Journal of Health Informatics in Africa (J Health Inform Afr) is an official journal of the Pan African Health Informatics Association (HELINA) published by Koegni-eHealth Innovation for Development
The Journal of Health Informatics in Africa (JHIA) is dedicated to publishing innovative, high-quality research that explores the use of information and communication technologies (ICTs) to address healthcare challenges in Africa. To maintain the journal’s integrity and commitment to originality, all submissions undergo a meticulous screening process. As part of this process, a Turnitin report is generated for each manuscript before it is assigned to reviewers. Only submissions with a Turnitin similarity index below 15% are considered for review. Manuscripts exceeding this threshold are promptly rejected. We urge authors to ensure their work is both original and unpublished prior to submission. Once a manuscript qualifies for review, it is subjected to a rigorous double-blind peer review process. This review determines whether the submission will be accepted, revised, or rejected. For manuscripts that are accepted, a second round of peer review is often required. Authors must carefully address the reviewers’ feedback and resubmit their revised manuscript for further evaluation. Final acceptance is granted only when both the reviewers and the editorial team are fully satisfied with the revisions, ensuring the publication of work that meets the highest scholarly standards. This issue features six insightful papers: Chumba, Waema, and Ochieng conducted a scoping review of 29 studies on Health Information Technology governance, highlighting its mechanisms, applications in hospital and national healthcare systems, and identifying gaps in community-level governance and alignment practices. Ssegujja, Msanjila, and Shao conducted a systematic literature review to evaluate frameworks for maternal e-service delivery in resource-constrained settings, highlighting limitations in current approaches, such as reliance on traditional methods, and proposing a conceptual framework to enhance maternal healthcare through technology-driven solutions. Ogundare demonstrated that tree-based machine learning models, particularly random forest and bagging classifiers, outperform non-tree-based algorithms in accurately subtyping renal cell carcinoma using RNA-seq gene expression data, highlighting their potential for improving personalized cancer treatment. Mwesigwa, Nakibuuka, Wanyana, Waiswa, Serubugo, and Tumwesigye evaluated the usability of a DHIS2-based cancer reporting system at Mbarara Regional Referral Hospital, finding it improved access to comprehensive cancer data with a high usability score, and recommending its scale-up to other regional hospitals. Gokula Chandar, Shanmugam, Vijayakumar, Sugumaran, Senthil, and Srinivasulu and Lakshmi developed a Smart Medical System using LoRaWAN and ESP32 microcontrollers to securely monitor and transmit encrypted health data in real-time, enabling remote access and efficient alerts for caregivers and doctors. Boateng, Agyapong, Dorson, Avuglah, and Nigre utilized a Random Forest model to predict malaria outbreaks in Ghanaian children under five, achieving strong accuracy while identifying regional disparities and emphasizing the potential of machine learning for targeted public health interventions. I extend my heartfelt thanks to the editorial team, authors, and peer reviewers for their unwavering dedication and efforts in bringing this issue to fruition. I also invite health informatics researchers to connect with me regarding opportunities to join JHIA's esteemed panel of reviewers. Your expertise and insights are vital in upholding the rigorous standards and excellence that define the research published in our journal. Thank you for your continued support of JHIA. Nicky Mostert June 2025
Copyright (c) 2025 Journal of Health Informatics in Africa
Improving Cancer Data Availability Within Routine Reporting Systems in a Low-Income Setting: A Case of Mbarara Regional Referral Hospital, Uganda
Background and purpose: Worldwide, an estimated 19.3 million new cancer cases and almost 10.0 million cancer deaths occurred in 2020. In the same year, 801,392 new cancer cases and 520,158 cancer deaths occurred in sub-Saharan Africa where cancer survival is even disproportionately lower. In Uganda, there is limited knowledge about the usability levels of national electronic reporting systems with patient-level cancer data. Such data guide operational planning, track progress and performance over time, evaluate and understand cancer risk factors, study phenomena, explore relationships, test hypotheses, or draw meaningful conclusions. This study intended to fix the knowledge gap on the usability level of a routine electronic reporting system using standard tools. Objective: To determine the usability of the developed reporting system at a cancer unit in a low-resource setting. Methods: This observational study used a design science approach, configuring the Maintenance application and Tracker domains in DHIS2 version 2.40.3. Retrospective records of 104 new cancer cases were purposively selected and entered into the instance. The mean usability score was determined using the system usability scale (SUS). Results: A mean SUS score of 72.34 (SD 11.23) was obtained at a 76.19% response rate. Most respondents were male (75%) with a mean age of 30.81 (SD 7.4). Conclusions: A web-based DHIS2 instance made cancer data available and accessible. There is a need to scale the instance to the remaining 15 regional hospitals out of 17, use prospective programmatic data in future studies, and conduct system pre-training to improve user engagement.
Editorial to JHIA Vol. 11(2024) Issue 3 Nicky Mostert Nelson Mandela University, Port Elizabeth, South Africa The Journal of Health Informatics in Africa (JHIA) is committed to publishing original, high-quality research focused on the application of information and communication technologies (ICTs) in the African healthcare sector. To uphold the integrity and originality of the journal, each submission undergoes a thorough process that includes obtaining a Turnitin report prior to assignment to reviewers. Submissions are only considered for review if their Turnitin similarity index is below 15%. Any manuscript exceeding this threshold is immediately rejected. We strongly encourage authors to ensure that their work is original and has not been published elsewhere before submission to JHIA. Once a paper is accepted for review, it undergoes a rigorous double-blind review process. This may result in either acceptance or rejection. In cases of acceptance, most submissions are subjected to a second round of peer review. Authors are required to revise their manuscripts based on reviewer feedback and resubmit them for further evaluation by the same reviewers. Only once both the reviewers and the editorial team are satisfied with the revisions is the paper formally accepted for publication. This issue features three insightful papers: Eleke, Nwaneri, Okoronkwo, and Samuel present a comprehensive review comparing paper-based and software-assisted nursing documentation, focusing on data precision and timeliness. Kigombola and Mahundi explore the use cases, approaches, and challenges associated with the implementation of blockchain technology in the healthcare sectors of low- and middle-income countries. Mwogosi, Kibusi, and Shaoa share insights into primary healthcare practitioners' perceptions of the effectiveness of electronic health record systems for decision support in Tanzania. I would like to extend my deepest gratitude to the editorial team, authors, and peer reviewers whose hard work has made this issue possible. I also encourage researchers engaged in health informatics to contact me about becoming reviewers for JHIA. The expertise of experienced researchers is crucial to maintaining the high quality of research published in our journal. Thank you for your continued support of JHIA. Nicky Mostert December 2024
Copyright (c) 2024 Journal of Health Informatics in Africa
Predicting Malaria Outbreaks in Children Under Five: Insights from Ghana
Background and Purpose: Malaria, a persistent public health challenge in sub-Saharan Africa, disproportionately affects children under five, with socio-economic disparities and environmental factors exacerbating its burden. This study seeks to identify patterns that serve as early indicators of potential outbreaks, thus enhancing the country’s ability to allocate resources efficiently and improve early warning systems. Methods: This study employs the Random Forest algorithm to predict malaria outbreaks using historical incidence data from Ghana (2011–2021). Results: By incorporating lagged variables and analyzing spatial and temporal dynamics, the model captures seasonality, including peaks during rainy seasons and regional disparities in malaria cases. The model achieved a robust R-squared value of 0.8193, reflecting substantial predictive accuracy. Regional hotspots such as Ashanti and Western exhibited higher case numbers than Greater Accra, emphasizing the need for localized interventions. Conclusions: The study demonstrates the potential of Random Forest as a scalable tool for malaria prediction in resource-constrained settings, enabling data-driven decision-making and optimizing public health resources. These findings align with global malaria reduction goals, emphasizing the integration of machine learning into public health strategies to reduce morbidity and mortality in vulnerable populations.
Smart Medical System for Trusted LoRaWAN Server
leading tech of LoRaWAN in Smart Medical System (SMS) measures the human health parameters with no laboratory diagnosis. The system uses an ESP32 microcontroller and bio-sensors to examine the human physiological conditions based on environmental factors using low power components but provides a seamless experience with long-range communication modules (LoRa). Monitored data is centralized in a server that can be accessed securely from remote place. The main goal of this paper is to implement the patient’s health records maintenance with end-to-end encrypted data using consensus algorithms. An Authorized person only accesses encrypted data with the private key through decentralization. Simultaneously, the proposed system introduces an efficient method to get alert messages from the patient that enables sharing the predicted data in real-time to the caretaker and hospital doctor.
A Tree-based Machine Learning Approach for Precise Renal Cell Carcinoma Subtyping using RNA-seq Gene Expression Data
Background and Purpose: Renal cell carcinoma (RCC) is a malignant neoplasm of the kidneys, characterized by distinct molecular and histological subtypes. Accurate subtyping is crucial for personalized treatment and improved patient outcomes. High-throughput sequencing has enabled precise gene expression profiling for cancer classification. This study compares tree-based and non-tree-based machine learning algorithms for differentiating between gene expression profiles of chromophobe, clear cell, and papillary RCCs. Methods: RNA-seq data from a diverse cohort of patients diagnosed with these three cancer subtypes was used. Data preprocessing and normalization were performed, followed by feature selection using Analysis of Variance (ANOVA). Tree-based and non-tree-based algorithms were trained on the preprocessed data. The tree-based algorithms included decision tree, random forest, extra trees classifier, and bagging classifier. The non-tree-based algorithms included logistic regression, support vector machine, and naive bayes. Each algorithm was evaluated using sensitivity, specificity, F1 score, and AUC. Results: Tree-based algorithms demonstrated superior performance across all evaluation metrics compared to non-tree-based algorithms. Specifically, the random forest classifier achieved the highest specificity and F1 score, the decision tree classifier achieved the highest sensitivity, while the bagging classifier achieved the highest AUC score. In contrast, non-tree-based algorithms showed comparatively lower performance in distinguishing between the cancer subtypes. Conclusions: This study demonstrates the potential of machine learning, particularly tree-based models, for precise RCC subtyping. By leveraging tree-based models, we can effectively capture the complex, non-linear patterns in gene expression datasets. Future studies should aim to validate these findings across larger and more diverse datasets of RCC subtypes.
Health Information Technology Governance: A Scoping Review of Literature
Abstract Purpose – This scoping review aimed to map the existing literature on Health Information Technology (HIT) Governance. Design/methodology/approach – Existing literature on this topic charts the nature and content by summarising existing evidence on HIT governance. Searches were conducted in PubMed and ScienceDirect databases for literature published between 1st January 2000 and 31st December 2023. Findings – A total of twenty-five (25) articles met the criteria and are included in this review. The findings indicate that HIT governance is operationalised through governance mechanisms and context-specific practices. In addition, HIT governance has mainly been for the systems functional at the hospital and national levels of healthcare, as well as systems that facilitate health information exchange, data governance, and health information governance. Governance of HIT systems functional at the community healthcare level has received little research attention. Furthermore, the alignment aspect is not addressed in the reviewed literature but is an essential aspect of HIT governance. Research limitations - A significant constraint of this scoping review is the limited scope of literature searches conducted exclusively on PubMed and ScienceDirect. Practical implications – This study contributes to the theoretical understanding of HIT governance in HIT implementation and use. Originality/value – This study covers HIT governance, addressing the need to investigate how HIT governance is achieved for different HIT integrations and applications and shape further research agenda. Keywords – Health Information Technology, Health Information Systems, Governance
Maternal Healthcare Access and Maternal Electronic Service Delivery in Resource-Constrained Environments: A Systematic Literature Review on Frameworks, Approaches, and Insights
Ensuring the well-being of mothers and newborns is contingent upon guaranteeing access to maternal health services. However, marginalized communities in Developing Countries (DCs) often face obstacles in accessing these critical services, primarily due to limitations in the strategies and methods used for delivering maternal healthcare. These barriers encompass various challenges, such as geographical remoteness, inadequate infrastructure, and socio-economic disparities. Additionally, the limited availability of trained healthcare professionals and insufficient medical facilities exacerbate the situation. Overcoming these challenges necessitates a comprehensive review of the existing literature to find the best practices for integrating sensitive interventions, community engagement, and innovative technological solutions for the subject under investigation. The study was motivated by the imperative to investigate the integration of maternal healthcare services with e-services and assess the effectiveness and efficiency of existing approaches for accessing maternal e-services. This was driven by a sustained objective of enhancing maternal health service delivery using technologically supported platforms. The study utilized a systematic literature review analysis, adhering to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) model. This rigorous approach ensured comprehensive coverage and transparency in selecting and analyzing relevant studies. The process involved systematically searching online databases using a keyword search technique to capture studies pertinent to maternal healthcare services and maternal e-services delivery. The results of the study highlighted numerous potential e-services for improving maternal healthcare, yet their implementation appears uncertain due to the limited effectiveness of existing approaches, which predominantly rely on traditional methods. While several e-service frameworks exist to guide maternal healthcare delivery, they predominantly focus on textual and voice-based maternal education, with limited attention to multimedia formats. To clearly understand this gap, the study developed a conceptual framework delineating the current state of maternal e-service delivery, emphasizing existing domains, and proposing a desired state that integrates potential e-services. This study emphasizes the urgency of exploring how technology-driven frameworks, especially those centered on mobile platforms, can integrate potential e-services to enhance maternal healthcare delivery. Bridging this gap holds the promise of revolutionizing maternal healthcare, making it more accessible and effective for women in need worldwide.
The Journal of Health Informatics in Africa (JHIA) only publishes original, high quality research papers focusing on the use of information and ICTs in the healthcare sector in Africa. To ensure originality a Turnitin report is obtained for each submission before being assigned to reviewers. Only submissions with a Turnitin similarity index below 15% are accepted for review. Submission with a higher similarity index is immediately rejected. Authors are thus urged to ensure that their submissions are original and that it has not been published elsewhere before submission is made to JHIA. Once a submission is accepted for review it passes through a rigorous double-blind review process that either results in a rejection or acceptance. Most submissions that are accepted are subject to a second round of review. Authors are tasked to revise the paper based on the reviewer feedback and re-submit it for a second round of review by the same reviewers. Only once the reviewers and editorial team are satisfied with the revisions are the paper then formally accepted for publication. To attest to the rigorous review process this issue comprises of only two papers: Gumede and Dyers presents a cross-sectional evaluation of the user experience of an Electronic Medical Record (EMR) in the public health sector of the Western Cape in South Africa. The user experience of the EMR is evaluated in terms of it’s pragmatic- and hedonic qualities. Mutunhu, Chipangura, and Singh explores opportunities for quantified-self technology in diabetes self-care through a systematic literature review. Four opportunities namely monitoring, adherence, reduced cost, and data collection and sharing are identified. I would like to extend a very special thank you to the editorial team, authors, and peer-reviewers that made this issue possible. I encourage readers active in health informatics research to make contact with me to become reviewers for JHIA. We rely on the expertise of experienced researchers to ensure the publication of high-quality research. Nicky Mostert March 2024
On 22 and 23 November, the Burundi Health Informatics Association organized the 2022 HELINA Special Topic Conference “SNCSU 2022, Digital Health Paving the Way to Universal Health Coverage” at the Royal Palace hotel in Bujumbura, focusing on the role of digital health in achieving universal health coverage (UHC) in low-income settings. The main objective of this conference was to share and capitalize on field experiences with digital tools for implementation of UHC in Sub-Saharan Africa. The conference brought together 254 participants from 13 different African countries and 48 of them attended the pre-conference workshops on “Smart glasses and telemedicine for bridging the clinical competence gaps” and “Evaluating digital health project risks and opportunities using social network analysis”. The main conference started with an overview of different national e-health strategies in African countries presented by health experts and authorities from Burundi, DRC, Mali, Senegal, Guinea, Tanzania and Benin. On the first day, parallel sessions hosted presentations on (i) Data warehousing, monitoring and evaluation, (ii) Ontologies and nomenclatures and (iii) Telemedicine. The second day of the conference 3 sessions ran in parallel with contributions on (i) Hospital information management systems, (ii) Clinical decision support, (iii) Education and training in digital health, (iv) E-health enterprise architectures, (v ) demonstrations of real-world UHC solutions and finally (vi) a track with a series of presentations in English (because the main language of the conference was French). A particularly interesting keynote was addressed by the representative of the UNDP project on mental health in Mali (SANDI), more specifically on the use of telemedicine for assisting with mental health issues in remote and security constrained areas. The scientific program of the conference was in the hands of the Institute of Public Health of Burundi and the Digital Health Campus of Lubumbashi, DRC. A total of 49 abstracts, demonstrations and scientific papers were peer-reviewed by 31 reviewers which resulted in the acceptance of 38 presentations of which 2 scientific full papers. The conference strengthened the insight that digital health is pivotal in achieving Universal Health Coverage (UHC), a goal set by the World Health Organization (WHO) to ensure that all individuals and communities receive the health services they need without suffering financial hardship. The integration of digital health technologies can significantly enhance the accessibility, quality, and efficiency of healthcare services, thereby playing a critical role in meeting UHC objectives. First, digital health tools, such as telemedicine and mobile health applications, bridge the gap between healthcare providers and patients, especially in remote and underserved areas. These technologies enable patients to receive consultations, diagnoses, and treatment plans without the need for physical travel, thereby reducing barriers to access. Second, digital health promotes better health outcomes through improved data management and personalized care. Electronic health records (EHRs) ensure that patient data is accurately recorded and easily accessible, facilitating better coordination of care and continuity across different healthcare providers. Additionally, the use of big data and artificial intelligence (AI) in healthcare can lead to more precise and tailored treatments, enhancing the effectiveness of interventions. Furthermore, digital health contributes to cost savings for both healthcare systems and patients. By streamlining administrative processes and reducing the need for unnecessary tests and hospital visits, digital tools can lower healthcare costs. For patients, reduced travel and quicker access to care can also mean less time off work and fewer out-of-pocket expenses. Finally, digital health fosters health education and literacy. Through online platforms and mobile apps, individuals can access reliable health information, empowering them to make informed decisions about their health and wellness. In summary, digital health is essential for achieving UHC as it enhances accessibility, improves quality of care, reduces costs, and empowers individuals with health knowledge. Integrating digital solutions into healthcare systems is a critical step towards ensuring that everyone, everywhere, can obtain the health services they need.
Perceptions of Primary Healthcare Practitioners on the Effectiveness of Electronic Health Records Systems for Decision Support in Tanzania
Background and Purpose: This study aims to examine the perceptions of primary healthcare practitioners on the effectiveness of Electronic Health Records (EHR) systems in providing decision support in Tanzania. Methods: The study employs a quantitative research approach, utilizing surveys and structured observations to collect data from healthcare practitioners in PHC settings. Descriptive statistical analysis is conducted to assess the functionalities and utilization of EHR systems. Results: The findings reveal that while EHR systems in PHC facilities offer certain benefits, such as facilitating access to patient information and improving administrative processes, there are limitations in their ability to support decision-making tasks effectively. Specific areas for improvement are identified, highlighting the need for targeted interventions to enhance the functionality of EHR systems in PHC settings. Conclusions: This study underscores the importance of addressing the identified limitations in EHR systems to optimize their effectiveness in supporting decision-making tasks in PHC settings in Tanzania. Targeted interventions are essential to enhance EHR functionality and improve healthcare delivery outcomes.
Data Precision and Timeliness of Paper versus Software-Assisted Nursing Documentation: A Rapid Review and Meta-Analysis
Background and Purpose: The nursing industry has progressively transitioned from paper-assisted documentation practices to software-assisted systems. Such a transition raises debates about its implications on the timeliness and precision of documented nursing data. This rapid review and meta-analysis examined existing literature on the effect of paper and software-assisted documentation systems on documentation precision and timeliness. Methods: Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, this review and meta-analysis examined studies published in the past 50 years (1973 to 2023) and available in PubMed electronic database. The search methodology combined free-text search terms with Boolean operators for a more precise and sensitive search. Results: The review and meta-analysis selected 15 studies from a pool of 314 articles after applying set inclusion criteria. The synthesis of evidence revealed that Software-assisted nursing documentation systems enhanced by twofold the precision of documented nursing data (Overall random effect Odds Ratio: 2.35, 95% CI: 1.32-4.17; p = < 0.010). Software-assisted nursing documentation systems reduced time spent on nursing documentation by nine minutes but was not significant (Overall random effects mean difference = 9.14 minutes; p = 0.330). Conclusions: Software-assisted nursing documentation is valuable for enhancing nursing documentation precision but not timeliness. This study recommends software-assisted nursing documentation systems for improving the precision of nursing documentation.
Implementing Blockchain for Health Sectors in Low- and Middle-Income Countries: Use Cases, Approaches and Challenges
Background and Purpose: Despite its complexity and resource constraints, the healthcare sector in low- and middle-income countries (LMICs) faces a crucial challenge of ensuring data integrity, interoperability, and transparency. Blockchain technology emerges as a potential solution, offering secure and immutable platforms for managing health information. This study investigates the use cases, approaches, and challenges of implementing blockchain in LMIC healthcare, focusing on health services and sector-wide management. Methods: The study employed a systematic review methodology following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) to ensure transparency and reproducibility in the review process. Results: Results show that while a number of LMICs countries have embarked on the implementation of blockchain-based applications, most projects remain as proposals or experiments. The study found 26 (82%) projects had some form of implementation. Of these, 11 (42%) were simulations, 2 (8%) evolved into working prototypes, and only 3 (12%) achieved full-fledged deployments. The most implemented use case was Electronic Health Record systems (EHR), which constituted about 23% of all implementations, followed by Remote Patient Monitoring (15%). Conclusions: Most of the blockchain initiatives in the health sector in LMICs are still in simulations and prototype stages. There is also low conversion of projects from this preliminary stage to fully-fledged solutions. To overcome this challenge more readiness programs both technical and administrative are required to ensure successful deployments of blockchain in the health sector in LMICs.
The User Experience of an Electronic Medical Record: A Cross-Sectional Study in the Public Health Sector of the Western Cape, South Africa
Background and Purpose: The Electronic Continuity of Care Record (eCCR) is a web-based Electronic Medical Record commissioned and implemented by the Western Cape Government Health and Wellness department in 2015 for all 53 public hospitals in the province to capture medical records of patients. While there has been previous research into the quality of clinical coding capture within the eCCR, there has not yet been a formal evaluation of end users’ experience (UX) of the application. This study is the first to formally evaluate the user experience of an eHealth application in the public sector in the Western Cape. This study evaluated the user experience of the eCCR end users in terms of its attractiveness, pragmatic qualities (efficiency, perspicuity, dependability) and hedonic qualities (stimulation, novelty), describes the characteristics of end users and explores associations between user characteristics and the UX of eCCR. Methods: A validated UX Questionnaire survey was made available online to evaluate the eCCR user experience. An invitation and link to the survey was added on the eCCR landing webpage specifically to target users of the application. Response data were collected over three months from June to August 2023 using 26 UEQ questions that comprised Lickert-type scales of 1-7 to rate experience. The mean was determined for each scale. Mean scale values > 0,80 represented a positive experience. Values between -0.80 and 0.80 represented neutral experience while values < -0,80 represented a negative experience. Results: There were 201 participants in this study. The question (item) response means were combined per scale: attractiveness=0.87, perspicuity=1.32, dependability=0.88, stimulation=0.76, efficiency and novelty reported low means of 0.55 and 0.30 respectively. Conclusion: The User Experience UX evaluation indicated that the eCCR was an easy-to-learn and understandable web-based application, the end users reported it was valuable, secure, enjoyable, and met user expectations. The overall attractiveness of application was positive. The pragmatic qualities of the eCCR were rated higher than the hedonic qualities. The study indicated that the eCCR can be strengthened with regard to its innovative and creative features to improve upon the experience scales related to novelty, as well as its efficiency.
The Journal of Health Informatics in Africa is the official journal of the Pan African Health Informatics Association (HELINA) and publishes the proceedings of the HELINA conferences, as well as open-call issues. This issue is an open-call issue comprising of seven double blind peer reviewed papers submitted directly to the journal. Papers written in French are also published by the journal, and this issue includes one French paper. The year 2023 celebrates the 10th year since the first publication of a JHIA issue and as we celebrate this milestone we are continuously working on improving the quality of the journal. This issue includes the following papers: The paper by Osembe, Adebesin, and Smuts utilise thematic analysis to examine themes around the opportunities for digital innovation in healthcare. Author Nyarko recommends strategies to promote artificial intelligence adoption in healthcare decision-making among Ghanaian tertiary students. In the paper by Mohsam an analysis of nurses’ lived experience with digital health technologies in practice is shared. Key competencies for different levels of study and design considerations for a Health Informatics course are identified by authors Bhebe, De La Harpe, Kaura, and Kabaso. Author Awami evaluates users’ acceptance of a computer-based health information system at Benghazi diabetes centre. The paper by Abotsi, Agbemafleb, and Ayimeyc highlights positive outcomes and challenges associated with electronic health records systems at a Ghanaian hospital. The French paper by authors Randimbison, Rainibarijaona, Rajaonarison, and Rabenja highlights the impacts of a low-cost software for automated interpretation of fetal heart rate developed for the use in remote areas in low-income countries such as Madagascar. I would like to extend a very special thank you to the editorial team, authors, and peer-reviewers that made this issue possible. Nicky Mostert March 2024
An Exploration of Opportunities for Quantified-Self Technology in Diabetes Self-Care: A Systematic Literature Review
Background and Purpose: To avoid the adoption of quantified-self technologies for diabetic self-care by trial and error, this study investigated quantified-self opportunities. The premise of the study was that the adoption of quantified-self technologies should be preceded by knowledge of the opportunities that are provided by the technology. In this respect, the research search question was, ‘What are the opportunities for the use of quantified self technology in the management of diabetes in developing countries?’. Methods: A systematic literature analysis was carried out to answer the research question. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to select articles from four databases, which are PubMed, ProQuest, Web of Science and Science Direct. A total of 50 peer-reviewed journal and conference articles published between 2018 and 2024 were analysed. Results: Literature analysis uncovered four opportunities for using quantified-self technologies in the management of diabetes. Opportunities include monitoring, adherence, reduced cost, and data collection and sharing. Conclusions: The identified opportunities are informative and empower diabetic patients with knowledge that helps them with decision making prior to the adoption of quantified-self technologies for diabetic self-care. The results of this study are equally applicable to the adoption of any other technology, as it is important that the opportunities brought by a technology should be known before its adoption.
Editorial to the HELINA 2023 Proceedings
The 2023 edition of the HELINA (HEaLthINformaticsinAfrica) conference was held from 01 – 03 November 2023 as an in-person conference in Cape Town, South Africa. The conference was hosted by the South African Health Informatics Association (SAHIA) in partnership with HELINA. The conference theme was focused on “Effective Implementation, Meaningful Use and Sustainability of Digital Health Interventions: The Role of Health Informatics and Imaging Informatics in Africa”. The aim was to provide a platform to showcase interventions in the following formats: Full research papers based on mature research results; Work in progress papers based on work in process research; and Case study presentations based on case studies and experience in digital health interventions. Review Process A total of 61 submissions in these categories were received. A double-blind peer review process was used for evaluating each full research and work in progress paper. These submissions were anonymized before being submitted to reviewers according to their area of expertise. The Scientific Programme Committee (SPC) based their final decision on the acceptance of each full research and work in progress paper on the recommendations and comments from reviewers. Accepted submissions were then sent back to the authors for revision according to the reviewers’ comments. Case study submissions were reviewed by the SPC for inclusion in the conference. This review process resulted in the following acceptance rates: Full research papers: 44% acceptance rate (9 received, 4 accepted) Work in progress papers: 66% acceptance rate (6 received, 4 accepted) Case studies and experience papers: 85% acceptance rate (46 received, 39 accepted) In order to be included in the conference proceedings, authors had to submit their final camera-ready papers after incorporating reviewer comments, and accepted papers had to be presented at the conference in person. Nicky Mostert HELINA 2023 SPC Chair
Role of Metrics in Medical Image Analysis based on Unsupervised Machine Learning
Background and Purpose: The paper point out the role of metrics and these mathematical properties in a resolution of problem by a machine learning. A methodology of building an unsupervised machine learning is described, following by an application of the model to a medical image analysis and an automatic diagnosis. Our model is based mainly on clustering. Methods: Considering the objectives of the medical image analysis such as to detect patterns on the image and to guide the diagnosis, we focus our interests on the unsupervised machine learning, specifically the clustering approach based the centroid and density models. These two models allow the data analysis and classification. Furthermore, we considered that classification can be done by attribution criteria such as object semantic and similarity criteria. Results: We have demonstrated the application of unsupervised learning for medical image analysis and diagnosis. Our model was tested on 40 different images of samples. The accuracy in our unsupervised machine learning means detection and correct classification of all necessary objects in a single image. Conclusions: Asking the machine to make a suitable grouping of the objects of an image in classes without human intervention by algorithms, this is the goal of unsupervised machine learning. To achieve this challenge, metrics play an important role. We built the formal model based on a set of rules and functions that can analyse and classifies objects’ image in classes. Our model as the benefit to be used for semi-supervised machine learning co-clustering applications. This can make it easier to label a large volume of data.
Systematic Literature Review on Opportunities for Digital Innovation in the Healthcare Sector
Background and Purpose: The concept of digital innovation has garnered significant attention recently and has the potential to revolutionise industries. With the recent advancements in healthcare and the emergence of new digital technologies, this manuscript reports the results of a systematic literature review (SLR) aimed at identifying the opportunities that digital innovation can afford the healthcare sector. These opportunities could guide policymakers and healthcare practitioners in making informed decisions regarding the implementation of digital innovation in healthcare. Methods: This study conducted a systematic literature review (SLR) that involved defining the purpose of the literature review, establishing inclusion and exclusion criteria, identifying data sources and search strategies, screening and determining eligibility, and making inclusion/exclusion decisions. This study also included quality assessment criteria to evaluate the selected publications. 1478 research papers were analysed using descriptive statistics and thematic analysis to identify themes from the papers included in the SLR. Results: The findings presented nine themes related to opportunities for digital innovation in healthcare. The following themes were discussed: precision/personalised medicine/healthcare, interoperability, privacy and security, improved decision-making process, real-time/remote monitoring, enabling new processes/services/products, training/education, knowledge acquisition/sharing, and other themes that could not be categorised. These themes include cost, effectiveness, and time management. Conclusions: This study utilised thematic analysis to examine the themes that emerged from the findings. These themes centred around the opportunities for digital innovation in healthcare. Awareness about each opportunity for digital innovation in healthcare is discussed. This study discussed the limitations of this SLR and future research opportunities for policymakers and healthcare practitioners wanting to implement digital innovation in healthcare.
Exploring Ghanaian Tertiary Students’ Perceptions Towards AI as a First-Hand Source of Health Information for Diagnosis and Self-Medication
Background and Purpose: The rapid advancement of Artificial Intelligence (AI) has opened new avenues in various sectors, including healthcare. In Ghana, where healthcare resources are limited, AI has the potential to bridge the accessibility gap and provide cost-effective health information and services. Therefore, this study aimed to explore Ghanaian tertiary students' perceptions toward AI-driven health information platforms. The study's objectives align with the broader impact of AI-driven health information platforms, emphasizing the need to assess awareness, trust, factors influencing willingness to use AI, and potential concerns among Ghanaian tertiary students. Methods: The study employed a cross-sectional survey design to gather quantitative data from 50 Ghanaian tertiary students using structured questionnaires. Open-ended responses related to concerns and reservations regarding AI as a health information source were analyzed using thematic analysis. Themes and patterns were identified. Results: The findings revealed that approximately 56% of respondents knew of AI-driven health platforms, with "Ada" being the most recognized. Trust in AI-based health information varied based on age and gender, with young females exhibiting the highest trust. Factors influencing willingness to use AI included perceived usefulness, perceived ease of use, positive prior experiences, and technological literacy. Conclusions: The study recommends educational campaigns, enhancing trust, user-friendly platforms, academic integration of AI education, and addressing ethical considerations to promote AI adoption in healthcare decision-making among Ghanaian tertiary students. These insights can inform policymakers and healthcare providers in developing effective strategies to harness AI's transformative potential in healthcare accessibility in Ghana. Keywords: Artificial Intelligence, healthcare delivery, Ada, Technology Acceptance Model (TAM), Ghana
Re-visiting Design and Development of a Low-Cost Computer on Wheels to support healthcare delivery for Low-Resource Settings
Background and Purpose: Unlike implementations in high-income country settings which span the entire breadth of a health facility, electronic health record (EHRs) implementations in low- and middle-income countries (LMICs) have mostly been disease specific. Since most disease-specific clinics are ambulatory in nature, the inpatient setting has been largely ignored with regards to EHR implementations in LMICs. Computers on wheels (CoWs) has improved access in high-income country hospital settings, but may not be financially feasible in LMIC settings. Here we describe the design and development of a low-cost CoW that has been done in a low-income country setting. Methods: We developed a set of functional requirements for a computer on wheels and a design approach for the development of a functional prototype from concept to finished product. We conducted a laboratory function evaluation to assess how the CoW would work. Results: We designed and developed a CoW comprising a cart, computing platform and a docking station for charging. Our computing platform is based on a Raspberry Pi single board computer with a 7-Inch touchscreen display, thermal label printer and 2-dimensional barcode scanner. The unit is powered by a rechargeable battery providing a runtime of roughly 16 hours between charges. Conclusions: We have demonstrated that fit-for-purpose solutions that may enhance clinical care in an in-patient setting can be designed and developed in an LMIC setting. This approach can reduce barriers to entry for EMR systems in hospitals by making more affordable and locally supportable solutions available.
Implications of Software Platform Architecture and Documentation on Developer Productivity: A Case of the Malawi Point of Care EMR Software
Background and Purpose: Software platform architecture and documentation affect platform customisability, developer productivity, and third-party contributions. This study examines how the Malawi Point of Care Electronic Medical Records Software (PoC-EMRS) architecture and documentation shape the platform’s customisation, developer productivity, and third-party contributions. The Malawi PoC-EMRS, as the primary case of analysis, was compared to CommCare and DHIS2 as configurable software platforms. Theoretically, we draw on Generativity and the Boundary Resource Model (BRM). Generativity evaluates the overall capacity of an artefact to produce solutions, for diverse use cases. BRM was used to evaluate how owners of the PoC-EMRS facilitate ecosystem value co-creation through documentation and exposure of APIs. Methods: Primary and secondary data were collected through interviews, observations and document analysis. Both qualitative and quantitative data were analysed to find common themes. Results: Malawi PoC-EMRS is less configurable than DHIS2 and CommCare, necessitating more developer effort to support a variety of use cases. Though Malawi PoC-EMRS exposes boundary resources, it lacks incentives to attract third-party developers. Lack of or limited access to detailed documentation also negatively affects internal and third-party development productivity. Conclusions: We established that CommCare and DHIS2 have the following strengths. First, the platforms feature standardised interfaces that allow third parties to design, configure, and customise the platforms into solutions for a varied range of use cases. Second, CommCare and DHIS2 have comprehensive documentation that is accessible through online repositories, communities of practice and demo sandboxes. Applying the strengths of these platforms in the development of the Malawi PoC-EMRS is likely to boost developer productivity.
Positive Outcomes and Challenges of Electronic Health Record Systems: A Case of a Ghanaian Hospital
Background and Purpose: Medical professionals keep a patient's medical record current using the Electronic Health Record System (EHRS), an electronic version of the document. It includes the crucial clinical and administrative information needed to manage the patient's treatment, such as demographics, issue notes, progress notes, prescriptions, vital signs, previous medical records, vaccination records, laboratory results, and radiological reports. Methods: The grounded theory methodology was used to review relevant literature and lay the groundwork for this investigation. Additionally, the information was gathered via a well-structured questionnaire distributed to medical professionals. The main objective of the study was made clear to the participants. The researchers distributed questionnaires to the individuals who provided healthcare using EHRS at their places of employment. Any queries the participants had regarding the questionnaire were allowed to be answered. Results: The main driving force behind this study was finding out what function AlphaChem Hospital's EHRS performs in delivering high-quality care. The study's key findings were that the EHRS helps the hospital by enhancing the accuracy of patient records, enabling the simultaneous care of multiple patients, streamlining appointment scheduling, and decreasing the time spent providing care while maintaining high user satisfaction. Frustrating factors include issues with lack of technical training, lack of technical support, and unstable internet connectivity. Conclusions: Most healthcare providers at AlphaChem Hospital were satisfied with the system and chose the electronic health record system over the paper-based one. However, there were some challenges with EHRS utilization. The report suggests that facility administrators properly orient all staff members on using the system. A facility that wants to gain a competitive edge must adopt, contribute to, and use an electronic health record system to manage health services. Keywords: Electronic Health Record System (EHRS), electronic medical record, healthcare, surgical, obstetrics
Digital Health Model for South Africa’s National Health Insurance: Addressing Hospital Occupancy and Emergency Care
Background and Purpose: South Africa will be unifying the current fragmented healthcare system by implementing the National Health Insurance. This poses inevitable challenges to the associated information systems. This research introduces the need for an information systems model to support the Federated Health Information Architecture proposed by the Department of Health. Methods: The Health Normative Standards Framework documentation was studied in conjunction with the Life Esidimeni Health Ombud report to determine gaps in the proposed architecture. Results: Five gaps were identified during this research (the view of shared Electronic Health Records (EHR) is oversimplified, key decision makers are not included in the list of stakeholders, emergency services is not adequately supported, medical aid schemes are not included, mature architectural standards need to be developed) and it was determined that a digital health systems model needs to be developed to support the current architecture to assist with resolving some of the identified gaps. Conclusions: Data synchronisation issues are inevitable with a large project such as the NHI. To minimise mistakes, fewer assumptions regarding the interoperability of systems need to be made. The proposed architecture as it stands may not cater to the needs of the NHI. A new model that can support the NHI especially within emergency care and hospital occupancy monitoring needs to be created.
Psycho-socio-cultural determinants for the implementation of telemedicine projects in Senegal
Background and objective: A teleconsultation solution for gyneco-obstetrics and neonatology in the Sokone region (Senegal) is proposed for implementation in the very near future. The intention is to use smart glasses to bring clinical expertise into the health center and health posts, with the goal of improving the quality and accessibility of health care and streamlining numerous referrals. But this has psychological implications for both the patient and the health care provider. Field experience, confirmed by the literature, tells us that the successful implementation of such telemedicine solutions depends in part on their proper integration into the socio-cultural environment of the country or region. A field mission was conducted to understand this local context and to document the main socio-cultural risk factors as well as the elements that promote the adoption and use of telemedicine applications in the region. Methods: Qualitative data collection was conducted through 4 focus groups and 2 in-depth interviews. To develop the interview guide, we drew on previous studies on the implementation and use of telemedicine applications. The following themes were addressed: (1) main benefits, (2) expected barriers, (3) who makes the decision to use, (4) costs of triangular consultation, (5) accountability for medical decisions, and (6) other potential applications of smart glasses. Results: The importance of on-site care, the quality of patient management, and the importance of smart glasses in emergencies are considered the main benefits for the region. The expected barriers can be broken down into 8 dimensions: financial, infrastructural, organizational, technological, cultural, individual, regulatory, and healthcare-related. The shared responsibility of the on-site provider and the remote physician for medical decisions made in a triangular consultation, as well as the financial allocation so that physicians are properly compensated for their services, are important issues that must have a legal basis. Finally, the participants see other opportunities in the use of the glasses, such as a tool for remote training and supervision. Conclusion: We can conclude that there is a great deal of enthusiasm, both among caregivers and patients, for the implementation of these smart glasses. It is expected that they will provide many benefits to the region in terms of quality of health care. But the focus groups also provided important information about the local context. In addition, the organization of the focus groups created a dynamic among the participants. Future users will feel involved and heard. We are aware that testing these results using a qualitative method would add value. There would be more support for the results and even more people would feel involved in the implementation process.
Development of an edge-based digital clinical workflow and data processing wizard for low-resource primary healthcare systems
In low resource settings, paperwork hampers the elaboration of a digital clinical workflow and data processing. As a result, some of the challenges in a low-resource setting are related to obtaining historical records from a manual system (i.e., clinical guidelines, point of care charts, and other contextual documents), missing card-sheet information, and deficient readability of handwriting. Furthermore, limited infrastructure, resource constraints, deficient data readiness, and bridging the divide between evidence and practice are posing additional challenges. A WEB-APP clinical decision system (CDS) was developed and deployed on a Raspberry Pi 4 Model B, which has a quad-core 64-bit processor and 4GB of RAM. The Raspberry Pi 4 is intended to work with a power bank when there is no electricity in remote areas. The CDS instrument is accessed via a smart phone's mobile data or wireless network. Then, the system generates a digital clinical workflow and data processing wizard based on measured symptoms. The method improves the quality of existing clinical pathways by dynamically mapping a knowledgebase to data-driven methods. As a result, the CDS WEB-APP was able to provide a point-of-care clinical reference, data processing, and workflow generator, as well as an interactive data visualization and clinical guidance wizard for low-resource settings.
An Analysis of nurses lived experience with digital health technologies in practice
Background and Purpose: In the healthcare field, technological innovations have been introduced which are referred to as digital health technologies (DHTs). As digital technologies continue to impact the nursing profession on a global scale, nurses are increasingly required to use a variety of digital health technologies when providing direct care across the healthcare sphere. Whilst the benefits of DHTs have been empirically proven, usability problems, often encountered with usage, can be frustrating to both healthcare professionals and patients compared to other industries. The aim of this qualitative study was to understand, analyse and assess nurses’ lived experiences of using DHTs as part of their work practices. Methods: The study employed an interpretive stance and a qualitative phenomenological approach to explore the lived experiences of experienced nurses presently using DHTs in practice. In-depth interviews and observation were used to collect data from nurses in two public hospitals in Cape Town. A thematic analysis was used to organise and analyse the data acquired from the participants. The Normalization Process Theory (NPT) served as a theoretical lens to interpret the findings of this study. Purposive sampling was used to identify participants. Results: Nurses, as end-users, have found DHTs to be relevant to their work practices and compatible with their existing work practices. It was found that, through the use of technology, nurses’ tasks have become easier and more time‑efficient, and as a result, nursing quality is improved. Conclusions: Findings indicate that DHTs have been fully embedded into their daily work activities as patient care is optimised. Nurses positively appreciate technologies, to the extent that they cannot do their work without DHTs, and this is substantiated by their desire to learn new technology, not only to optimise patient care but to augment their knowledge and skill. Keywords: nurse, digital health, digital health technology, lived experience, normalisation process theory.
Expert Perspectives on Competencies in Health Informatics for Informatics Students
Background and Purpose: Informatics practitioners who are knowledgeable in health informatics and understand the need for clinical practitioner workflows contribute towards improved health information systems. The aim of this paper is to discuss insights gained from health informatics experts on their perspectives on competencies that could be taught to informatics students. The researcher explores (i) the competency needs of ICT students and practitioners to develop health ICTs with the involvement of healthcare practitioners, and (ii) how informatics education can be designed to incorporate healthcare domain knowledge in the training of ICT practitioners. Methods: A questionnaire was administered to health informatics experts. The research sample was purposively selected to include practitioners who have worked in the Health Informatics domain, and have at least a Master’s degree. Respondents identified topics and competencies appropriate for teaching undergraduate informatics students Results: Thematic analysis identified key competencies for different levels of study and design considerations for a Health Informatics course. Conclusions: Having Health domain Knowledge may provide opportunities for more roles that IT practitioners can play, especially for those who are not scientifically strong.
Editorial to JHIA Vol. 9 (2022) Issue 1 Nicky Mostert Nelson Mandela University, Gqeberha, South Africa The Journal of Health Informatics in Africa is the official journal of the Pan African Health Informatics Association (HELINA) and publishes the proceedings of the HELINA conferences, as well as open-call issues. This issue is the first open-call issue for 2022 comprising of two research papers submitted directly to the journal. These papers have been double blind peer-reviewed before being accepted for publication. Although papers written in French are also published by the journal, both papers in this issue was written in English. The paper by Walusimbi and Wamema proposes a collaborative mobile application architecture to improve collaboration among healthcare providers at the point of care. Mkayula, Mbise, and Mahundi investigated the challenges associated with Electronic Medical Record (EMR) interoperability between hospitals and make recommendations to improve interoperability. I would like to make use of this opportunity to urge authors to ensure that only original, unpublished manuscripts are submitted to JHIA for review. All submissions are checked and if evidence of plagiarism or previous publication is found such a submission is immediately rejected. I wish to thank the dedicated peer-reviewers that took time out of their busy schedules to assist with the review process. Also a word of thanks to the editorial team and authors who made this issue of JHIA possible. Your dedication is very much noted and appreciated.
Copyright (c) 2022 Journal of Health Informatics in Africa
The Evaluation of Users' Acceptance of a Computer-based HIS at Benghazi Diabetes Centre
Background and Purpose: This study investigated whether an electronic medical record implemented at a medical centre was successful and shed the light on some of the factors that may have contributed to such outcome. Important indicators of the system’s success include its acceptance by the users, meaningful use, and likelihood of sustainability. The users’ acceptance is a reflection of their satisfaction with the amount of effort required, the amount of benefits realized, and the kind of experience they’ve developed using the system. Methods: based on user acceptance literature, a questionnaire was designed and administered to clinicians at the medical centre. 18 clinicians participated in this qualitative, descriptive, cross-sectional study to evaluate users’ acceptance of the system. Results: expressing general impression, 56% of the participants think that the system is easy to use and 61% judge the system as useful for supporting their work tasks. Regarding their use experience, third of the participants object that the system’s performance was timely and more than 80% agree that the system facilitates data documentation and medication order. Conclusions: despite the system’s suboptimal performance, it is accepted by the users and it is well integrated into their routine work. The few participants who evaluate the system negatively may belong to ‘late adopters’ group who will eventually adopt. Users’ self-efficacy, the mandatory policy of the centre and the leadership of the centre management are some of the factors that may have contributed to such outcome. Issues of system performance and some of the participants’ requirements ought to be addressed to insure the system’s sustainability.