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Through the lens of culture,The Internet of Elsewherelooks at the role of the Internet as a catalyst in transforming communications, politics, and economics. Cyrus Farivar explores the Internet's history and effects in four distinct and, to some, surprising societies-Iran, Estonia, South Korea, and Senegal. He profiles Web pioneers in these countries and, at the same time, surveys the environments in which they each work. After all, contends Farivar, despite California's great success in creating the Internet and spawning companies like Apple and Google, in some areas the United States is still years behind other nations. Surprised?You won't be for long as Farivar proves there are reasons that: Skype was invented in Estonia-the same country that developed a digital ID system and e-voting;Iran was the first country in the world to arrest a blogger, in 2003;South Korea is the most wired country on the planet, with faster and less expensive broadband than anywhere in the United States;Senegal may be one of sub-Saharan Africa's best chances for greater Internet access.The Internet of Elsewherebrings forth a new complex and modern understanding of how the Internet spreads globally, with both good and bad effects.

Open access publication rates have been steadily increasing over time. In spite of this growth, academics in low income settings struggle to gain access to the full canon of research literature. While the vast majority of open access repositories and funding organizations with open access policies are based in high income countries, the geographic patterns of open access publication itself are not well characterized. In this study, we developed a computational approach to better understand the topical and geographical landscape of open access publications in the biomedical research literature. Surprisingly, we found a strong negative correlation between country per capita income and the percentage of open access publication. Open access publication rates were particularly high in sub-Saharan Africa, but vastly lower in the Middle East and North Africa, South Asia, and East Asia and the Pacific. These effects persisted when considering papers only bearing authors from within each region and income group. However, papers resulting from international collaborations did have a higher percentage of OA than single-country papers, and inter-regional collaboration increased OA publication for all world regions. There was no clear relationship between the number of open access policies in a region and the percentage of open access publications in that region. To understand the distribution of open access across topics of biomedical research, we examined keywords that were most enriched and depleted in open access papers. Keywords related to genomics, computational biology, animal models, and infectious disease were enriched in open access publications, while keywords related to the environment, nursing, and surgery were depleted in open access publications. This work identifies geographic regions and fields of research that could be priority areas for open access advocacy. The finding that open access publication rates are highest in sub-Saharan Africa and low income countries suggests that factors other than open access policy strongly influence authors' decisions to make their work openly accessible. The high proportion of OA resulting from international collaborations indicates yet another benefit of collaborative research. Certain applied fields of medical research, notably nursing, surgery, and environmental fields, appear to have a greater proportion of fee-for-access publications, which presumably creates barriers that prevent researchers and practitioners in low income settings from accessing the literature in those fields.

Existing literature on how employment loss affects depression has struggled to address potential endogeneity bias caused by reverse causality. The COVID-19 pandemic offers a unique natural experiment because the source of unemployment is very likely to be exogenous to the individual. This study assessed the effect of job loss and job furlough on the mental health of individuals in South Africa during the COVID-19 pandemic. The data for the study came from the first and second waves of the national survey, the National Income Dynamics-Coronavirus Rapid Mobile Survey (NIDS-CRAM), conducted during May-June and July-August 2020, respectively. The sample for NIDS-CRAM was drawn from an earlier national survey, conducted in 2017, which had collected data on mental health. Questions on depressive symptoms during the lockdown were asked in Wave 2 of NIDS-CRAM, using a 2-question version of the Patient Health Questionnaire (PHQ-2). The PHQ-2 responses (0-6 on the discrete scale) were regrouped into four categories making the ordered logit regression model the most suited for assessing the impact of employment status on depressive symptoms. The study revealed that adults who retained paid employment during the COVID-19 lockdown had significantly lower depression scores than adults who lost employment. The benefits of employment also accumulated over time, underscoring the effect of unemployment duration on mental health. The analysis revealed no mental health benefits to being furloughed (on unpaid leave), but paid leave had a strong and significant positive effect on the mental health of adults. The economic fallout of the COVID-19 pandemic resulted in unprecedented job losses, which impaired mental wellbeing significantly. Health policy responses to the crisis therefore need to focus on both physical and mental health interventions.

Digital technologies offer a potential solution to improve sustainability—economic, social, and environmental—of agri-food systems around the globe. While developed countries have led the innovation and adoption of digital agriculture, the potential impact in developing countries—including in the Middle East and North Africa (MENA) region—is massive. This article synthesizes existing evidence to review the potential and current contribution of digital technologies to the agri-food sectors in MENA. Digital agriculture shows promise in addressing the key challenges facing the agri-food sector across MENA countries. Improvements in primary production, supply chain and logistics performance, and optimized use of scarce natural resources (notably agricultural water) could be notable, if digital technologies can be implemented as envisioned. Available evidence shows that adoption of digital agriculture is at early stages, generally led by high-value agricultural production targeting domestic markets in Gulf countries and export markets in Mashreq countries. Economic sustainability appears the strongest force for current adoption, with less focus on social or environmental sustainability. Public policies should not only foster the adoption of digital technologies in MENA but also ensure equity of access, transparency of use, data protections, and labor protections. Policymakers should move beyond traditional, production-centric views to deliver also on social and environmental sustainability.

The concept of digital literacy has been defined in numerous ways over the last two decades to incorporate rapid technological changes, its versatility, and to bridge the global digital divide. Most approaches have been technology-centric with an inherent assumption of cultural and political neutrality of new media technologies. There are multiple hurdles in every stage of digital literacy implementation. The lack of solutions such as local language digital interfaces, locally relevant content, digital literacy training, the use of icons and audio excludes a large fraction of illiterate people. In this article, we analyse case studies targeted at under-connected people in sub-Saharan Africa and India that use digital literacy programmes to build knowledge and health literacy, solve societal problems and foster development. In India, we focus on notable initiatives undertaken in the domain of digital literacy for rural populations. In Sub-Saharan Africa, we draw from an original project in Kenya aiming at developing digital literacy for youth from low-income backgrounds. We further focus on Senegal, Mali, Burkina Faso and Tanzania, where field studies have been conducted on the use of digital technologies by low-literacy people and on how audio and icon-based interfaces and Internet lite standard could help them overcome their limitations. The main objective of this article is to identify key performance indicators (KPIs) in the context of digital literacy skills as one of the pillars for digital inclusion. We will learn how digital literacy programmes can be used to build digital literacy and how KPIs for sustainable development can be established. In the final discussion, we offer lessons learned from the case studies and further recommendation for stakeholders and decision-makers in the field of digital health literacy.

Background Digital technologies are promoted as transformational for smallholders in Africa through the potential to enhance access to knowledge, increase productivity and food security. Despite the anticipations for agricultural digitalization in Africa, smallholders' engagement with digitalization is empirically underexplored. Hence, we surveyed 1565 rural farmers in Northern Ghana to explore how farmers interact with digital tools and services, and the variations in their engagements. Results We found that despite the growing array of digital opportunities (with diverse tools and services available to farmers), farmers are mainly confined to simple devices (mobile phones, radio, and TV) as access to digital resources, including the internet remains limited. Meanwhile, the main sources of digitalization services for smallholders remain largely the highly subisidized, development-orieted. NGOs and private-sector projects, which generally leverage SMS, Interactive Voice Response (IVR), radio, or field agents to reach farmers. Nonetheless, participation in digitalization services remains limited, unimpressive at best, and often fades over time because of weak building blocks evident in low literacies, lack of digital competencies and the limited access to digital resources. Conclusions Thus, full-scale digitalization remains a distant goal, and transformation claims are disconnected from smallholders' lived realities. However, opportunities exist to create a ‘digitalization for smallholders’ that is sensitive to the current and future structural limitations of smallholder agriculture, including low literacy and limited access to digital tools, to make agriculture digitalization reach its full potential in Africa.

This scoping review explores and summarizes the existing literature on the use of chatbots to support and promote health in Africa. The primary aim was to learn where, and under what circumstances, chatbots have been used effectively for health in Africa; how chatbots have been developed to the best effect; and how they have been evaluated by looking at literature published between 2017 and 2022. A secondary aim was to identify potential lessons and best practices for others chatbots. The review also aimed to highlight directions for future research on the use of chatbots for health in Africa. Using the 2005 Arksey and O'Malley framework, we used a Boolean search to broadly search literature published between January 2017 and July 2022. Literature between June 2021 and July 2022 was identified using Google Scholar, EBSCO information services-which includes the African HealthLine, PubMed, MEDLINE, PsycInfo, Cochrane, Embase, Scopus, and Web of Science databases-and other internet sources (including gray literature). The inclusion criteria were literature about health chatbots in Africa published in journals, conference papers, opinion, or white papers. In all, 212 records were screened, and 12 articles met the inclusion criteria. Results were analyzed according to the themes they covered. The themes identified included the purpose of the chatbot as either providing an educational or information-sharing service or providing a counselling service. Accessibility as a result of either technical restrictions or language restrictions was also noted. Other themes that were identified included the need for the consideration of trust, privacy and ethics, and evaluation. The findings demonstrate that current data are insufficient to show whether chatbots are effectively supporting health in the region. However, the review does reveal insights into popular chatbots and the need to make them accessible through language considerations, platform choice, and user trust, as well as the importance of robust evaluation frameworks to assess their impact. The review also provides recommendations on the direction of future research.

Background In African Regional Economic Communities (RECs), notable and enduring disparities exist in health outcomes. This study investigates the impact of macro-level characteristics of countries on health outcomes disparities within the African Regional Economic groupings. The study used panel data from the World Bank Development Indicators (WDI) and the Worldwide Governance Indicators (WGI), spanning 37 African countries, grouped into eight RECs between 2000 and 2019. We employed infant and under-five mortality rates and life expectancy at birth as indicators of health outcomes. Method The study used a multilevel linear (ML) mixed-effect approach to examine the influence of country-level factors on health outcome disparities within the eight African RECs recognized by the African Union. Results The findings show that higher unemployment rates and HIV incidence exacerbate these disparities, while a growing elderly population and improved access to basic drinking water can mitigate them. Increased internet usage correlates with higher within-regional inequalities in child mortality rates but reduces disparities in life expectant at birth. Urbanization trends contribute to lower-intra-regional inequality in infant mortality rates and life expectancy at birth. Higher domestic government health expenditure as a share of general government spending is linked to reduced disparities in under-five and infant mortality rates. Still, it increases inequalities in life expectancy at birth within the regional groupings. Moreover, a higher proportion of the population below 15 years old and trade gains positively influence regional disparities in life expectancy. Conversely, DTP immunization coverage among children aged 12–23 months is associated with higher within-regional inequality in infant mortality rates. Conclusions Polices aimed at reducing unemployment rates and HIV incidence should be prioritized. In addition, governments should invest in elderly care programs and infrastructure development for water supply. Efforts to promote internet access should be complemented by interventions to enhance child health and healthcare accessibility. Encouraging urban planning policies that prioritize developing healthcare infrastructure and facilitating healthcare access in urban areas is crucial. Furthermore, Governments should increase their health expenditure allocation in general government spending. Promoting strategies to enhance healthcare access and quality for specific demographics, alongside leveraging trade gains to invest in healthcare infrastructure and services, is imperative. Targeted interventions ensuring equitable access to immunization services should also be emphasized.

E-learning has been heralded as a revolutionary force for medical education, especially for low-resource countries still suffering from a dire lack of health care workers. However, despite over two decades of e-learning endeavors and interventions across sub-Saharan Africa and other low- and middle-income countries, e-learning for medical education has not gained momentum and continues to fall short of the anticipated revolution. Many e-learning interventions have been cul-de-sac pilots that have not been scaled up but rather terminated after the pilot phase. This is usually a result of not adopting a system-wide approach, which leads to insufficient scope of training, insufficient technological maintenance and user support, unattainably high expectations, and unrealistic financial planning. Thus, a multitude of e-learning evaluations have failed to provide scientifically sound evidence of the effectiveness of e-learning for medical education in low-resource countries. Instead, it appears that technological development has overwhelmed rather than revolutionized medical education. The question of how to push e-learning into a higher gear in low-resource countries persists. Provision of e-learning as a technology is insufficient. E-learning needs to be vigorously and sustainably integrated into the local educational setting and aligned with national strategies and other national endeavors and interventions. Adhering to a standardized framework for the implementation and evaluation of e-learning endeavors is key, especially to bridge the gap in robust evidence that should also guide e-learning implementations. The primary objective of e-learning for medical education is to strengthen the health system in order to serve the population's health care needs and expectations. Currently, medical e-learning does not measure up to its potential or do justice to medical students in low-resource countries. Technology may help unfold the potential of e-learning, but an all-encompassing change is needed. This can only be achieved through a joint effort that follows a systematic and standardized framework, especially for implementation and evaluation.

Digital technologies provide unprecedented opportunities for health and nutrition interventions among adolescents. The use of digital media and devices among young adolescents across diverse settings in sub‐Saharan Africa is unclear. This cross‐sectional study aimed to assess the use of digital media and devices and the socioeconomic determinants of use among young adolescents in Burkina Faso, Ethiopia, South Africa, Sudan and Tanzania. The study included 4981 adolescents aged 10–15 from public schools selected by multistage sampling. Access to various digital media and devices was self‐reported by adolescents. Logistic regression models were used to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between sociodemographic characteristics and access to digital media and devices. Approximately 40% of the adolescents in Burkina Faso and South Africa, 36% in Sudan, 13% in Ethiopia and 3% in Tanzania owned mobile phones. Compared with boys, girls had a lower ownership of mobile phones (odds ratio [OR] = 0.79; 95% confidence interval [CI]: 0.68, 0.92; p = 0.002), computers (OR = 0.83; 95% CI: 0.70, 0.99; p = 0.04) and social media accounts (OR = 0.68; 95% CI: 0.56, 0.83; p < 0.001). Higher maternal education and greater household wealth were positively associated with access to digital media and devices. While digital media and devices are promising platforms for interventions in some settings due to relatively high levels of access, their utility in delivering health and nutrition interventions to adolescents in these contexts should be further examined. Key messages There is considerable variation in adolescents’ access to digital media and devices across settings in sub‐Saharan Africa. Access to someone else's phone is the most common channel of digital connection among sub‐Saharan African adolescents. Male sex, higher maternal education and higher household wealth are associated with greater access to digital media and devices among sub‐Saharan African adolescents. While digital media and devices are promising platforms for interventions in some settings due to relatively high levels of access, their utility in delivering health and nutrition interventions to adolescents in these contexts should be further examined.