Digital health in fragile states in the Middle East and North Africa (MENA) region: A scoping review of the literature

• Published in: PloS one Vol. 18; no. 4; p. e0285226
• Main Authors: El-Jardali, Fadi, Bou-Karroum, Lama, Jabbour, Mathilda, Bou-Karroum, Karen, Aoun, Andrew, Salameh, Sabine, Mecheal, Patricia, Sinha, Chaitali
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 28-04-2023; Public Library of Science (PLoS)
• Subjects: Africa, Northern; Armed Conflicts; Biomedical Technology; Computer and Information Sciences; Continuing education; Coronaviruses; COVID-19; Digital computers; Disease transmission; Evaluation; Fragility; Health care; Health care industry; Health care policy; Health promotion; Health services; Humans; Infectious diseases; Innovations; Intervention; Literature reviews; Medicine and Health Sciences; Mental disorders; Mental health; Middle East; Observational studies; People and Places; Political violence; Public health; Research and Analysis Methods; Telemedicine; Womens health; Africa, Northern; Middle East; Northern Africa; Lebanon; North Africa; Iraq; Yemen
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0285226

Conflict, fragility and political violence, that are taking place in many countries in the Middle East and North Africa (MENA) region have devastating effects on health. Digital health technologies can contribute to enhancing the quality, accessibility and availability of health care services in fragile and conflict-affected states of the MENA region. To inform future research, investments and policy processes, this scoping review aims to map out the evidence on digital health in fragile states in the MENA region.
We conducted a scoping review following the Joanna Briggs Institute (JBI) guidelines. We conducted descriptive analysis of the general characteristics of the included papers and thematic analysis of the key findings of included studies categorized by targeted primary users of different digital health intervention.
Out of the 10,724 articles identified, we included 93 studies. The included studies mainly focused on digital health interventions targeting healthcare providers, clients and data services, while few studies focused on health systems or organizations managers. Most of the included studies were observational studies (49%). We identified no systematic reviews. Most of the studies were conducted in Lebanon (32%) followed by Afghanistan (13%) and Palestine (12%). The first authors were mainly affiliated with institutions from countries outside the MENA region (57%), mainly United Kingdom and United States. Digital health interventions provided a platform for training, supervision, and consultation for health care providers, continuing education for medical students, and disease self-management. The review also highlighted some implementation considerations for the adoption of digital health such as computer literacy, weak technological infrastructure, and privacy concerns.
This review showed that digital health technologies can provide promising solutions in addressing health needs in fragile and conflict-affected states. However, rigorous evaluation of digital technologies in fragile settings and humanitarian crises are needed to inform their design and deployment.