Document Type : Original Article

Authors

Abstract

BACKGROUND: Health communication is a field that uses social and behavioral models to improve
health outcomes and raise awareness on major health risks that threaten human well‑being.
Low‑income countries (LICs) suffer from the effects of communicable and noncommunicable diseases
that are exacerbated by weak health‑care systems, lack of awareness campaigns, and ineffective
communication tactics. This work aims to explore health communication research in LICs to find
strategies that help improve health outcomes in the future.
MATERIALS AND METHODS: The PubMed database was explored systematically for publications
related to health communication from LICs between January 1, 1960, and January 1, 2020.
Publications were categorized according to country of origin and were analyzed with respect to
population size, gross domestic product (GDP), and primary school enrollment of each state as
obtained from the World Bank Open Data.
RESULTS: Collectively, LICs published 796 contributions, comprising 1.08% of the total biomedical
research published by LICs and 0.27% of the world’s health communication research. Malawi had
the highest number of publications per GDP, with 32.811 publications per billion US$. Uganda had
the most contributions per population, with 9.579 publications per million persons. Ethiopia had the
highest amount of contributions per primary school enrollment with a ratio of 2.461 publications per
%gross. The role of health communication in promoting HIV awareness and prevention was the most
common theme explored. Other infectious diseases, such as malaria, tuberculosis, and Ebola, were
also highlighted. Improving communication in health education was also explored.
CONCLUSION: Health communication is a rising field in LICs, with research focusing on disease
prevention. Efforts to amplify research are key to effectively utilize the health communication models
and improve health outcomes in LICs.

Keywords

  1. Mheidly N, Fares  J. Health communication research in the
    Arab world: A bibliometric analysis. Integrated Healthc J
    2020;2:e000011.
    2. Centers for Disease Control and Prevention. Health
    Communication Basics; 2020. Available from: https://www.
    cdc.gov/healthcommunication/healthbasics/WhatIsHC.html.
    [Last accessed on 2020 Apr 15].
    3. World Bank. World Bank Country and Lending Groups;
    2020. Available from: https://datahelpdesk.worldbank.
    org/knowledgebase/articles/906519‑world‑bank‑country‑
    and‑lending‑groups. [Last accessed on 2020 Apr 15].
    4. Institute for Health Metrics and Evaluation. Findings from the
    Global Burden of Disease Study 2017. IHME; 2018.
    5. Bösenberg AT. 51‑Pediatric anesthesia in developing countries.In:
    Coté CJ, Lerman J, Anderson BJ, editors. A Practice of Anesthesia
    for Infants and Children. 6th ed. Philadelphia: Content Repository
    Only!; 2019. p. 1161‑74.e1163.
    6. Pantoja T,Opiyo N, Lewin S, Paulsen E, Ciapponi A,Wiysonge CS,
    et al. Implementation strategies for health systems in low‑income
    countries: An overview of systematic reviews. Cochrane Database
    Syst Rev 2017;9:CD011086.
    7. Hurt K, WalkerRJ, CampbellJA, Egede LE. mHealth Interventions
    in low and middle‑income countries: A systematic review. Glob
    J Health Sci 2016;8:54429.
    8. World Bank. Prevalence of HIV, Total  (% of Population ages
    15‑49) – LowIncome;2019.Availablefrom:https://data.worldbank.
    org/indicator/SH.DYN.AIDS.ZS?locations=XM. [Last accessed
    on 2020 Apr 15].
    9. UNAIDS. Uganda; 2018. Available from: https://www.unaids.
    org/en/regionscountries/countries/uganda. [Last accessed on
    2019 Dec 26].
    10. Ngonzi  J, Mugyenyi G, Kivunike M, Mugisha  J, Salongo W,
    Masembe S, et al. Frequency of HIV status disclosure, associated
    factors and outcomes among HIV positive pregnant women at
    Mbarara Regional Referral Hospital, southwestern Uganda. Pan
    Afr Med J 2019;32:200.
    11. Klingberg  S, King R, Seeley  J, Lubwama R, Namuganga M,
    Nabiryo B, et al. Courage and confidence to stop lying: Caregiver
    perspectives on a video to support paediatric HIV disclosure in
    Kampala, Uganda. Afr J AIDS Res 2018;17:273‑9.
    12. Mugisha  JO, Schatz EJ, Hansen C, Leary E, Negin  J, Kowal P,
    et al. Social engagement and survival in people aged 50 years and
    over living with HIV and without HIV in Uganda: A prospective
    cohort study. Afr J AIDS Res 2018;17:333‑40.
    13. Derek A, Seme A, Anye CS, Nkfusai CN, Cumber SN. Modern
    family planning use among people living with HIV/AIDS:
    A facility based study in Ethiopia. Pan Afr Med J 2019;33:224.
    14. UNAIDS. Ethiopia; 2018. Available from: https://www.unaids.
    org/en/regionscountries/countries/ethiopia. [Last accessed on
    2019 Dec 26].
    15. Mekonen MT, Dagnew HA, Yimam TA, Yimam HN, Reta MA.
    Adolescent‑parent communication on sexual and reproductive
    health issues and associated factors among high school students
    in Woldia town, Northeastern Ethiopia. Pan Afr Med J 2018;31:35.
    16. UNAIDS. Democratic Republic of the Congo; 2018. Available
    from: https://www.unaids.org/en/regionscountries/countr
    ies/democraticrepublicofthecongo. [Last accessedon 2019 Dec 26].
    17. Akilimali PZ, Musumari PM, Kashala‑Abotnes E, Kayembe PK,
    Lepira FB, Mutombo PB, et al. Disclosure of HIV status and its
    impact on the loss in the follow‑up of HIV‑infected patients
    on potent anti‑retroviral therapy programs in a  (post‑) conflict
    setting: A retrospective cohort study from Goma, Democratic
    Republic of Congo. PLoS One 2017;12:e0171407.
    18. Fogel JM, Sandfort T, Zhang Y, Guo X, Clarke W, Breaud A, et al.
    Accuracy of self‑reported HIV status among African men and
    transgender women who have sex with men who were screened
    for participation in a research study: HPTN 075. AIDS Behav
    2019;23:289‑94.
    19. Kalembo  FW, Kendall GE, Ali M, Chimwaza AF, Tallon MM.
    Primary caregivers, healthcare workers, teachers and community
    leaders’ perceptions and experiences of their involvement,
    practice and challenges of disclosure of HIV status to children
    living with HIV in Malawi: A  qualitative study. BMC Public
    Health 2018;18:884.
    20. Sanga ES, Mukumbang FC, Mushi AK, Lerebo W, Zarowsky C.
    Understanding factors influencing linkage to HIV care in a rural
    setting, Mbeya, Tanzania: Qualitative findings of a mixed methods
    study. BMC Public Health 2019;19:383.
    21. Cawley C, Wringe A, Wamoyi J, Lees S, Urassa M. ‘It is just the
    way it was in the past before I went to test’: A qualitative study
    to explore responses to HIV prevention counselling in rural
    Tanzania. BMC Public Health 2016;16:489.
    22. Conserve DF,Bay C, Kilonzo MN,Makyao NE, Kajula L,Maman S.
    Sexual and social network correlates of willingness to self‑test for
    HIV among ever‑tested and never‑tested men: Implications for
    the Tanzania STEP project. AIDS Care 2019;31:169‑76.
    23. Ross MW, Larsson M, Jacobson  J, Nyoni  J, Agardh A. Social
    networks of men who have sex with men and their implications
    for HIV/STI interventions: Results from a cross‑sectional study
    using respondent‑driven sampling in a large and a small city in
    Tanzania. BMJ Open 2016;6:e012072.
    24. Ross MW, Nyoni J, Ahaneku HO, Mbwambo J, McClelland RS,
    McCurdy  SA. High HIV seroprevalence, rectal STIs and risky
    sexual behaviour in men who have sex with men in Dar es Salaam
    and Tanga, Tanzania. BMJ Open 2014;4:e006175.
    25. Kajula LJ, Sheon N, De Vries H, Kaaya SF, Aarø LE. Dynamics
    of parent‑adolescent communication on sexual health and HIV/
    AIDS in Tanzania. AIDS Behav 2014;18 Suppl 1:S69‑74.
    26. Yaya  I, Saka  B, Landoh  DE, Patchali  PM, Patassi  AA,
    Aboubakari AS, et al. HIV status disclosure to sexual partners,
    among people living with HIV and AIDS on antiretroviral therapy
    at Sokodé regional hospital, Togo. PLoS One 2015;10:e0118157.
    27. Dahourou DL,Masson D, Aka‑Dago‑Akribi H, Gauthier‑Lafaye C,
    Cacou C, Raynaud JP,et al. HIV disclosure to the child/adolescent
    in central and West Francophone Africa. Bull Soc Pathol Exot
    2019;112:14‑21.
    28. Dahourou D, Raynaud JP, Leroy V. The challenges of timely and
    safe HIV disclosure among perinatally HIV‑infected adolescents
    in sub‑Saharan Africa. Curr Opin HIV AIDS 2018;13:220‑9.
  2. 29. Yé M, Kagoné M, Sié A, Bagagnan C, Sanou H, Millogo O, et al.
    Promoting access equity and improving health care for women,
    children and people living with HIV/AIDS in Burkina Faso
    through mHealth. J Public Health (Oxf) 2018;40:ii42‑51.
    30. Winskell K, Kus L, Sabben G, Mbakwem BC, Tiéndrébéogo G,
    SingletonR. Social representations of mother‑to‑child transmission
    of HIV and its prevention in narratives by young Africans from
    five countries, 1997‑2014: Implications for communication. Soc
    Sci Med 2018;211:234‑42.
    31. Kelly A, Worth H, Akuani F, Kepa B, Kupul M, Walizopa L, et al.
    Gendered talk about sex, sexual relationships and HIV among
    youngpeople inPapuaNewGuinea.CultHealthSex 2010;12:221‑32.
    32. Dyrehave C, Rasmussen DN, Hønge BL, Jespersen S,
    Correia  FG, Medina  C, et al. Nonadherence is associated with
    lack of HIV‑related knowledge: A cross‑sectional study among
    HIV‑infected individuals in Guinea‑Bissau. J Int Assoc Providers
    AIDS Care 2015;15:350‑8.
    33. World Bank. Low Income; 2019. Available from: https://data.
    worldbank.org/income‑level/low‑income. [Last accessed on
    2020 Apr 15].
    34. UNESCO. Education Data Release: One in Every Five
    Children, Adolescents and Youth is Out o f School;
    2018. Available from: http://uis.unesco.org/en/news/
    education‑data‑release‑one‑every‑five‑children‑adolescents‑
    and‑youth‑out‑school. [Last accessed on 2020 Apr 15].
    35. Alupo  P, Ssekitoleko R, Rabin  T, Kalyesubula R, Kimuli  I,
    Bodnar BE. Improving inpatient medication adherence using
    attendant education in a tertiary care hospital in Uganda. Int J
    Qual Health Care 2017;29:587‑92.
    36. Nsangi A, Semakula D, Oxman AD, Sewankambo NK. Teaching
    children in low‑income countries to assess claims about treatment
    effects: Prioritization of key concepts. J  Evid Based Med
    2015;8:173‑80.
    37. Mariam DH, Sagay AS, Arubaku W, Bailey RJ, Baingana RK,
    Burani A, et al. Community‑based education programs in Africa:
    Faculty experience within the Medical Education Partnership
    Initiative (MEPI) network. Acad Med 2014;89 8 Suppl: S50‑54.
    38. Anya SE, Hydara A, Jaiteh LE. Antenatal care in The
    Gambia: Missed opportunity for information, education and
    communication. BMC Pregnancy Childbirth 2008;8:9.
    39. Rosa WE, Male MA, Uwimana  P, Ntizimira  CR, Sego R,
    Nankundwa E, et al. The advancement of palliative care in
    rwanda: transnational partnerships and educational innovation.
    J Hosp Palliat Nurs 2018;20:304‑12.
    40. Budhathoki  SS, Pokharel  PK, Jha N, Moselen  E, Dixon R,
    Bhattachan M, et al. Health literacy of future healthcare
    professionals: A cross‑sectional study among health sciences
    students in Nepal. Int Health 2019;11:15‑23.
    41. Bagala JP, Macheka ND, Abebaw H, Wen LS. Implementation of
    the Medical Education Partnership Initiative: Medical students’
    perspective. Acad Med 2014;89 8 Suppl: S32‑4.
    42. Theobald  S, Brandes N, Gyapong M, El‑Saharty  S, Proctor  E,
    Diaz T, et al. Implementation research: New imperatives and
    opportunities in global health. Lancet 2018;392:2214‑28.
    43. Cole DC, Nyirenda LJ, Fazal N, Bates I. Implementing a national
    health research for development platform in a low‑income
    country  – A review of Malawi’s Health Research Capacity
    Strengthening Initiative. Health Res Policy Syst 2016;14:24.
    44. Vargas E, Becerril‑Montekio V, Gonzalez‑Block MÁ, Akweongo P,
    Hazel CN, Cuembelo Mde F,et al. Mapping the use ofresearch to
    support strategies tackling maternal and child health inequities:
    Evidence from six countries in Africa and Latin America. Health
    Res Policy Syst 2016;14:1.
    45. Aidam  J, Sombié I. The West African Health Organization’s
    experience in improving the health research environment in the
    ECOWAS region. Health Res Policy Syst 2016;14:30.
    46. Dagenais C, Somé TD, Boileau‑Falardeau M, McSween‑Cadieux E,
    Ridde V. Collaborative development and implementation of a
    knowledge brokering program to promote research use in Burkina
    Faso, West Africa. Glob Health Action 2015;8:26004.
    47. Kurumop  SF, Bullen  C, Whittaker R, Betuela  I, Hetzel MW,
    Pulford J.Improving health worker adherence to malaria treatment
    guidelines in Papua New Guinea: Feasibility and acceptability of
    a text message reminder service. PLoS One 2013;8:e76578.
    48. Romore I, Ali AM, Semali I, Mshinda H, Tanner M, Abdulla S.
    Assessment of parental perception of malaria vaccine in Tanzania.
    Malar J 2015;14:355.
    49. Andre  E, Isaacs  C, Affolabi D, Alagna R, Brockmann D,
    de Jong BC, et al. Connectivity of diagnostic technologies:
    Improving surveillance and accelerating tuberculosis elimination.
    Int J Tuberc Lung Dis 2016;20:999‑1003.
    50. Nhavoto  JA, Grönlund Å, Klein GO. Mobile health treatment
    support intervention for HIV and tuberculosis in Mozambique:
    Perspectives of patients and healthcare workers. PLoS One
    2017;12:e0176051.
    51. Thiam S, Delamou A, Camara S, CarterJ, Lama EK, Ndiaye B, et al.
    Challenges in controlling the Ebola outbreak in two prefectures
    in Guinea: Why did communities continue to resist? Pan Afr Med
    J 2015;22 Suppl 1:22.
    52. Boland  ST, Polich  E, Connolly A, Hoar A, Sesay  T, Tran AA.
    Overcoming operational challenges to ebola case investigation
    in Sierra Leone. Glob Health Sci Pract 2017;5:456‑67.
    53. Mukama T, Ndejjo R, Musabyimana A, Halage AA, Musoke D.
    Women’s knowledge and attitudes towards cervical cancer
    prevention: A  cross sectional study in Eastern Uganda. BMC
    Womens Health 2017;17:9.
    54. Mekonnen  FA, Ambaw  YA, Neri  GT. Socio‑economic
    determinants of anemia in pregnancy in North Shoa Zone,
    Ethiopia. PLoS One 2018;13:e0202734.
    55. Birhanu M, Gedefaw  L, Asres Y. Anemia among school‑age
    children: Magnitude, severity and associated factors in Pawe
    Town, Benishangul‑Gumuz Region, Northwest Ethiopia. Ethiop
    J Health Sci 2018;28:259‑66.
    56. Atmar MH.Politicisation ofhumanitarianaidandits consequences
    for Afghans. Disasters 2001;25:321‑30.
    57. Ng  LC, López B, Pritchard M, Deng D. Posttraumatic stress
    disorder, trauma, and reconciliation in South Sudan. Soc
    Psychiatry Psychiatr Epidemiol 2017;52:705‑14.
    58. Alammar AM, Heshmeh OA. Lip repositioning with a myotomy
    of the elevator muscles for the management of a gummy smile.
    Dent Med Probl 2018;55:241‑6.
    59. Saleh M, Hajeer MY, Muessig D. Acceptability comparison
    between Hawley retainers and vacuum‑formed retainers
    in orthodontic adult patients: A single‑centre, randomized
    controlled trial. Eur J Orthod 2017;39:453‑61.
    60. Khattab TZ, Farah H, Al‑Sabbagh R, Hajeer MY, Haj‑Hamed Y.
    Speech performance and oral impairments with lingual and labial
    orthodontic appliances in the first stage of fixed treatment. Angle
    Orthod 2013;83:519‑26.
    61. Fares J, Salhab HA, Fares MY, Khachfe HH, Fares Y. Academic
    medicine and the development of future leaders in healthcare.
    In: Laher I, editors. Handbook of Healthcare in the Arab World.
    Cham: Springer; 2020.
    62. Fares MY, Fares  J, Baydoun H, Fares Y. Sport and exercise
    medicine research activity in the Arab world: A 15‑year
    bibliometric analysis. BMJ Open Sport Exerc Med 2017;3:e000292.
    63. Fares Y, Fares J. Neurosurgery in Lebanon: History, development,
    and future challenges. World Neurosurg 2017;99:524‑32.
    64. Fares Y, Fares J, Kurdi MM, Bou Haidar MA. Physician leadership
    and hospital ranking: Expanding the role of neurosurgeons. Surg
    Neurol Int 2018;9:199.
    65. Mheidly N, Fares J. Leveraging media and health communication
    strategies to overcome the COVID‑19 infodemic. J Public Health
    Policy 2020. (In press).