Implementation and impact of mhealth in the management of diabetes mellitus in Africa: A systematic review and meta-analysis

Background: The World Health Organization (WHO) has proposed the concept of mobile health to support healthcare systems delivery worldwide. Mobile health (mHealth) involves using Information and Communication Technology (ICT) for health care provision or delivery services. In the context of Africa, a region that has witnessed a significant increase in mobile phone availability and usage in the last decade and a corresponding rise in the incidence and prevalence of diabetes mellitus, this study has global implications. We conducted a systematic review on the extent of mHealth implementation in managing diabetes mellitus in Africa. We estimated its impact on achieving desired glycemic targets, sustained control, and preventing complications in the past decade. Methods and analysis: The studies assessing the utilization of mHealth in managing patients with diabetes mellitus in Africa were considered based on the PICO method: Population, Intervention, Comparator, and Outcomes. MEDLINE, PubMed, SCOPUS, and the Pan African Clinical Trials Registry were searched. Two authors, independent of each other, screened titles and abstracts retrieved using the search strategy, retrieved the full-text articles, and assessed them for eligibility, extracting data after that. A third independent reviewer was brought in to resolve disagreements between the two authors by discussion. The revised Cochrane Collaboration Risk of Bias Tool was used to assess the quality of included studies. A narrative synthesis of extracted data was done due to the paucity of eligible studies, and the results were summarized in a meta-analysis. Results: None of the six included studies measured the mean FPG or percentage changes as primary outcomes. Five measured the percentage change in HbA1c from baseline to the end of the study. The percentage change in HbA1c from the baseline ranged from 3.6% to 20.53%, achieving significance in three studies. In the meta-analysis the overall WMD (95% CI) was 0.992 (0.48, 1.50). This, in combination with a high z score of 3.822, p