Digital platforms and non-communicable diseases in sub-Saharan Africa
Authors: Elaine Okanyene Nsoesie, Olubusola Oladeji, Moinina David Sengeh
Journal: The Lancet Digital Health (2020)

By 2050, it is projected that 68% of the world's population will live in urban areas.1United Nations68% of the world population projected to live in urban areas by 2050, says UN.https://www.un.org/development/desa/en/news/population/2018-revision-of-world-urbanization-prospects.htmlDate: 2018Date accessed: June 19, 2019Google Scholar This urban migration will lead to an increase in obesity-related non-communicable diseases, such as, diabetes, hypertension, and cardiovascular diseases,2Atun R Gale EA The challenge of diabetes in sub-Saharan Africa.Lancet Diabetes Endocrinol. 2015; 3: 675-677Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar creating substantial challenges, especially for countries in which the health systems are weak. In sub-Saharan Africa, for example, those affected by hypertension are projected to increase from 75 million in 2008 to 126 million in 2025.3Twagirumukiza M De Bacquer D Kips JG de Backer G Stichele RV Van Bortel LM Current and projected prevalence of arterial hypertension in sub-Saharan Africa by sex, age and habitat: an estimate from population studies.J Hypertens. 2011; 29: 1243-1252Crossref PubMed Scopus (134) Google Scholar Insufficient exercise and unhealthy diets, coupled with tobacco use and excessive alcohol consumption are to blame for this increase.4Mayosi BM The 10 'Best Buys' to combat heart disease, diabetes and stroke in Africa.Heart. 2013; 99: 973-974Crossref PubMed Scopus (38) Google Scholar The reduction of these underlying risk factors requires the strengthening of health systems and the implementation of hybrid interventions—both digital and physical—that encourage healthy lifestyle behaviours and enable timely monitoring of risk factors and patients. Data from internet sources can be used to improve timely surveillance of behavioural risk factors.5Cesare N Nguyen QC Grant C Nsoesie EO Social media captures demographic and regional physical activity.BMJ Open Sport Exerc Med. 2019; 5e000567Crossref PubMed Scopus (14) Google Scholar Although most of this research has been done in high-income countries, similar data can be used to study health across sub-Saharan Africa.6Abebe R Hill S Vaughan JW Small PM Schwartz HA Using search queries to understand health information needs in africa.Proc Int AAAI Conf Web Soc Media. 2019; : 3-14Google Scholar An estimated 268 million people used the internet in 2018,7ITU Statisticshttps://www.itu.int/en/ITU-D/Statistics/Pages/stat/default.aspxDate accessed: December 3, 2019Google Scholar and there are 216 million active social media users in sub-Saharan Africa.8We are SocialThe global digital report.https://wearesocial.com/global-digital-report-2019Date accessed: December 3, 2019Google Scholar The adoption of these technologies provides opportunities to study how health, social, and behavioural data on the internet could be used to improve health. Although digital tools for health data analytics are being developed and used in Africa by start-ups such as Talamus and companies such as IBM, many of these solutions do not use data from social media, internet forums, and search engines (hereafter referred to as, digital platforms). Digital platforms offer the opportunity to see and understand the health of a population with greater precision. We discuss three ways in which these data can be useful for addressing the non-communicable disease epidemic in sub-Saharan Africa. First, we can monitor health information seeking. Digital platforms provide opportunities for seeking and sharing health information. Patients can find information on medical conditions by submitting a query or by reading postings. For example, the Facebook group, Weight Loss South Africa, which provides information on diet and exercise for weight loss, has nearly 15 000 members.9Facebook GroupWeight loss South Africa.https://www.facebook.com/groups/1538242486490313/Date accessed: December 3, 2019Google Scholar This availability of health information on the internet can be useful for regions where clinicians and access to quality health information are scarce. Only one study has assessed what types of health information related to communicable diseases individuals are seeking across Africa.6Abebe R Hill S Vaughan JW Small PM Schwartz HA Using search queries to understand health information needs in africa.Proc Int AAAI Conf Web Soc Media. 2019; : 3-14Google Scholar Similar studies are needed to characterise information seeking related to non-communicable diseases and their risk factors. Research can focus on identifying the types of information individuals seek, regions where knowledge gaps exist, as well as differences across demographics and health conditions. This would support the design of interventions that target specific populations (eg, the promotion of information on the accounts of authoritative sources such as Ministries of Health or public figures, which encourage young adults to make healthy dietary choices or to seek medical services for early diagnosis of diabetes—62% of diabetic cases are undiagnosed).2Atun R Gale EA The challenge of diabetes in sub-Saharan Africa.Lancet Diabetes Endocrinol. 2015; 3: 675-677Summary Full Text Full Text PDF PubMed Scopus (29) Google Scholar Second, we can monitor behavioural risk factors. Studies have shown that community indicators on behavioural risk factors can be constructed by combining data from multiple digital platforms.10Cesare N Dwivedi P Nguyen QC Nsoesie EO Use of social media, search queries, and demographic data to assess obesity prevalence in the United States.Palgrave Commun. 2019; 5: 1-9Crossref Scopus (11) Google Scholar Data for such studies are usually collected by location or keywords via the digital platforms' Application Programming Interface. These data could improve our understanding of the role of social network structures that intertwine people on the basis of physical relationships, place, culture, and interest in daily behavioural decisions that affect health in sub-Saharan Africa. Furthermore, we can quantify trends in postings of engagement and intent to engage in behavioural risk factors. Although it is difficult to distinguish intent from actual engagement simply by looking at a social media photo, the mere prevalence of alcohol, tobacco, or unhealthy food images could reflect changing community attitudes. By monitoring changes in population behavioural trends on digital platforms, online and offline interventions could be more effective in promoting healthy behaviours. Lastly, we can monitor health misinformation related to behavioural risk factors at individual and population levels. Health misinformation (eg, miracle cures) can harm the public's health by delaying care or aggravating health conditions. The spread of misinformation on online social networks, including which actors are influencing it, its velocity, framing, and how it is embedded within belief systems, can evolve and differs by topic (eg, infectious vs chronic diseases). Tools are needed for tracking and quantifying the extent of health misinformation on digital platforms, and how misinformation exposure can increase engagement in risky behaviours. If used properly and ethically, digital platforms can transform how we listen to and address non-communicable disease risk factors in sub-Saharan African communities. However, most digital platforms were not created for studying health and are therefore encumbered with values and structures that do not always benefit vulnerable populations. The adoption of these digital platforms for public health surveillance creates complex challenges, requiring the development of solutions specific to the sub-Saharan African context. For example, owing to large socioeconomic inequalities, individuals seeking or sharing health information on digital platforms might not be representative of the entire population. Also, substantial cultural influences in sub-Saharan Africa mean individuals discuss health and disease differently (eg, an individual diagnosed with hypertension might search for medication side-effects but also traditional or natural remedies). In addition, a shortage of high-quality surveillance data on the prevalence of many non-communicable diseases in sub-Saharan Africa make the assessment of the usefulness of data from digital platforms challenging. However, survey estimates that suggest that the prevalence of obesity and related non-communicable diseases are increasing in many countries (figure) could be used in initial studies. To address these challenges, we need to develop ethical frameworks that acknowledge the limitations of consent, privacy, and bias. Specifically, locally developed and contextualised strategies should include digital literacy education, the design of consent systems that give users of digital platforms the right to opt-out of research studies, and methods that address a lack of demographic representation. African public health practitioners, data scientists, clinicians, social scientists, technologists, and ethicists can collaboratively work to develop systems that take advantage of data from digital platforms to address the epidemic of non-communicable diseases while avoiding issues of data colonialism. EON has received travel support from Google. MDS is the Chief Innovation Officer for the Government of Sierra Leone. OO declares no competing interests.