The Bio-Digital Divide: Digital trial adoption and the Bio-digital gap in Africa

Peter Ebot Eyong; Jacob Muruhukye; Rita Ewah Mbah; Endurance Lum Ambe; Vahid Esangaya Ntoung-Mbi; Spritney Nashua Ninpa; Gloria Margaret Nanono

Authors

Peter Ebot Eyong Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, Cameroon https://orcid.org/0009-0004-2964-1634 (unauthenticated)
Jacob Muruhukye School of Public Health, Makerere University, Uganda https://orcid.org/0009-0003-7534-7674 (unauthenticated)
Rita Ewah Mbah Directorate of Research and Grants, Kabale University, Uganda
Endurance Lum Ambe Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, Cameroon
Vahid Esangaya Ntoung-Mbi Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, Cameroon
Spritney Nashua Ninpa Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O Box 63, Buea, Cameroon
Gloria Margaret Nanono School of Public Health, Makerere University, Uganda https://orcid.org/0009-0008-1714-2415 (unauthenticated)

Abstract

Research question

In health technology innovation, does the adoption of decentralized and digital trial method indicate a growing bio-digital gap between African and high-income research ecosystems?

Methods: This review analyzed ClinicalTrial.gov records up to Mach 2026, evaluating digital trail components across Africa (268 trials) and United states (4,540 trials) through keyword searches for wearable, virtual and decentralized trial elements. Investigators reported the digital adoption rate as primary indicator of technological readiness.

Results: The findings showed that only 1.1% of rate in Africa included digital features which was 17 times lower compared to the rate of United states, suggesting continued dependence on traditional site-based research approach. The shift towards mobile and wearable technologies in Europe during the Covid-19 period appears to have widened this gap [1] from estimated ten-fold to seventen-fold between 2019 and 2025.

Interpretation: African patients risk exclusion from the next generation of decentralized clinical innovation if this gap is not addressed [2,3]. These findings quantify the bio-digital divide as a measurable infrastructure deficit. The interpretation is limited by the lack of evolving terminology of digital trial components

Note Block

Dashboard Results: https://mahmood726-cyber.github.io/africa-e156-students/health-disease/dashboards/digital-transformation.html

Code: https://mahmood726-cyber.github.io/africa-e156-students/health-disease/code/digital-transformation.py

References

1. Izmailova ES, Ellis R, Benko C. Remote Monitoring in Clinical Trials During the COVID-19 Pandemic. Clinical and Translational Science. 2020;13(5):838–41.

2. Nebie EI, Sawadogo HN, Eeuwijk P van, Signorell A, Reus E, Utzinger J, Burri C. Opportunities and challenges for decentralised clinical trials in sub-Saharan Africa: a qualitative study. 2023;

3. Ejigu DA, Fekadu A, Makonnen E, Hervé J, Eaton N, Conradie A, Liebenberg C, Demarest H, Croucher K, Manyazewal T. Assessing the adoption and impact of decentralized clinical trial approaches in Africa: a multi-country survey. 2026;