MICA: BIOS - Assessing the potential of wearable digital biosensors for health system strengthening in LMICs.

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Non-communicable diseases, including heart diseases, cancers, chronic respiratory diseases, and diabetes, are increasingly important health concerns in many developing countries. In 2012, for example, a global survey found that non-communicable diseases accounted for 34.5 million deaths of the 52.8 million deaths worldwide, and nearly 75% of those occurred in developing countries. Most premature deaths from these diseases are preventable through changes in lifestyle, such as increasing physical activity, quitting smoking, reducing the consumption of alcohol, and eating healthier food. However, capacities of public health authorities to promote healthier habits and thus improve lives are still inadequate worldwide. In poor-resourced countries, moreover, the burden of non-communicable diseases and the prevalence of associated risk factors is often not known with precision due to the lack of resources and weak information systems. For example, recent reviews of global trends in health surveys found that population data on cholesterol were not available in 100 countries, and no data on blood pressure were obtained for 64 countries. As a result, health authorities lack essential information to develop policy and programmes to address these challenges.The development of new wearable technologies for health monitoring, such as smartwatches and smartbands, is a promising technological innovation with great potential to support programmes for the prevention and control of non-communicable diseases. Boosted by commercial success of wireless medical devices and the rapid uptake of fitness trackers in high-income countries, advances in this sector have led to increasingly sophisticated hardware and software which can capture a wide range of biometric data, including respiration, oxygen saturation, heart rate, blood pressure, skin temperature, and more. In parallel, there has been a great expansion of wireless networks in developing countries, which can provide the necessary infrastructure to enable data transfer from users to health information systems. Thus, wearable health systems could be introduced to conduct regular surveys on risk factors for preventable diseases and their distribution across population groups, providing important information to health authorities who develop policy to minimise these risks. Wearable health systems can also be used to deliver messages to the users based on individual progress, helping them to achieve health targets and reduce risks. Despite these promises, however, the public health potential of wearable health monitors remains untapped, as no studies to date have explored ways in which such devices could support health policy and programmes. This project aims to conduct a preliminary evaluation of this potential, laying the foundation of a more comprehensive multi-country study. Research activities will be conducted in Cambodia, where a prototype device will be deployed for field evaluation. This is an exemplary case country in which most research and prevention to date have focused on infectious diseases, while non-communicable diseases have received much less attention and support despite their increasing importance. In this context, the introduction of wearable devices could be useful for strengthening preventive programmes and monitoring of population health. Aware that the introduction of a novel technology is a complex process, we will explore the full range of institutional, socio-economic and technical factors that may be more or less conducive to the uptake of the proposed innovation, with particular attention to the response of individual users.