Healthcare provider-targeted mobile applications to diagnose, screen, or monitor communicable diseases of public health importance in low- and middle-income countries: a systematic review

Communicable diseases remain a leading cause of death and disability in low- and middle-income countries (LMICs). mHealth technologies carry considerable promise for managing these disorders within resource-poor settings, but many existing applications simply represent digital versions of existing guidelines or clinical calculators, communication facilitators, or patient self-management tools. We thus systematically searched PubMed, Web of Science, and Cochrane Central for studies published between January 2007 and October 2019 involving technologies that were mobile phone- or tablet-based; able to screen for, diagnose, or monitor a communicable disease of importance in LMICs; and targeted health professionals as primary users. We excluded technologies that merely digitized existing paper-based tools or simply facilitated communication. Extracted data included disease category, pathogen type, diagnostic method, intervention purpose, study/target population, sample size, study methodology, development stage, accessory requirement, country of development, operating system, and cost. Given the search timeline and the extremely rapid turnover in the science concerning Coronavirus Disease 2019 and its novel variants, studies involving it were not included in the analysis. Of 13,262 studies identified by the screen, 33 met inclusion criteria. 12% were randomized clinical trials (RCTs), with 58% of publications representing technical descriptions. 62% of studies had 100 or fewer subjects. All studied technologies involved diagnosis or screening steps; none addressed the monitoring of infections. 52% focused on priority diseases (HIV, malaria, tuberculosis), but only 12% addressed a neglected tropical disease. Although most reported studies were priced under 20USD at time of publication, two thirds of the records did not yet specify a cost for the study technology. We conclude that there are only a small number of mHealth technologies focusing on innovative methods of screening and diagnosing communicable diseases potentially of use in LMICs. Rigorous RCTs, analyses with large sample size, and technologies assisting in the monitoring of diseases are needed. Author SummaryAlthough significant progress has been made in decreasing their worldwide impact, infectious diseases still represent a considerable burden of disease and death. This is especially the case in certain regions of low- and middle-income countries, where limited healthcare resources, personnel, and facilities can make it difficult to provide high quality care. Mobile health (mHealth) technologies are disruptive tools that hold considerable promise in these resource-constrained settings by circumventing some of the aforementioned obstacles. To better understand the availability and characteristics of mHealth technologies for use in low- and middle-income countries, we systematically searched for studies published in English between January 2007 through October 2019 to identify all existing mobile phone- or tablet-based innovations targeted at healthcare providers for use against infectious diseases in these settings and summarized their qualities and performance. We found that four times as many publications focused on tools that simply made data transfer more simple than there were on new tools for detecting or monitoring diseases. Few studies were tested under the most rigorous scientific methods. Many diagnostic technologies we identified require specialized attachments or additional laboratory equipment that connect to the smartphone or tablet, which could make their use in some settings more challenging.