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Digital Health Solutions During COVID-19 in Low- and Middle-Income Countries: A Systematic Review of Current Evidence

Background: The COVID-19 pandemic has increased the demand for scaling up digital health solutions such as telemedicine, mobile health (mHealth), artificial intelligence (AI), and social media in low- and middle-income countries (LMICs). The application and acceptability of digital health solutions in LMICs could differ from the contexts of high-income countries. Thus, this study aimed to review various digital health solutions implemented in LMICs during the COVID-19 pandemic. 
 
Methods: This systematic review followed PRISMA guidelines and is registered with PROSPERO (CRD42021231836). Searches were performed on PubMed, CINAHL, EMBASE, and SCOPUS for research articles published between January 1, 2020 and March 17, 2021. The inclusion criteria comprised people residing in LMICs, digital health solutions that could improve the overall health and wellbeing, user experiences, and acceptability. RCTs, quasi-experimental studies, and cohort study designs were included. The risk of bias assessments for randomized studies and non-randomized intervention studies were performed. 
 
Findings: Of the 2200 studies retrieved from search, 1912 studies were screened after removal of duplicates. Of the 270 full texts assessed for eligibility, six studies were included in the narrative synthesis. The studies were from Zimbabwe, China, and Turkey. Two studies were RCTs, one was cohort, and three were non-randomized intervention studies. Three studies focused on telemedicine and three on social media.  All studies indicated positive results with the intervention. However, each study employed different digital health technology and measured different outcomes, and, thus, meta-analysis was not possible. 
 
Interpretation: Digital health interventions can be an effective way to improve health and provide health consultations during the pandemic. However, the available evidence from this review cannot determine the effectiveness of digital health solutions in LMICs. Remote consultations with the aid of social media, teleconsultation, and internet hospitals are the future of healthcare. Therefore, well-designed intervention studies in digital health are necessary. 
 
Funding Statement: None. 
 
Declaration of Interests: We declare no competing interests.