediate needs while strengthening country resilience over the long term. Abrégé Les réponses aux récentes épidémies ont permis de tirer d'importants enseignements sur la façon dont le recours aux technologies numériques et aux systèmes de données peut appuyer le déclenchement rapide d'interventions fondées sur des éléments probants contre les urgences de santé publique. L'arrivée de la COVID-19 et, par la suite, celui du vaccin contre la COVID-19 ont contraint de nombreux pays à tenter de créer des dossiers numérisés au niveau individuel à grande échelle et rapidement. En 2022, l'United States Agency for International Development (USAID) a rassemblé quatre projets mondiaux qu'elle finançait dans le but d'explorer si et comment les données de l'USAID relatives au vaccin contre la COVID-19 ainsi que les investissements en santé numérique appuyant la réponse d'urgence avaient renforcé l'environnement propice à la santé numérique et, par extension, s'ils avaient contribué au renforcement du système de santé dans son ensemble. Chaque projet a conçu et mis en œuvre des activités d'apprentissage individuelles alignées sur leurs activités spécifiques de riposte au vaccin contre la COVID-19 financées par l'USAID. Le groupe a collaboré pour élaborer une théorie du changement afin d'étudier la relation potentielle entre les investissements dans le numérique et dans les données liées au vaccin contre la COVID-19 et leur réponse immédiate à la COVID-19 ainsi que deux itinéraires d'impact à moyen et à long terme: l'un était axé sur l'impact et les résultats spécifiques à la COVID-19 et le second sur le renforcement de l'environnement propice à la santé numérique et du système de santé dans son ensemble. Ce supplément a pour objectif principal d'examiner la théorie du changement associée à ce dernier itinéraire. Reconnaissant qu'il est probable que les conflits, les changements climatiques et les urgences sanitaires causées par des chocs dus à des épidémies continueront de caractériser l'environnement dans lequel sont offerts les programmes de santé, cette recherche vise à mieux faire comprendre la façon dont les technologies numériques et les systèmes de données peuvent être exploités le plus efficacement possible pour répondre aux besoins immédiats tout en renforçant la capacité de résilience des pays sur le long terme. Resumen Las respuestas a las epidemias recientes proporcionan lecciones críticas sobre cómo se puede apoyar respuestas oportunas y de base empírica a las emergencias de salud pública mediante el uso de tecnologías digitales y sistemas de datos. La llegada de la COVID-19 y, posteriormente, la vacuna contra esa enfermedad, obligó a muchos países a tratar de crear registros individuales digitalizados, a gran escala y rápidamente. En 2022, United States Agency for International Development (USAID) reunió cuatro proyectos globales que había financiado para estudiar si sus datos sobre la vacuna contra la COVID-19 y las inversiones en salud digital en apoyo de la respuesta de emergencia habían fortalecido el entorno propicio para la salud digital y, por extensión, si habían contribuido a fortalecer el sistema de salud en general, y de qué forma lo habían hecho. En cada proyecto se habían diseñado e implementado actividades de aprendizaje individuales, acordes con las actividades específicas de respuesta vacunal financiadas por USAID. El grupo desarrolló en forma colaborativa una teoría del cambio para analizar la posible relación entre las inversiones digitales y de datos y la vacuna contra la COVID-19 y su respuesta inmediata a la pandemia, así como dos vías de impacto a mediano y largo plazo: una primera centrada en los resultados y efectos específicos en la pandemia, y una segunda centrada en fortalecer el entorno propicio para la salud digital y un sistema de salud más amplio. El enfoque de este suplemento consiste principalmente en examinar la teoría del cambio vinculada con esta última vía. Reconociendo que es probable que las emergencias sanitarias provocadas por los brotes de enfermedades, el cambio climático y los conflictos continúen caracterizando el entorno en el que se ejecutan los programas de salud, esta investigación busca ayudar a que se comprenda mejor la forma en que las tecnologías digitales y los sistemas de datos pueden aprovecharse de manera más efectiva para satisfacer las necesidades inmediatas, fortaleciendo la resiliencia de los países a largo plazo.

Precision public health, the key for future outbreak management: A scoping review

Background

Precision Public Health (PPH) is a newly emerging field in public health medicine. The application of various types of data allows PPH to deliver more tailored interventions to a specific population within a specific timeframe. However, the application of PPH possesses several challenges and limitations that need to be addressed.

Objective

We aim to provide evidence of the various use of PPH in outbreak management, the types of data that could be used in PPH application, and the limitations and barriers in the application of the PPH approach.

Methods and analysis

Articles were searched in PubMed, Web of Science, and Science Direct. Our selection of articles was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Scoping Review guidelines. The outcome of the evidence assessment was presented in narrative format instead of quantitative.

Results

A total of 27 articles were included in the scoping review. Most of the articles (74.1%) focused on PPH applications in performing disease surveillance and signal detection. Furthermore, the data type mostly used in the studies was surveillance (51.9%), environment (44.4), and Internet query data. Most of the articles emphasized data quality and availability (81.5%) as the main barriers in PPH applications followed by data integration and interoperability (29.6%).

Conclusions

PPH applications in outbreak management utilize a wide range of data sources and analytical techniques to enhance disease surveillance, investigation, modeling, and prediction. By leveraging these tools and approaches, PPH contributes to more effective and efficient outbreak management, ultimately reducing the burden of infectious diseases on populations. The limitation and challenges in the application of PPH approaches in outbreak management emphasize the need to strengthen the surveillance systems, promote data sharing and collaboration among relevant stakeholders, and standardize data collection methods while upholding privacy and ethical principles.

Predicting the combined effects of case isolation, safe funeral practices, and contact tracing during Ebola virus disease outbreaks

BACKGROUND

The recent outbreaks of Ebola virus disease (EVD) in Uganda and the Marburg virus disease (MVD) in Ghana reflect a persisting threat of Filoviridae to the global health community. Characteristic of Filoviridae are not just their high case fatality rates, but also that corpses are highly contagious and prone to cause infections in the absence of appropriate precautions. Vaccines against the most virulent Ebolavirus species, the Zaire ebolavirus (ZEBOV) are approved. However, there exists no approved vaccine or treatment against the Sudan ebolavirus (SUDV) which causes the current outbreak of EVD. Hence, the control of the outbreak relies on case isolation, safe funeral practices, and contact tracing. So far, the effectiveness of these control measures was studied only separately by epidemiological models, while the impact of their interaction is unclear.

METHODS AND FINDINGS

To sustain decision making in public health-emergency management, we introduce a predictive model to study the interaction of case isolation, safe funeral practices, and contact tracing. The model is a complex extension of an SEIR-type model, and serves as an epidemic preparedness tool. The model considers different phases of the EVD infections, the possibility of infections being treated in isolation (if appropriately diagnosed), in hospital (if not properly diagnosed), or at home (if the infected do not present to hospital for whatever reason). It is assumed that the corpses of those who died in isolation are buried with proper safety measures, while those who die outside isolation might be buried unsafely, such that transmission can occur during the funeral. Furthermore, the contacts of individuals in isolation will be traced. Based on parameter estimates from the scientific literature, the model suggests that proper diagnosis and hence isolation of cases has the highest impact in reducing the size of the outbreak. However, the combination of case isolation and safe funeral practices alone are insufficient to fully contain the epidemic under plausible parameters. This changes if these measures are combined with contact tracing. In addition, shortening the time to successfully trace back contacts contribute substantially to contain the outbreak.

CONCLUSIONS

In the absence of an approved vaccine and treatment, EVD management by proper and fast diagnostics in combination with epidemic awareness are fundamental. Awareness will particularly facilitate contact tracing and safe funeral practices. Moreover, proper and fast diagnostics are a major determinant of case isolation. The model introduced here is not just applicable to EVD, but also to other viral hemorrhagic fevers such as the MVD or the Lassa fever.

Digital health technology used in emergency large-scale vaccination campaigns in low- and middle-income countries: a narrative review for improved pandemic preparedness

INTRODUCTION

Large-scale vaccination campaigns can benefit from using digital health tools, particularly in low- and middle-income countries (LMICs). Selecting the best tool to fit into a pre-existing digital landscape can be challenging.

AREAS COVERED

We conducted a narrative review in PubMed and the grey literature for data available within 5 years to provide an overview of digital health tools used in large-scale vaccination campaigns for outbreak response in LMICs. We discuss tools used along the typical steps of a vaccination process. Digital tool functionalities and technical specifications, open-source options, data privacy and security concerns, and lessons learned from the use of these tools are discussed.

EXPERT OPINION

The landscape of digital health tools for large-scale vaccination processes in LMICs is growing. For efficient implementation, countries should prioritize the appropriate tool(s) depending on their needs and available resources, develop a robust framework around data privacy and security, and select sustainable features. Improving internet connectivity and digital literacy in LMICs will facilitate adoption. This review may aid LMICs still needing to prepare large-scale vaccination campaigns in the selection of supporting digital health tools. Further research on impact and cost-effectiveness is needed.

Diagnostics of Ebola virus

Ebola is a highly pathogenic virus, which in humans reaches a mortality rate above 50%. Due to a lack of laboratories in territories where Ebola viruses are endemic and the limited number of surveillance programmes, tests for the confirmation of suspected cases of Ebola are often performed in Reference Laboratories. While this provides guarantees regarding the accuracy of results, the shipment of samples to a centralized facility where the diagnostic test can be performed and the time required to achieve the results takes several days, which increases costs and entails delays in the isolation of positive subjects and therapeutic intervention with negative consequences both for patients and the community. Molecular tests have been the most frequently used tool in Ebola diagnosis in recent outbreaks. One of the most commonly used molecular tests is the Real-Star Altona, which targets a conserved area of the L gene. This assay showed different sensitivities depending on the Ebola virus: 471 copies/mL (EBOV) and 2871 copies/ml (SUDAN virus). The Cepheid system also showed good sensitivity (232 copies/mL). The LAMP platform is very promising because, being an isothermal reaction, it does not require high-precision instrumentation and can be considered a Point of Care (PoC) tool. Its analytical sensitivity is 1 copy/reaction. However, since data from real life studies are not yet available, it is premature to give any indications on its feasibility. Moreover, in November 2014, the WHO recommended the development of rapid diagnostic tests (RDT) according to ASSURED criteria. Several RDT assays have since been produced, most of which are rapid tests based on the search for antibody anti-Ebola viral proteins with immunochromatographic methods. Several viral antigens are used for this purpose: VP40, NP and GP. These assays show different sensitivities according to the protein used: VP40 57.4-93.1%, GP 53-88.9% and 85% for NP compared to reference molecular assays. From these results, it can be deduced that no RDT reaches the 99% sensitivity recommended by the WHO and therefore any RDT negative results in suspected cases should be confirmed with a molecular test.

Global health and health security - conflicting concepts for achieving stability through health?

Global health has become fashionable and an important topic on the international policy agenda. Even before the COVID-19 pandemic, cross-border infectious diseases had provoked a great deal of media and public interest, academic research and foreign-policy agendas. This paper analyses the relevance of health security in global health. It stresses global health as an explicitly political concept taking into consideration existing inequalities and power asymmetries. Global health represents the necessary evolution of public health in the face of ubiquitous global challenges and the growing number of international players. Some of them tend to divert global health towards technification, marketisation and privatisation, promoting biomedical reductionism and predominantly technological solutions. Overall, the current global health concept fails to adequately consider the global burden of disease, which is largely determined by non-communicable conditions. Global health goes beyond preventing infectious diseases and health security and must first and foremost focus on the social, economic, ecologic and political determination of health, which interacts with non-communicable and communicable diseases, turning them into syndemics. Health-in-all policies in a global perspective are required for sustainably reducing health inequalities within and between countries, instead of primarily focusing on security and safeguarding the status quo in a changing world.

Digital health for quality healthcare: A systematic mapping of review studies

Objective

To systematically catalogue review studies on digital health to establish extent of evidence on quality healthcare and illuminate gaps for new understanding, perspectives and insights for evidence-informed policies and practices.

Methods

We systematically searched PubMed database using sensitive search strings. Two reviewers independently conducted two-phase selection via title and abstract, followed by full-text appraisal. Consensuses were derived for any discrepancies. A standardized data extraction tool was used for reliable data mining.

Results

A total of 54 reviews from year 2014 to 2021 were included with notable increase in trend of publications. Systematic reviews constituted the majority (61.1%, (37.0% with meta-analyses)) followed by scoping reviews (38.9%). Domains of quality being reviewed include effectiveness (75.9%), accessibility (33.3%), patient safety (31.5%), efficiency (25.9%), patient-centred care (20.4%) and equity (16.7%). Mobile apps and computer-based were the commonest (79.6%) modalities. Strategies for effective intervention via digital health included engineering improved health behaviour (50.0%), better clinical assessment (35.1%), treatment compliance (33.3%) and enhanced coordination of care (24.1%). Psychiatry was the discipline with the most topics being reviewed for digital health (20.3%).

Conclusion

Digital health reviews reported findings that were skewed towards improving the effectiveness of intervention via mHealth applications, and predominantly related to mental health and behavioural therapies. There were considerable gaps on review of evidence on digital health for cost efficiency, equitable healthcare and patient-centred care. Future empirical and review studies may investigate the association between fields of practice and tendency to adopt and research the use of digital health to improve care.

Data and Digital Solutions to Support Surveillance Strategies in the Context of the COVID-19 Pandemic

Background: In order to prevent spread and improve control of infectious diseases, public health experts need to closely monitor human and animal populations. Infectious disease surveillance is an established, routine data collection process essential for early warning, rapid response, and disease control. The quantity of data potentially useful for early warning and surveillance has increased exponentially due to social media and other big data streams. Digital epidemiology is a novel discipline that includes harvesting, analysing, and interpreting data that were not initially collected for healthcare needs to enhance traditional surveillance. During the current COVID-19 pandemic, the importance of digital epidemiology complementing traditional public health approaches has been highlighted. Objective: The aim of this paper is to provide a comprehensive overview for the application of data and digital solutions to support surveillance strategies and draw implications for surveillance in the context of the COVID-19 pandemic and beyond. Methods: A search was conducted in PubMed databases. Articles published between January 2005 and May 2020 on the use of digital solutions to support surveillance strategies in pandemic settings and health emergencies were evaluated. Results: In this paper, we provide a comprehensive overview of digital epidemiology, available data sources, and components of 21st-century digital surveillance, early warning and response, outbreak management and control, and digital interventions. Conclusions: Our main purpose was to highlight the plausible use of new surveillance strategies, with implications for the COVID-19 pandemic strategies and then to identify opportunities and challenges for the successful development and implementation of digital solutions during non-emergency times of routine surveillance, with readiness for early-warning and response for future pandemics. The enhancement of traditional surveillance systems with novel digital surveillance methods opens a direction for the most effective framework for preparedness and response to future pandemics.

Digital Technology-Based Telemedicine for the COVID-19 Pandemic

In the year 2020, the coronavirus disease 2019 (COVID-19) crisis intersected with the development and maturation of several digital technologies including the internet of things (IoT) with next-generation 5G networks, artificial intelligence (AI) that uses deep learning, big data analytics, and blockchain and robotic technology, which has resulted in an unprecedented opportunity for the progress of telemedicine. Digital technology-based telemedicine platform has currently been established in many countries, incorporated into clinical workflow with four modes, including "many to one" mode, "one to many" mode, "consultation" mode, and "practical operation" mode, and has shown to be feasible, effective, and efficient in sharing epidemiological data, enabling direct interactions among healthcare providers or patients across distance, minimizing the risk of disease infection, improving the quality of patient care, and preserving healthcare resources. In this state-of-the-art review, we gain insight into the potential benefits of demonstrating telemedicine in the context of a huge health crisis by summarizing the literature related to the use of digital technologies in telemedicine applications. We also outline several new strategies for supporting the use of telemedicine at scale.

Systematic Review and Meta-Analysis of the Diagnostic Accuracy of Mobile-Linked Point-of-Care Diagnostics in Sub-Saharan Africa

Mobile health devices are emerging applications that could help deliver point-of-care (POC) diagnosis, particularly in settings with limited laboratory infrastructure, such as Sub-Saharan Africa (SSA). The advent of Severe acute respiratory syndrome coronavirus 2 has resulted in an increased deployment and use of mHealth-linked POC diagnostics in SSA. We performed a systematic review and meta-analysis to evaluate the accuracy of mobile-linked point-of-care diagnostics in SSA. Our systematic review and meta-analysis were guided by the Preferred Reporting Items requirements for Systematic Reviews and Meta-Analysis. We exhaustively searched PubMed, Science Direct, Google Scholar, MEDLINE, and CINAHL with full text via EBSCOhost databases, from mHealth inception to March 2021. The statistical analyses were conducted using OpenMeta-Analyst software. All 11 included studies were considered for the meta-analysis. The included studies focused on malaria infections, Schistosoma haematobium, Schistosoma mansoni, soil-transmitted helminths, and Trichuris trichiura. The pooled summary of sensitivity and specificity estimates were moderate compared to those of the reference representing the gold standard. The overall pooled estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of mobile-linked POC diagnostic devices were as follows: 0.499 (95% CI: 0.458–0.541), 0.535 (95% CI: 0.401–0.663), 0.952 (95% CI: 0.60–1.324), 1.381 (95% CI: 0.391–4.879), and 0.944 (95% CI: 0.579–1.538), respectively. Evidence shows that the diagnostic accuracy of mobile-linked POC diagnostics in detecting infections in SSA is presently moderate. Future research is recommended to evaluate mHealth devices’ diagnostic potential using devices with excellent sensitivities and specificities for diagnosing diseases in this setting.

Differential Laboratory Diagnosis of Acute Fever in Guinea: Preparedness for the Threat of Hemorrhagic Fevers

Acute febrile illnesses occur frequently in Guinea. Acute fever itself is not a unique, hallmark indication (pathognomonic sign) of any one illness or disease. In the infectious disease context, fever's underlying cause can be a wide range of viral or bacterial pathogens, including the Ebola virus. In this study, molecular and serological methods were used to analyze samples from patients hospitalized with acute febrile illness in various regions of Guinea. This analysis was undertaken with the goal of accomplishing differential diagnosis (determination of causative pathogen) in such cases. As a result, a number of pathogens, both viral and bacterial, were identified in Guinea as causative agents behind acute febrile illness. In approximately 60% of the studied samples, however, a definitive determination could not be made.

Virtually Serving the Underserved: Resident Perceptions of Telemedicine Use While Training During Coronavirus Disease 2019

Background: To adapt during the coronavirus disease 2019 (COVID-19) pandemic, a large safety-net hospital in Atlanta, Georgia and other hospitals across the United Sates, increased telemedicine (TM) for outpatient visits. The impact on resident physicians, including minority providers, had not yet been reported. We aimed to assess how primary care residents perceived increased TM in clinics during the pandemic, and assess resident burnout. Materials and Methods: An online survey was sent to 60 internal medicine (IM) and 18 family medicine (FM) residents who used TM to treat underserved patients, from March to May 2020, at the onset of the COVID-19 pandemic. The questionnaire included questions on resident demographics, satisfaction with TM, screening capability for COVID-19, effectiveness for patient education on COVID-19, impact on patient interactions and time management. Burnout was assessed with the Abbreviated Maslach Burnout Inventory. Results: A majority (62 of 78) eligible residents (79.5%) responded to the survey. Ninety-one percent of residents agreed that TM was a secure alternative to face-to-face encounters. Seventy-nine percent used it to screen for signs/symptoms of COVID-19 and 93% provided patient education on COVID-19. Average visit length decreased by 10-20 min with TM. Post-TM, scores for overall burnout were decreased (p = 0.0003) and less residents in total exhibited burnout (p = 0.0156). Discussion and Conclusions: IM and FM residents viewed TM as an efficient way to screen for and provide education on COVID-19, as well as a secure alternative to face-to-face encounters. With increased used of TM during COVID-19, there was decreased burnout among primary care residents.

Mobile health applications for disease screening and treatment support in low-and middle-income countries: A narrative review

The advances in mobile technologies and applications are driving the transformation in health services delivery globally. Mobile phone penetration is increasing exponentially in low-and middle-income countries, hence using mobile phones for healthcare services could reach more people in resource-limited settings than the traditional forms of healthcare provision. The review presents recent literature on facilitators and barriers of implementing mHealth for disease screening and treatment support in low-and middle-income countries. We searched for relevant literature from the following electronic databases: MEDLINE; CINAHL with full text via EBSCOhost; Science Direct; PubMed; Google Scholar and Web of Science using the keywords for relevant studies. We searched for published studies from 2015 to August 2020 with no language limitations. A total of 721 articles identified, 125 articles met the inclusion criteria and were included in the qualitative synthesis. The review demonstrates relevant facilitators for the implementation of mHealth, which includes knowledge, attitudes, and perceptions of stakeholders on the use of mHealth and the performance of mHealth for disease diagnosis in low and-middle-income countries. Barriers and challenges hindering the implementation of mHealth applications were also identified. We proposed a framework for improving the implementation of mHealth for disease screening and treatment support in low-and middle-income countries.

Characteristics and Symptoms of App Users Seeking COVID-19-Related Digital Health Information and Remote Services: Retrospective Cohort Study

BACKGROUND

Patient-facing digital health tools have been promoted to help patients manage concerns related to COVID-19 and to enable remote care and self-care during the COVID-19 pandemic. It has also been suggested that these tools can help further our understanding of the clinical characteristics of this new disease. However, there is limited information on the characteristics and use patterns of these tools in practice.

OBJECTIVE

The aims of this study are to describe the characteristics of people who use digital health tools to address COVID-19-related concerns; explore their self-reported symptoms and characterize the association of these symptoms with COVID-19; and characterize the recommendations provided by digital health tools.

METHODS

This study used data from three digital health tools on the K Health app: a protocol-based COVID-19 self-assessment, an artificial intelligence (AI)-driven symptom checker, and communication with remote physicians. Deidentified data were extracted on the demographic and clinical characteristics of adults seeking COVID-19-related health information between April 8 and June 20, 2020. Analyses included exploring features associated with COVID-19 positivity and features associated with the choice to communicate with a remote physician.

RESULTS

During the period assessed, 71,619 individuals completed the COVID-19 self-assessment, 41,425 also used the AI-driven symptom checker, and 2523 consulted with remote physicians. Individuals who used the COVID-19 self-assessment were predominantly female (51,845/71,619, 72.4%), with a mean age of 34.5 years (SD 13.9). Testing for COVID-19 was reported by 2901 users, of whom 433 (14.9%) reported testing positive. Users who tested positive for COVID-19 were more likely to have reported loss of smell or taste (relative rate [RR] 6.66, 95% CI 5.53-7.94) and other established COVID-19 symptoms as well as ocular symptoms. Users communicating with a remote physician were more likely to have been recommended by the self-assessment to undergo immediate medical evaluation due to the presence of severe symptoms (RR 1.19, 95% CI 1.02-1.32). Most consultations with remote physicians (1940/2523, 76.9%) were resolved without need for referral to an in-person visit or to the emergency department.

CONCLUSIONS

Our results suggest that digital health tools can help support remote care and self-management of COVID-19 and that self-reported symptoms from digital interactions can extend our understanding of the symptoms associated with COVID-19.

The Importance of Developing Rigorous Social Science Methods for Community Engagement and Behavior Change During Outbreak Response

Despite growing international attention, the anthropological and socio-behavioral elements of epidemics continue to be understudied and under resourced and lag behind the traditional outbreak response infrastructure. As seen in the current 2019 coronavirus disease (COVID-19) pandemic, the importance of socio-behavioral elements in understanding transmission and facilitating control of many outbreak-prone pathogens, this is problematic. Beyond the recent strengthening of global outbreak response capacities and global health security measures, a greater focus on the socio-behavioral components of outbreak response is required. We add to the current discussion by briefly highlighting the importance of socio-behavior in the Ebola virus disease (EVD) response, and describe vital areas of future development, including methods for community engagement and validated frameworks for behavioral modeling and change in outbreak settings.

Global Health - emergence, hegemonic trends and biomedical reductionism

Background

Global Health has increasingly gained international visibility and prominence. First and foremost, the spread of cross-border infectious disease arouses a great deal of media and public interest, just as it drives research priorities of faculty and academic programmes. At the same time, Global Health has become a major area of philanthropic action. Despite the importance it has acquired over the last two decades, the complex collective term “Global Health” still lacks a uniform use today.

Objectives

The objective of this paper is to present the existing definitions of Global Health, and analyse their meaning and implications. The paper emphasises that the term “Global Health” goes beyond the territorial meaning of “global”, connects local and global, and refers to an explicitly political concept. Global Health regards health as a rights-based, universal good; it takes into account social inequalities, power asymmetries, the uneven distribution of resources and governance challenges. Thus, it represents the necessary continuance of Public Health in the face of diverse and ubiquitous global challenges. A growing number of international players, however, focus on public-private partnerships and privatisation and tend to promote biomedical reductionism through predominantly technological solutions. Moreover, the predominant Global Health concept reflects the inherited hegemony of the Global North. It takes insufficient account of the global burden of disease, which is mainly characterised by non-communicable conditions, and the underlying social determinants of health.

Conclusions

Beyond resilience and epidemiological preparedness for preventing cross-border disease threats, Global Health must focus on the social, economic and political determinants of health. Biomedical and technocratic reductionism might be justified in times of acute health crises but entails the risk of selective access to health care. Consistent health-in-all policies are required for ensuring Health for All and sustainably reducing health inequalities within and among countries. Global Health must first and foremost pursue the enforcement of the universal right to health and contribute to overcoming global hegemony.

The Use of Digital Health in the Detection and Management of COVID-19

Digital health is uniquely positioned to enhance the way we detect and manage infectious diseases. This commentary explores the potential of implementing digital technologies that can be used at different stages of the COVID-19 outbreak, including data-driven disease surveillance, screening, triage, diagnosis, and monitoring. Methods that could potentially reduce the exposure of healthcare providers to the virus are also discussed.

China-UK partnership for global health: practices and implications of the Global Health Support Programme 2012-2019

Background

Over the past few decades, a series of major challenges to global health have successively emerged, which call for China’s deeper engagement in global health governance. In this context, the China-UK Global Health Support Programme (GHSP) was launched in 2012 with about 12 million pounds funded by the United Kingdom.

Objectives

The GHSP was expected to explore a new type of China-UK partnership to strengthen the cooperation in global health, and enhance China’s capacity to engage in global health governance and provide effective development assistance in health (DAH), in order to jointly improve global health outcomes.

Programme design and implementation

The GHSP was programmed to support capacity building activities in Chinese experience distillation, DAH, global health governance and pilot partnership at national and institutional levels between October 2012 and March 2019. These activities were assigned to different project implementing agencies (PIAs) and their project cooperative agencies (PCAs) or pilot areas, and were then implemented under the guidance and management by the strategic oversight committee and the project management office of GHSP respectively.

Main achievements

At the national level, the GHSP held five rounds of China-UK high-level dialogues, conducted studies on China Global Health Strategies to provide robust evidence for developing and issuing relevant national policies, and supported the establishment of the China Global Health Network. At the institutional level, the GHSP funded a series of activities in research, training, international exchange and pilots etc., produced a large number of high-quality research outputs and policy briefings, cultivated a group of PIAs and individual researchers, facilitated the partnership building between the PIAs and PCAs, enhanced the practical ability of Chinese institutions to conduct overseas DAH, and improved the health service delivery and outcomes in pilot areas of three Asian and African countries.

Policy implications

In the GHSP, China and UK have established a good model for North-South Cooperation and the programme facilitated the 2030 Agenda for Sustainable Development by building a new type of bilateral partnership and carrying out triangular cooperation practices. This model has demonstrated huge potential for cooperation through partnership and can also be referred to by other countries to develop bilateral partnerships.