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
Copyright (c) 2022 Journal of Health Informatics in Africa
« 2arcf Systeme » Un Logiciel A Moindre Cout Pour L’interprétation du Rythme Cardiaque Fœtal
Contexte : Madagascar, un pays en développement, a des difficultés à acquérir les nouvelles technologies médicales, parmi elles les appareils d’interprétation du rythme cardiaque fœtal (RCF). Notre étude consiste à la création d’un logiciel qui analyse automatiquement le RCF avec les ressources matérielles disponibles et l’évaluation de son efficacité. Méthode : Le projet informatique s’est fait en deux étapes : la phase de spécifications et la phase de codage du logiciel incluant la phase test. Matrix Laboratory a été utilisé pour la création de ce logiciel. Pour la phase test, nous avons recruté au hasard des enregistrements du RCF puis analysé le logiciel créé. Une étude prospective descriptive sur ces enregistrements a été menée et pour préciser la fiabilité des résultats du logiciel, nous avons réalisé une étude comparative de ces derniers avec l’analyse conventionnelle se basant sur la classification du RCF du CNGOF. Résultats : Le logiciel « 2ARCF système » a été créé. Cent dix enregistrements ont été recrutés. Après analyse conventionnelle 40,9% des tracés revenaient normaux contre 61,8% après analyse informatisée avec un coefficient de concordance de kappa à 0,564. La moyenne des écarts entre les valeurs du rythme de base des deux méthodes selon la procédure décrite par Bland et Altman était de 1,249 bpm. Conclusion : L’application « 2ARCF système » a montré sa fiabilité. Elle est un atout, surtout dans les régions éloignées de Madagascar. Mots-clés : analyse, logiciel, Madagascar, rythme cardiaque fœtal.
Copyright (c) 2024 Journal of Health Informatics in Africa
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
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.
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.
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.
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.
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.
Community-Based Health Information System Governance Structural Mechanism: Its Role in Attaining the Alignment and Improving the Community Health Outcomes
Purpose - Health Information Technology (HIT) governance is necessary for the effective functioning of HIT systems to improve health outcomes. However, practices associated with the Community-Based Health Information System (CBHIS) governance structural mechanism remain unclear. In addition, there is a paucity of knowledge on the nature of the interrelationships between the CBHIS governance structural mechanism, alignment and community health outcomes. The study sought to establish and validate practices associated with the CBHIS governance structural mechanism and its interrelationships with community health-CBHIS alignment and community health outcomes. Methodology - This study employed a mixed-method research approach, utilising a convergent parallel research design. Two study sites were purposefully chosen from a total of 47 counties due to their experience in CBHIS implementation and use. A sample size of 179 respondents participated in the study. To analyse research data, the study used partial least squares (PLS) structural equation modelling (SEM). Findings - The study had eight different practices associated with the CBHIS governance structural mechanism construct and six indicators measuring community health outcomes. Reliability and validity of constructs were used to assess the measurement model. Cronbach’s alpha and composite reliability were utilised and study findings reveal that all the indicators met thresholds. In addition, the convergent validities for the two constructs were above the minimum threshold of 0.5000 (AVE>0.5000). Furthermore, the two constructs in this study met the discriminant validity criterion assessed using three techniques namely the Fornell-Lacker Criterion, HTMT and cross-loadings. The assessment of the structural model reveals a positive and significant relationship between the CBHIS structural mechanism and community health outcomes. The linkage between the CBHIS governance structural mechanism and community health outcomes have a Beta coefficient (β) of 0.507 (original sample) and 0.521 (bootstrap sample). The T statistic (t) is 7.159***. In addition, the positive relationship is highly significant at a P-value (p) 0.000. Furthermore, the coefficient of determination (R2) is 0.257. In addition, the study findings reveal a predictive relevance (Q2) of 0.224 (22.4%) of the exogenous construct on the endogenous construct. The study concludes that the model has an overall predictive relevance. Practical implications – The study findings reveal the practices associated with the CBHIS governance structural mechanism necessary for community health-CBHIS alignment to occur and consequently translate to improved community health outcomes. Keywords: Alignment, Governance structural mechanism, Health Information Technology
Copyright (c) 2026 Journal of Health Informatics in Africa
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.
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.
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.
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.
Copyright (c) 2025 Journal of Health Informatics in Africa
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
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.
User Engagement with Mobile Health Applications for Self-management of Diabetes: A Principal Component Analysis Approach
Background and Purpose: Diabetes is a non-communicable disease that can arise from a genetic predisposition or develop due to the unhealthy lifestyle of an individual. mHealth applications (apps) can potentially revolutionise diabetes management by empowering people diagnosed with diabetes to take better control of their condition and promoting effective self-management. User engagement and sustained usage are critical determinants of mHealth apps’ success. While user engagement has been studied, detailed guidelines for developing applications that meet engagement requirements are limited. This study reported in this paper investigated the applicability of the User Engagement Scale (UES) in evaluating user engagement with a mHealth app for diabetes self-management. Methods: A 30-item UES questionnaire was distributed through Diabetes South Africa (DSA), a non-governmental organization that supports and advocates for people living with diabetes in South Africa. Participants, who are either diagnosed with Type 1 or Type 2 diabetes, rated their agreement with each statement in the UES using a 5-point Likert scale. Principal Component Analysis (PCA) was conducted on 55 responses to evaluate the UES’s dimensionality. Results: PCA suitability was confirmed by the Kaiser-Meyer-Olkin (KMO) measure of 0.650 and a significant Bartlett’s test of sphericity, χ2(435) = 1124.16, p < 0.001. A new factor, Incentive, emerged by combining Aesthetic Appeal and Reward, which impacted user engagement. Additionally, Focused Attention and Perceived Usability were identified as significant predictors of user engagement. A revised 25-item scale was produced after five items were removed due to low factor loadings. Conclusions: This study validated the UES in a mHealth app context among South African participants, suggesting that the three-factor, 25-item solution is effective in evaluating user engagement in mHealth application settings.
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.
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.
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.
Trust And Access in Telemedicine - A Review
Background and Purpose: Telemedicine has the potential to revolutionise healthcare delivery, especially in digitally marginalised populations; however, persistent challenges in access and trust limit its widespread adoption. Despite technological advancements, there remains a significant gap in understanding how these factors jointly influence telemedicine uptake in low- and middle-income contexts. Methods: This study employed a systematic literature review guided by the PRISMA framework, analysing 32 peer-reviewed studies published between 2018 and 2025 that address access and trust in telemedicine. Results: Telemedicine interventions yielded notable access gains in underserved settings, with rural reach improving by 40–75% across multiple studies. Trust outcomes, however, were less consistent, with confidence levels ranging from 44–71% and often constrained by privacy concerns, provider scepticism, and technological reliability Conclusions: This research contributes a comprehensive synthesis of empirical evidence highlighting the critical interplay between access and trust, providing actionable insights for designing user-centred, secure telemedicine systems. By addressing this dual gap, the study offers a foundation for future technological innovation and policy development aimed at equitable healthcare delivery in underserved populations.
Exploring Digital Health Innovations Across Africa: Challenges, Opportunities and the Way Forward
Objectives: To systematically review the current state, applications, barriers, and outcomes of digital health technologies across Africa, and to identify opportunities for enhancing healthcare delivery through digital innovation. Design: Systematic review following PRISMA guidelines. Methods: A comprehensive search was conducted across PubMed, Scopus, Web of Science, African Journals Online, and Google Scholar databases from 2014-2025. Search terms included "digital health," "mHealth," "telemedicine," "electronic health records," "artificial intelligence," and "Africa." Studies were included if they focused on digital health interventions, implementation, or outcomes in African countries. Results: Sixty-eight studies from 32 African countries were analyzed. Mobile health (mHealth) represented 45% of interventions, telemedicine 28%, electronic health records 18%, and artificial intelligence 9%. Key applications included maternal and child health (34%), infectious disease management (29%), and chronic disease monitoring (21%). Major barriers included inadequate infrastructure (78% of studies), limited digital literacy (65%), and financial constraints (59%). Success factors included stakeholder engagement (82%), appropriate technology selection (76%), and integration with existing systems (71%). Conclusions: Digital health technologies demonstrate significant potential for transforming healthcare delivery across Africa. However, successful implementation requires addressing infrastructure limitations, enhancing digital literacy, ensuring sustainable financing, and developing context-appropriate solutions. Strategic investments in enabling infrastructure and capacity building are essential for realizing the full potential of digital health 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.
Improving Collaboration Among Healthcare providers in Resource Constrained Healthcare Facilities: An Enterprise Architecture Approach
Background and Purpose: Application of an Information System that can provide a seamless flow of patient information and medical guidelines is highly desirable in the practice of Evidence Based Medicine (EBM). Information systems in Resource Constrained Health Facilities including Uganda have been found to be inadequate in supporting collaboration among healthcare providers. This study aimed at optimising collaboration and information sharing among healthcare providers by developing an architecture for a collaborative mobile application. Methods: The study adopted a cross-sectional research design and qualitative data was collected from 32 informants using a series of data collection methods including; interviews, focus group discussions, observation and document reviews from the hospital’s resource centre, published articles and online informatics journals. Results: Findings from this study showed that there were various information and communication systems including computers, e-mails, internet access and suffice to note, telephone calls for both landline and mobile were still being used for collaboration. Collaboration challenges that were identified include system integration issues, infrastructure limitations, data quality issues, system usability and geographical dispersals of both healthcare providers and healthcare facilities among others. The study further established that current systems focus more on monitoring and evaluation, surveillance of chronic diseases and data capture; less is done towards optimisation of collaboration. Conclusions: Healthcare providers ought to make decisions based on the most up-to-date, solid, reliable and scientific evidence, this study proposed a collaborative mobile application architecture to improve collaboration among healthcare providers at any point of care. The architecture was developed using enterprise architecture principles taking cognizance of its four crucial C’s; connection, collaboration, communication and customer.
Approaches Towards Interoperability of Electronic Medical Records Systems: A Case of Selected Referral Hospitals in Tanzania
Background and Purpose: Electronic Medical Record (EMR) systems are different among hospitals and they often come from different vendors. As a result, it is difficult to share patient information across them. The ability to exchange patient information, also known as interoperability, has become a challenge both within the hospital and across hospitals. This study, therefore, investigated the interoperability of EMR systems in hospitals and sought to explore approaches to achieve interoperability between EMR systems in health facilities. Methods: The study employed a qualitative design, which involved two parts, narrative literature review and semi-structured interviews. The literature review was used for identification of factors influencing the interoperability of EMRs. Thereafter, data were collected through semi-structured interviews with 14 key personnel in the ICT department from 4 Regional Referral Hospitals (RRH) and the Muhimbili National Hospital (MNH). The qualitative data from the interviews were analysed using the content analysis method. Results: The initiatives related to EMRs interoperability among hospitals should start with the Ministry responsible for health. Establishment of hospital ICT policy to support interoperability of EMR systems within the hospital. Hospitals should invest in interoperability technologies such as REST API and HL7 FHIR to achieve interoperability of EMR systems. Conclusions: Interoperability of EMR systems require enough budget to be allocated both within the hospital and between hospitals. Also, adherence to the Tanzania health enterprise architecture which provides the framework towards achieving interoperability of digital health systems.
eHealth Architecture-based Health Data Exchange
Background and Purpose: A blueprint of the national-level arrangement of health system components in Ethiopia is depicted in the eHealth Architecture (eHA). At the time of the study, the lack of practical implementation experience limited Ethiopia’s ability to move toward maturing the architecture. In this study, the team set out to explore practical implementation and scaling solutions that leverage open standards and tools. Two major components of the eHA were used to demonstrate the health data exchange: the legacy Electronic Medical Record (EMR) system and the national electronic Health Management Information System (HMIS) instances. At the time of the research, the HMIS contained 53 data sets used by more than 35,000 health facilities serving at different layers of the health sector, including health posts, health centers, hospitals, and other facilities, to deliver reports of various types. It is the major source of information by the Federal Minister of Health. The main purpose of this study was to explore potential opportunities and overcome challenges related to health data exchange patterns of national eHA. Methods: A thorough assessment of related works were conducted to examine global, national, and local perspectives. An eHA-based health data exchange model was developed, which leveraged open tools and standards. HAPI FHIR, an open-source and Java-based HL7 FHIR solution was adopted to extract local relational EMR data to FHIR messaging formats. With the main focus on design scalability, the team developed a strategy for mapping local data elements to FHIR resources and created an OpenHIM mediator. To demonstrate the developed model, existing architecture components with high impact on national-level health data quality were selected. Finally, an evaluation method was conducted using the top ten diseases which compared the computer-based solution and manual tally sheet-based data entry. Results: The developed model was aligned with national eHA data exchange patterns and resulted in enhanced data quality. Data quality was examined using timelines, accuracy, completeness, and cost parameters over a 12-month period of production EMR data for the top ten disease classifications. Scalable local EMR data-to-FHIR resource data element mapping was developed using the HAPI FHIR library. Its effectiveness was proven as the model effectively mapped to the elements for the identified FHIR resources. Study results also showed the use of eHA interoperability patterns produced enhanced HMIS data quality and established reusable data exchange modules with national impact. Though Ethiopia has a standardized national classification of disease adopted from World Health Organization ICD-10, this extensive experiment revealed fragmented efforts toward health data reporting resulting in inconsistent data elements. To overcome the challenge, the study suggested using national terminology service instances with the capability to cascade concepts at a facility level. Conclusions: A scalable health data exchange model was developed and tested with the major data source components of eHA, EMR, and the national HMIS instances. Interoperability of those systems significantly fostered national eHA maturity. Therefore, this study asserts the use of open global standards and tools facilitates the maturity of the national eHA.
Use of a digital database of cardiac auscultations to search for associations between auscultatory and echocardiographic abnormalities in children with congenital heart disease
Introduction : L’auscultation cardiaque et l’échocardiographie sont essentielles pour l’évaluation des cardio- pathies congénitales. L’utilisation d’outils numériques (stéthoscopes électroniques, logiciels de traitement et d’annotation) permet l’enregistrement audio des auscultations cardiaques, améliore leur écoute et favorise leur description détaillée. L’objectif de cette étude était de rechercher les associations qui existeraient entre les anomalies retrouvées à l’auscultation cardiaque et les paramètres échocardiographiques chez les enfants por- teurs de cardiopathies congénitales, en s’appuyant sur une base de données d’auscultations annotées. Méthodologie : Une étude transversale descriptive a été réalisée au Centre Mère et Enfant de la Fondation Chantal Biya. Les enfants porteurs de cardiopathies congénitales non corrigées étaient inclus. Les sons issus de l’auscultation cardiaque de ces enfants ont été enregistrés et permis de constituer une base de données d’aus- cultations cardiaques. Les bruits d’intérêt issus de ces auscultations ont été décrits et annotés par un cardiopédi- atre à l’aide d’un logiciel de traitement et d’annotation d’enregistrements audios. Ces enfants ont ensuite bé- néficié chacun d’une échocardiographie. Les associations qui existaient entre les anomalies retrouvées à l’aus- cultation cardiaque et les paramètres échographiques ont été recherchées chez les enfants porteurs de commu- nication interventriculaire (CIV), de sténose valvulaire pulmonaire (SVP) ou de persistance du canal artériel (PCA) isolées. Résultats : 54 enfants ont été recrutés, soit 324 enregistrements audios pour une durée totale de 121 minutes. Les enfants de 29 jour à moins de 3 ans représentaient 51,9 % des participants. À l’auscultation, 51 patients (94,4 %) avaient un souffle cardiaque et 6 patients (11,1%) avaient un éclat du B2 pulmonaire. Les cas de CIV, PCA et SVP isolés représentaient respectivement 37%, 20,4% et 11,1% des participants. Il existait une diffé- rence statistiquement significative entre ces trois groupes de pathologies isolées par rapport au foyer où le souffle avait une intensité maximale à l’auscultation cardiaque (p=0,005). Par contre, il n’y avait pas d’associ- ation statistiquement significative entre l’intensité du souffle et les différents gradients de pression ainsi qu’avec la pression artérielle pulmonaire moyenne pour ces trois groupes de pathologies isolées. Enfin, l’éclat du B2 n’était pas associé de manière statistiquement significative à la pression artérielle pulmonaire moyenne chez les patients ayant une CIV isolée. Conclusion : L’utilisation d’outils numériques permet d’améliorer l’expérience et les performances en auscul- tation cardiaque. Il servent comme support pour la description d’anomalies de l’auscultation cardiaque et fa- cilitent ainsi la recherche d’associations entre les anomalies retrouvées à l’auscultation cardiaque et les paramètres échocardiographiques. Le foyer d’auscultation où le souffle est perçu avec une intensité maximale pourrait permettre de prédire la nature de la cardiopathie pour les trois groupes de pathologies isolées étudiées. Mots clés : Cardiopathie congénitale, auscultation cardiaque, échocardiographie, stéthoscope électronique.
Improving health literacy in rural Africa through mobile phones: a systematic literature review
Background and Purpose: Mobile phones have been used to support healthcare systems through various mobile health (m-health) applications. In Africa, m-health initiatives have been used in many interventions, including education and awareness, clinical and non-clinical decision support systems, epidemic outbreak tracking, training of healthcare workers and remote monitoring, and many others. But despite the great enthusiasm around m-health, few studies have examined the use of mobile phones to improving health literacy in rural areas in Africa. Methods: We performed a literature review using SCOPUS and Google scholar, combined with manual searching methods to search for studies related to m-health initiatives in Africa. The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) protocol. Four steps were followed to identify relevant publications related to the contribution of mobile technologies in improving health literacy :(1) Database selection (2) Keyword search, (3) Study selection and (4) Data extraction. Results: In our study, we found 5 studies related to health literacy and mobile technologies in Africa. However, none of them were focused on health literacy and mobile technologies in rural areas of Africa. This result provides insights of future studies to conduct. Conclusions: We found that m-health initiatives were so far not inclusive. It appears that few m-health solutions integrate local languages in the development of m-health solution. The mhealth initiatives need to be implemented based on the local realities, so experimental studies are desired to test the adaptability of mhealth projects and to explore any adjustments required.
Leveraging technology to support HELINA Education Working Group activities
Background and Purpose: Working groups implementing activities for health informatics associations need the right technological infrastructure to support the range of activities they conduct. In this paper, we describe the approach taken and results achieved in developing the technology-based infrastructure to support HELINA Education Working Group activities. Methods: Technological infrastructure needs for the EWG were guided by work sets for the WG. In collaboration with the technical team, the technology tools were identified with a bias towards open-source tools. The waterfall model was used for the development of needed features. Results: Tools implemented to support the HELINA EWG included a website (HELINAnet), a discussion forum (HELINAtalk), an eLearning and content organization platform (HELINALearn), social media accounts (Twitter, LinkedIn, and Facebook), a video conferencing platform based on Zoom, an email-based google mailing list (helina-ewg@googlegroups.com), and an electronic newsletter. Metrics of use were maintained. Conclusions: The approach taken to implement the technological infrastructure to support EWG activities can serve as a demonstrative model that could be employed by other HELINA WG, as well as the larger organization. Keywords: Health Informatics, Education, Working Group, Technology
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.
Assessing the Knowledge and Practice of E-Tracker Among Nurses in the Ho Municipality
Background and Purpose: Electronic health is an integration of technology in healthcare delivery to facilitate its service delivery. It ranges from the use of desktops to handheld devices to facilitate care, data capture, and data transmission. Due to the wide ranges of technology usage in varieties of services, the healthcare industry is not left behind. It improves upon quality of data generations to facilitate proper decision making. The current study aimed at evaluating the knowledge and practice of e-tracker among nurses in the Ho Municipality of the Volta region of Ghana. Methods: A descriptive cross-sectional approach was used. Simple Random Sampling technique was used to recruit the participants and a semi-structured questionnaire was used to capture the desired data. Data collected was entered using EpiData 3.0 and further exported into Stata 16 IC for analysis. Results were presented using tables and graphs. Results: 129 (69.3%) of the nurses had high knowledge of e-tracker while 42 (22.6%) had high e-tracker usability. 66 (35.5%) of nurses synchronized data immediately after entry while 114 (61.3%) do not ask clients whether if they had been enrolled onto the e-tracker for their first visit. Nurses who consulted District (HI) were 4.9 [COR=4.9; CI(95%)=2.45 – 9.63; p-value=0.000] and 6.8 [AOR=6.8; CI(95%)=2.78 – 16.53; p-value=0.000] times to have high knowledge than their counterparts that did consult their in-charges for assistance. Conclusions: Though there was a high knowledge level of e-tracker among nurses in the Ho municipality there was a very low usability of e-tracker among nurses.