Online Health in the Developing World

sri-lankaFollowing on from Monday’s post about health information on twitter, it seemed a nice coincidence that I came across a research paper focusing on healthcare information available in the developing world.

The web is still relatively young and yet many people can barely remember a time when they could not simply click a mouse and gain access to health and medical information. Apparently, hundreds of millions of people regularly access the internet for the sole purpose of finding healthcare information, news about the latest medicines, and advice on every ailment and illness you can imagine and some you can’t.

According to Mahinda Kommalage and Anoj Thabrew, of the Faculty of Medicine at the University of Ruhuna in Sri Lanka, most research into such internet use has focused on health information in developed countries. There have been thousands of scientific papers published on this topic by Western researchers, but a mere handful of results on PubMed cite locations such as Sri Lanka, Nepal, and Bangladesh in keyword searches together with the word “internet”. Moreover, of the six results for “Sri Lanka and Internet”, just one study from 1999 is actually about a health website.

Kommalage and Thabrew suggest that given the enormous growth of Internet usage across the globe almost irrespective of geography, it is quite surprising that so little research into medical and health information sites in developing countries has been carried out. This is particularly worrying given the almost total lack of controls and regulations on medical information on the web.

The researchers have focused on health education websites in Sri Lanka in a survey of what is available. Their first discovery relates to the size of the website most (almost 90%) have fewer than 100 pages, which is barely enough to cover the basics. Moreover, while the quality of local non-commercial sites was higher than those owned by businesses fewer than one in ten provided health education content for the general public.

The notion that the internet might help the developing world improve its health status is not new. As long ago as 2000, the British Medical Journal published an article from WHO scientist Tessa Tan-Torres Edejer entitled “Disseminating health information in developing countries: the role of the internet”. A rare few related papers can be found with a little Googling, including one from Johns Hopkins’ Madhav Goyal and colleagues writing in JAMA who lament the fact that in poor nations invaluable healthcare information rarely reaches those who need it most.

I asked Gabriel Guimaraes a Physician at ASEFE in Brazil about the issue and he points out that the internet does reduce the differences. “This question has so many possible answers,” she says, “We could either talk about the evidence based medicine and everything related to it (MedLine, NCBI and Cochrane’s Metanalysis), which in Latin America would also relate to SCIELO database, or health record software which would relate for example to Health Informatics Societies (like SBIS), or about telemedicine. Anyway there is not much difference between developing and developed because we are talking about recent technology which has almost simultaneously started for every country.”

But, his conclusions do not bear up to the scrutiny of Kommalage and Thabrew, at least for Sri Lanka.

“The total number of websites has not increased compared to the increase in internet usage in Sri Lanka during the last few years,” the researchers say. If their findings apply to the wider developing world then the internet represents a massively underutilised health education resource in parts of the world where improved health education could be used to reduce significantly the incidence of many lethal diseases, such as malaria, HIV/AIDS, and parasitic infections.

For anyone interested in what is being done to redress the balance, check out antropologi.info blog and Health Information for all 2015. The raison d’être is the following fact:

Tens of thousands of people die every day, often for the simple reason that the parent, carer or health worker lacks the information and knowledge they need to save them.

Somewhat related to this post but more about scientific research than information is SciDev.net. Also of interest: Uneca, science with Africa.

Research Blogging IconMahinda Kommalage, Anoj Thabrew (2008). The use of websites for disseminating health information in developing countries: an experience from Sri Lanka Int. J. Electronic Healthcare, 4 (3/4), 327-338

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6 thoughts on “Online Health in the Developing World”

  1. Interesting article. I think readers might also be interested in this telemedicine/humanitarian program that I have heard about- iCons in Medicine.(www.iconsinmed.org)
    This program uses telemedicine to connect healthcare providers in remote or medically underserved areas, with specialty physicians, who provide expertise, encouragement, and advice on difficult cases.The iCons in Medicine program uses a special software that enables those having relatively low bandwidths and limited connectivity to utilize the system with a secure SSL connection. The software, which is based on store and forward technology, saves the consultation form until connectivity is available and then functions like e-mail to route the case to the network of volunteer physicians according to the specialty desired. It is a free service and it also is a very good social networking site for those in the healthcare industry.

  2. Ben Bland said: “I don’t quite understand the issue of information not being available outside of the developed world, when online information is international.”

    The vast majority of health workers in low-income countries do not have access to the internet. Many of them have no reliable reference or learning materials at all. As a result they do not have the basic information they need to deliver safe, effective health care. There are many other barriers – the language barrier, which you mention, is important even for the fortunate few who have access to the internet.

    It’s a complex challenge but a vital one: lack of healthcare information is a hidden killer. HIFA2015 involves more than 2000 professionals from 135 countries, working together to identify solutions. Anyone with an interest is welcome to join:

    http://www.hifa2015.org

    Best wishes,
    Neil

    Dr Neil Pakenham-Walsh MB,BS
    Coordinator, HIFA2015 Campaign
    Co-director, Global Healthcare Information Network
    16 Woodfield Drive
    Charlbury, Oxfordshire OX7 3SE, UK
    Tel: +44 (0)1608 811338
    Email: neil.pakenham-walsh@ghi-net.org
    Web: http://www.ghi-net.org
    Web (HIFA2015): http://www.hifa2015.org

    Join HIFA2015 and CHILD2015 – send your name, organisation and brief description of your professional interests to hifa2015-admin@dgroups.org and child2015-admin@dgroups.org (or direct to Neil PW at neil.pakenham-walsh@ghi-net.org )

    “Healthcare Information For All by 2015: By 2015, every person worldwide will have access to an informed healthcare provider”

    With thanks to our 2009 Sponsors: British Medical Association, Royal College of Midwives, Royal College of Nursing

  3. How the developing world can benefit from online information is a really exciting area.

    I don’t quite understand the issue of information not being available outside of the developed world, when online information is international. I’m probably missing the point, besides the obvious English language barrier.

    We publish case reports from clinicians all over the world and are eager to be as accessible to those in developing regions as possible. We get lots of case reports submitted from developing countries, which is very encouraging. As an open platform, doctors in developing countries are able to share knowledge about treatment of diseases affecting local populations that may be overlooked by the mainstream international medical journals.

  4. Thanks for the mention of the HIFA2015 campaign.

    HIFA2015 brings together more than 2000 professionals from 135 countries, committed to a common goal: By 2015, every person worldwide will have access to an informed health care provider. The campaign was launched in Mombasa, Kenya, in 2006. We highlight the link between the lack of availability of relevant, reliable information for healthcare providers in developing countries, and the daily toll of tens of thousands of deaths in developing countries. Many of these deaths could have been prevented if carers had known what to do, and when and where to seek help.

    The campaign brings together all those involved in the creation, exchange and use of information. We share expertise and experience in two dynamic email communities: HIFA2015 (general) and CHILD2015 (child health). Anyone with an interest is welcome.

    “HIFA2015 is the best thing to happen in my life concerning my career. I have learnt so, so much from the discussions… Long live HIFA2015!”
    Beatrice Muraguri, Health Information Officer, Ministry of Health, Nairobi, Kenya

    Best wishes,
    Neil

    Dr Neil Pakenham-Walsh MB,BS
    Coordinator, HIFA2015 Campaign
    Co-director, Global Healthcare Information Network
    Tel: +44 (0)1608 811338
    Email: neil.pakenham-walsh-AT-ghi-net.org
    Web (HIFA2015): http://www.hifa2015.org

    With thanks to our 2009 Sponsors: British Medical Association, Royal College of Midwives, Royal College of Nursing

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