Digital Health Technologies for Maternal and Child Health in Africa and Other Low- and Middle-Income Countries: Cross-disciplinary Scoping Review With Stakeholder Consultation

**Background:** Maternal and child health (MCH) remains a critical global health concern, disproportionately affecting low- and middle-income countries (LMIC) where poor access to quality health services, lack of infrastructure, and inadequate training for healthcare workers contribute to high infant mortality, mother-to-child HIV transmission, malnutrition, and other adverse outcomes. Digital health technologies have shown promise in supporting MCH by facilitating access to information and healthcare services, yet existing reviews have been discipline-specific and lack coherence across fields. This review was conducted as part of the COMACH project (Co-designing Community-Based ICT Interventions to Enhance Maternal and Child Health in South Africa) to synthesize literature across public health, social sciences applied to health, and human-computer interaction (HCI) research in healthcare.

**Methods:** The authors employed the Arksey and O'Malley 6-stage scoping review framework. They searched Scopus, PubMed, Google Scholar, ACM Digital Library, IEEE Xplore, Web of Science, and PLOS databases. Inclusion criteria required articles to contain a community focus, take a co-design approach, and have digital deployment. Exclusion criteria eliminated editorials, research protocols, short abstracts, reviews, publications without digital deployment, and non-English articles. Three researchers from the three disciplines independently screened and tagged articles using a custom data extraction framework with 10 characteristics (caregivers, values, technology, context, deployment, measure, implications, methods, target, and stakeholders). Additionally, 28 key informant interviews were conducted with stakeholders (6 from social sciences, 7 from public health, 6 practitioners/NGO personnel, and 9 from HCI research) to inform and validate findings.

**Key Results:** From 284 initially identified articles, 41 duplicates were removed, and 141 met inclusion criteria: 34 from social sciences applied to health, 58 from public health, and 49 from HCI research in healthcare. Digital interventions included custom-developed mobile apps (42/92, 46%), SMS text messaging (29/92, 32%), web-based applications (6/92, 7%), social media (6/92, 7%), wearables (5/92, 5%), and videos/voice messages/movies (4/92, 4%). The scope of digital MCH targeted health education (breastfeeding, child nutrition), care and follow-up of health service use (supporting community health workers), maternal mental health, and nutritional/health outcomes. Only 5 of 141 articles (3.5%) focused on maternal mental health. Key challenges identified included: little attention to understanding lived experiences of communities; exclusion of fathers (only 11 articles), grandparents (only 4 articles), and other family members; and study designs based on nuclear families that do not represent local cultural family structures. Values identified across disciplines included inclusion, trust, respect, beneficence, and equity, yet there was significant methodological confusion between community engagement and community-based co-design, with many researchers not distinguishing between the two. Only 4 articles measured use of ICT deployments, and only 3 addressed usability explicitly.

**Clinical Implications:** The review demonstrates that digital MCH interventions in LMIC predominantly target community health workers rather than direct beneficiaries (mothers and families), and communities are typically included too late in the design process—often only for usability testing after deployment. This approach has led to intervention failures, such as one project that collapsed due to not considering mobile phone ownership and SMS costs. The authors recommend genuine community-based co-design that treats community members as equal design partners from the outset, includes fathers and grandparents who significantly influence MCH outcomes, addresses the neglected area of maternal mental health, and moves beyond text-based communications to accommodate low-literacy users. The failure of research to inform policy remains a major challenge, with only 3.8% of sampled articles in a cited review ultimately improving government policy. The authors advocate for interdisciplinary approaches combining values from all three disciplines to create frameworks that capture the essence of community-based co-design and improve both intervention effectiveness and policy translation.