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Mapping Digital and Multi-Omics Evidence on Stress and Cardiometabolic Health Trajectories Among Women in Sub-Saharan Africa: A Scoping Review Protocol

Melaku Haile Likka  *,†,‡
,Sherilyn A. Francis  †,‡,Mesfin Haile Kahissay  †,Wondmagegn Tamiru Tadesse  †
,Abdu Mengesha  †,Makka Adam  †,Aliyi Hassen Jarso  †,Chad Evans  †,Jean Baptiste Nyandwi  †,Jean Paul Sinumvayo  †,Domina Asingizwe  †,Vedaste Kagisha  †,Marie Francoise Mukanyangezi  †,Lambert Nzungize  †,Alex Rugamba  †,Joyce Kamanzi  †,Leon Mutesa  †
,Eulambius Mlugu  †,Raphael Sangeda  †
,Ritah Mutagonda  †,Florence Urio  †,Alphonce Mareale  †
,Herman A. Taylor  †,Erica L. Johnson  †,Tennille Leak-Johnson  †
,Candice Alick  †,Luis Villacorta  †

  † These authors contributed equally to this work.

  ‡ Co-first authors.

Submitted:

30 June 2026

Posted:

02 July 2026

You are already at the latest version

Abstract
Review objectives: This scoping review aims to map the extent and nature of digital, biomarker, and multi-omics evidence on stress and cardiometabolic health trajectories among women in Sub-Saharan Africa, with particular attention to hypertension, glycemic and diabetes-related outcomes, adiposity and obesity, dyslipidemia, metabolic syndrome, pregnancy-related cardiometabolic conditions, and cardiovascular sequelae. In addition, the review will consider patterns of vulnerability and potential indicators of cardiometabolic resilience, defined broadly as the capacity to maintain or regain health despite exposure to stressors, where these are explicitly examined or can be inferred from study findings. Cardiometabolic markers are being captured alongside real-time physiological and behavioral data through digital tools and wearable technologies, providing opportunities for early detection, continuous monitoring, and risk stratification of cardiometabolic disorders (CMDs). The review will further assess the degree of integration across these domains, while identifying key research gaps and emerging methodological trends. Methods: The review will follow the Joanna Briggs Institute methodology for scoping reviews and will be reported in accordance with the PRISMA extension for Scoping Reviews. A comprehensive search will be conducted across electronic databases, including MEDLINE (PubMed), Embase, Scopus, Web of Science Core Collection, CINAHL, PsycINFO, Global Index Medicus, the Cochrane Library, and IEEE Xplore, as well as grey literature sources such as Google Scholar, World Health Organization Institutional Repository for Information Sharing, and the World Bank Open Knowledge Repository using pre-specified Boolean operators and keywords. Studies published in English from January 2015 to the date involving women aged 18 years and above in Sub-Saharan Africa that examine stress in relation to cardiometabolic outcomes using digital, biomarker, and/or multi-omics approaches will be included. Findings will be synthesized descriptively, with evidence stratified by cardiometabolic domain where feasible, including blood pressure and hypertension, glycemic and diabetes-related outcomes, adiposity and obesity, lipid-related outcomes, pregnancy-related cardiometabolic conditions, and broader cardiovascular outcomes.
Keywords: 
digital health
;  
multi-omics
;  
psychosocial stress
;  
cardiovascular health trajectories
;  
cardiometabolic disorders
;  
women
;  
longitudinal studies
;  
SSA
Subject: 
Medicine and Pharmacology  -   Cardiac and Cardiovascular Systems

Introduction

Background

Cardiometabolic disorders (CMDs) include an interrelated group of conditions that include cardiovascular disease (CVD), hypertension, type 2 diabetes and dysglycemia, obesity and adiposity-related disorders, dyslipidemia, metabolic syndrome, and related renal-metabolic dysfunction. These conditions share overlapping pathophysiologic mechanisms, including chronic inflammation, endothelial dysfunction, autonomic and neuroendocrine dysregulation, insulin resistance, and adverse vascular remodeling [1,2,3,4]. In addition to traditional metabolic risk factors, psychosocial stress contributes to the onset and progression of CMD through neuroendocrine activation, systemic inflammation, and adverse health behaviors [1,2,3,4,5].
Cardiometabolic conditions are a leading cause of morbidity and mortality among women globally. Cardiovascular diseases alone account for approximately one-third of all female deaths worldwide, corresponding to an estimated 8–9 million deaths annually. In low- and middle-income countries (LMICs), including Sub-Saharan Africa (SSA), CVD accounts for more than 35–40% of female mortality [6]. Global estimates further indicate that incident CVD cases among women increased by approximately 74% between 1990 and 2019, rising from 15.9 million to 27.6 million cases [7].
Women’s cardiometabolic health (CMH) is shaped by a complex interplay of psychosocial, biologic, social, environmental, and reproductive factors. Chronic stress has been associated with coronary heart disease, hypertension, impaired glucose regulation, metabolic dysfunction, and recurrent cardiometabolic events through mechanisms involving insulin resistance, central adiposity, dyslipidemia, and inflammatory dysregulation [5,6,7,8,9,10]. In SSA, women often experience multiple and intersecting stressors, including socioeconomic disadvantage, rapid urbanization, caregiving responsibilities, food insecurity, and environmental exposures such as household air pollution from solid fuel combustion, which may contribute to systemic inflammation, hypertension, and broader cardiometabolic dysfunction [11,12,13,14,15]. In addition, sex-specific and reproductive factors influence cardiometabolic risk across the life course. Adverse pregnancy outcomes, including preeclampsia, gestational hypertension, and gestational diabetes, are associated with increased long-term cardiometabolic and cardiovascular risk [16]. Similarly, the menopausal transition is characterized by adverse changes in lipid profiles, vascular function, and metabolic regulation that may further increase risk [5,6,7,8,10,11,12,15,16,17].
Despite widespread exposure to stressors, cardiometabolic outcomes vary considerably across individuals and populations, suggesting the presence of adaptive or protective processes that may mitigate the effects of stress. Emerging frameworks emphasize cardiovascular resilience, defined as the capacity of biological systems to maintain or regain homeostasis in response to physical, psychosocial, and environmental challenges [18]. Related constructs, such as psychological resilience, describe adaptive responses to stress and have been linked to more favorable cardiometabolic outcomes. Although resilience has gained increasing attention in cardiovascular research globally, it remains relatively underexplored in SSA, where research has traditionally focused on disease burden and risk factors rather than protective mechanisms and adaptive responses.
Recent advances in precision medicine and systems biology have created new opportunities to investigate the complex relationships among stress, resilience, and CMH. Multi-omics approaches—including genomics, epigenomics, transcriptomics, proteomics, metabolomics, and lipidomics—together with biomarkers reflecting inflammatory, endocrine, renal-metabolic, and lipid pathways, provide increasingly comprehensive tools for characterizing the biological mechanisms underlying cardiometabolic dysfunction [19,20,21,22]. These approaches have demonstrated that CMDs emerge through interacting genetic, metabolic, inflammatory, behavioral, and environmental processes and may help identify novel biomarkers, mechanistic pathways, and intervention targets [19,22,23,24,25,26,27]. They may also contribute to understanding biological signatures of adaptive responses to stress, including mechanisms related to autonomic flexibility, inflammatory regulation, and metabolic adaptability.
In parallel, digital technologies are transforming cardiometabolic research and care. Mobile health applications, wearable devices, telemedicine platforms, and remote monitoring systems enable continuous or near-real-time assessment of physiological, behavioral, and contextual data [28,29,30,31,32,33,34,35,36,37,38]. Such technologies can capture dynamic indicators relevant to both CMD and resilience processes, including blood pressure, heart rate variability, sleep patterns, physical activity, recovery dynamics, and glucose-related measures where available [29,32,33,38]. Digital health interventions have demonstrated potential to improve patient engagement, support behavior change, and strengthen prevention and management of CMDs [30,31,35]. These technologies may be particularly valuable in SSA, where they offer potentially scalable and cost-effective approaches to addressing limitations in healthcare access and infrastructure [28,29,30,31,32,33,35,37,38,39]. However, their implementation is also influenced by persistent digital divides related to device access, connectivity, digital literacy, and data governance, which may affect both research participation and health equity.

Rationale

Although growing evidence shows the importance of stress in shaping CMH, knowledge gaps remain regarding stress-related cardiometabolic trajectories among women in SSA. Existing studies are dispersed across multiple disciplines and vary in their populations, exposures, outcomes, and methodological approaches. Consequently, the extent to which digital technologies, biomarkers, and multi-omics approaches have been used to investigate stress-related cardiometabolic outcomes in this population is unclear.
In particular, it is unclear how studies conducted in SSA have examined hypertension, glycemic regulation and diabetes-related outcomes, adiposity and obesity, lipid disorders, pregnancy-related cardiometabolic conditions, and broader cardiovascular outcomes using digital technologies, biomarkers, and multi-omics approaches. Furthermore, the extent to which these approaches have been integrated within individual studies is not well characterized. Important gaps also remain regarding the representation of different stages of the female life course and the use of longitudinal study designs to examine cardiometabolic trajectories and adaptive responses to stress over time.
A comprehensive mapping of the available evidence is therefore needed to identify the range of digital, biomarker, and multi-omics approaches used, characterize the cardiometabolic outcomes and stress-related factors investigated, examine how resilience-related processes have been assessed, and identify gaps to inform future research and intervention development. A scoping review is particularly appropriate given the breadth and heterogeneity of the emerging literature.
This scoping review aims to map and synthesize evidence on digital, biomarker, and multi-omics approaches used to investigate stress and CMH trajectories among women in SSA, including both cardiovascular and metabolic manifestations of risk, and to identify evidence gaps and priorities for future research.

Review Objectives

The scoping review will address the following objectives:
  • Map the extent and nature of evidence on stress and CMH trajectories among women in SSA using digital, biomarker, and multi-omics approaches.
  • Examine how these approaches are applied including the extent of integration across digital, biomarker, and multi-omics domains; the measurement and conceptualization of stress across psychosocial, biologic, physiologic, environmental, and reproductive domains across life-course stages and identify geographic, longitudinal, and methodological gaps in SSA.

Research Questions

The following research questions will guide the review:
  • What digital approaches have been used to measure stress, behavior, environment, or cardiometabolic physiology among women in SSA?
  • What biomarker and multi-omics approaches have been used to study stress-related CMH among women in SSA?
  • To what extent have digital, biomarker, and multi-omics data been integrated within the same studies, and how have these data been analyzed in relation to specific cardiometabolic domains?
  • How is stress operationalized across studies, including psychosocial, biologic, physiologic, environmental, and reproductive stress domains, and what cardiometabolic outcomes or trajectory indicators are reported?
  • What methodological, geographic, life-course, and cardiometabolic-domain gaps currently limit the development of longitudinal digital and multi-omics research among women in SSA?

Methods

Review Design

This scoping review protocol was developed in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews and will be conducted following the JBI Manual for Evidence Synthesis [40]. The protocol is reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement [41], where applicable to scoping review protocols (see S1 File: PRISMA-P checklist). The completed review will be reported according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guideline [42]. To enhance transparency and methodological rigor, the protocol was prospectively registered with the Open Science Framework (OSF) in May 2026 (DOI: https://doi.org/10.17605/OSF.IO/CVFNR) [43].

Eligibility Criteria

The scoping review will follow the population, concept, and context (PCC) framework (Table 1), in accordance with JBI methodological guidance [40].

Inclusion Criteria

Population: The population included in this scoping review will be women aged 18 years and above. Studies involving women only, or studies with sex-disaggregated findings for women, will be included. Where reported, studies will also be charted by life-course subgroup, including reproductive-age, pregnant, postpartum, midlife, menopausal, and older women.
Concept: Stress, encompassing psychosocial, biologic, physiologic, environmental, and reproductive domains, assessed using digital approaches, biomarkers, and/or multi-omics methods, and examined in relation to cardiometabolic outcomes or trajectory indicators. Cardiometabolic outcomes of interest will include, where available, blood pressure and hypertension, glucose dysregulation and diabetes-related measures, adiposity and obesity, lipid-related outcomes, metabolic syndrome, pregnancy-related cardiometabolic conditions, renal-metabolic markers, and broader cardiovascular outcomes such as coronary disease, stroke, and heart failure. Where reported, indicators of adaptive or recovery responses to stress (e.g., physiological variability or buffering processes) will also be captured.
Context: Studies conducted in SSA will be included
Study designs: Quantitative and mixed-methods studies will be included. Qualitative studies will be included when they address feasibility, acceptability, implementation, workflow, or infrastructure considerations relevant to digital, biomarker, or multi-omics approaches in relation to stress and cardiovascular health.
Time period: Studies published from January 2015 to the date of the final search will be included. This cutoff was chosen to reflect the contemporary era of digital health and omics research, during which wearable technologies, mobile health tools, remote monitoring platforms, and scalable molecular profiling approaches became more widely used. Given the review’s focus on digital and multi-omics evidence, methodological trends, and the extent to which studies integrate these domains and employ longitudinal designs, a 2015 – onward timeframe is likely to yield a more relevant and methodologically coherent evidence base.
Language: Published in English

Exclusion Criteria

Studies not conducted in SSA; not involving women or lacking sex-disaggregated data; not addressing stress and cardiometabolic outcomes; or using only conventional clinical measures without a digital, biomarker, or omics component will be excluded. Editorials, commentaries, opinion pieces, and reviews (systematic reviews, scoping reviews, and meta-analyses) will also be excluded.

Information Sources

Information sources spanning biomedical, public health, psychosocial, digital health, metabolism, and omics-related disciplines will be searched to comprehensively cover the literature. The following electronic bibliographic databases will be included in the search strategy: MEDLINE (PubMed), Embase (Elsevier), Scopus (Elsevier), Web of Science Core Collection (Clarivate), CINAHL (EBSCOhost), PsycINFO (APA PsycNet), Global Index Medicus (WHO), African Journals Online (AJOL), ClinicalTrials.gov and WHO ICTRP, PROSPERO, and the Cochrane Library (Wiley). Technical and engineering literature will be sourced via the IEEE Xplore Digital Library. To identify grey literature and other non-indexed sources, searches will also be conducted in Google Scholar, the World Health Organization (WHO) Institutional Repository for Information Sharing (IRIS), the World Bank Open Knowledge Repository, and relevant websites of governmental agencies, research institutes, and international organizations involved in women’s health, CMH, and digital health in SSA.
To enhance the comprehensiveness of the search, the reference lists of all included sources will be screened for additional eligible studies. Forward citation tracking of key articles will also be undertaken where feasible. If necessary, corresponding authors may be contacted to identify further relevant evidence.
The search will be run from database inception to the date of the final search; however, records will be screened for inclusion only if they were published from January 2015 onward, consistent with the review’s focus on contemporary digital, biomarker, and omics approaches. Searches will be rerun prior to final synthesis to identify newly published studies.

Search Strategy

A three-step search strategy, in line with the JBI methodology [40], will be employed. First, an initial limited search of selected databases will be undertaken to identify relevant articles or documents. This step will be used to analyze the text words contained in the titles and abstracts of retrieved papers, as well as the MeSH and Emtree index terms used to describe relevant studies. Key concepts will include women, stress, cardiometabolic outcomes, SSA, and three evidence streams: digital approaches, biomarkers, and multi-omics approaches.
Second, a comprehensive search strategy will be developed using all identified keywords, controlled vocabulary terms, and Boolean operators. The refined strategy will be structured around five concept blocks: women, stress, cardiometabolic outcomes, SSA context, and digital and/or biomarker and/or multi-omics evidence. The cardiometabolic outcome block will explicitly include terms related to hypertension, blood pressure, diabetes and dysglycemia, insulin resistance, obesity and adiposity, dyslipidemia, metabolic syndrome, pregnancy-related cardiometabolic conditions, and broader cardiovascular outcomes. This search strategy will then be adapted and applied across all included electronic databases listed in the Information Sources section above, accounting for differences in indexing systems and search syntax.
Third, the reference lists of all included studies and relevant reviews will be screened for additional eligible studies. In addition, forward citation tracking will be conducted to identify newer studies that have cited key included articles. Where necessary, subject experts or corresponding authors may be contacted to identify further relevant evidence. The searches strategy for MEDLINE (via PubMed), Embase, and Scopus is provided in S2 File: Search strategy.

Study Selection

All records identified through the database and grey literature searches will be imported into Zotero and duplicates will be removed. The records with no duplication will then be uploaded to Rayyan or Covidence, depending on institutional access, for screening.
Prior to formal screening, reviewers will pilot test the eligibility criteria on a sample of records and refine decision rules where necessary. Study selection will be conducted in two stages. First, titles and abstracts will be independently screened by two reviewers against the PCC-based eligibility criteria. Studies that do not meet the inclusion criteria will be excluded at this stage. Full-text articles of potentially relevant studies will then be retrieved and assessed independently by the same two reviewers for final inclusion. Where essential information is unavailable, study authors may be contacted for clarification.
Any disagreements between reviewers at either the title/abstract or full-text screening stage will be resolved through discussion, and if consensus cannot be reached, a third reviewer will be consulted as a tie-breaker. The reasons for exclusion of full-text articles will be documented and reported in the final review. The study selection process will be presented in a PRISMA-ScR flow diagram to ensure transparency and reproducibility.

Data Charting Process

Per JBI guidance, standardized data charting form will be developed based on the framework presented in Table 2 and piloted on a sample of three studies to ensure clarity, consistency, and comprehensiveness. The form will be iteratively refined as needed during the charting process. Table 2 presents the planned data charting framework, which will be used as the basis for the development of the final charting tool.
Data charting will be independently conducted by two reviewers using a predesigned data extraction (charting) template. Any discrepancies between reviewers will be resolved through discussion, and if consensus cannot be reached, a third person, who act as a tie-breaker, will be consulted.
The data items to be extracted will include: author(s), year of publication, country and setting (including SSA classification and urban/rural or clinic/community context where available), study design, population characteristics, life-course subgroup, sample size, whether sex-disaggregated data were primary or secondary, type of digital health tools used, biomarker measures, multi-omics approaches, methods of stress assessment and operationalization, cardiometabolic domain studied, cardiometabolic outcomes or trajectory indicators reported, whether digital and biological data were integrated analytically, study duration and follow-up frequency, analytical approaches, and key findings relevant to the review questions. Cardiometabolic domains will be charted, where feasible, as blood pressure and hypertension, glycemic and diabetes-related outcomes, adiposity and obesity, lipid-related outcomes, metabolic syndrome, pregnancy-related cardiometabolic conditions, renal-metabolic markers, and broader cardiovascular outcomes.

Data Synthesis and Presentation of Results

A narrative and descriptive synthesis will be used because substantial heterogeneity in study designs, populations, digital health technologies, biomarker measures, multi-omics approaches, and cardiometabolic domains is expected.
Methodological quality appraisal of included studies will not be undertaken. Consistent with JBI guidance for scoping reviews, the objective of this review is to map the extent, range, and nature of the available evidence rather than to evaluate intervention effectiveness or determine the risk of bias of individual studies.
Quantitative findings will be summarized using descriptive statistics to map the distribution of evidence across study characteristics, including publication year, geographic distribution, study designs, life-course subgroup representation, longitudinal versus cross-sectional designs, types of digital health tools, biomarker measures, multi-omics approaches, stress measurement methods, cardiometabolic domains, and specific cardiometabolic outcomes. Where feasible, results will be presented in tables and visually to show patterns and trends in the literature.
Qualitative and textual data will be synthesized using thematic analysis, with a specific emphasis on feasibility, acceptability, implementation, workflow, and infrastructure considerations related to digital, biomarker, and multi-omics approaches in SSA settings.
The synthesis will focus on mapping the extent, range, and nature of available evidence rather than assessing effect sizes. Evidence will be grouped, where feasible, into digital-only, biomarker-only, multi-omics-only, and integrated studies, and further described by cardiometabolic domain. Gaps in the literature and methodological trends will be identified and narratively described to inform future longitudinal, women-centered cardiometabolic research in SSA.

Study Status and Timeline

At the time of protocol resubmission, the protocol registration stage has been completed (registered May 2026). No study results have been generated, and formal literature searching, study selection, data charting, and evidence synthesis have not yet been initiated. The remaining stages are estimated to proceed as follows:
Record screening: Anticipated to commence with systematic database searches in July 2026 and reach completion by August 2026.
Data extraction (data charting): Anticipated to be completed by October 2026.
Expected results: Evidence synthesis and final reporting of results are anticipated by November 2026.

Ethics and Dissemination

As this study is a scoping review based on publicly available literature and will not involve the collection of primary data from human participants, ethical approval is not required.
The findings of this review will be disseminated through peer-reviewed journal publication and presentation at relevant scientific conferences, and will be used to inform the design of future longitudinal digital and multi-omics cardiometabolic research among women in SSA.

Supplementary Materials

The following supporting information can be downloaded at the website of this paper posted on Preprints.org.

Acknowledgments

We used Grammarly to support language editing, grammar correction, and clarity improvement. All intellectual content, interpretation, and final approval of the manuscript are the responsibility of the authors.

List of Acronyms/Abbreviations

CVD Cardiovascular disease
CMD Cardiometabolic disorders
CMH Cardiometabolic health
IEEE Institute of Electrical and Electronics Engineers
JBI Joanna Briggs Institute
PCC Population, concept, context
PRISMA-ScR Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews
PRISMA-P Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols
SSA Sub-Saharan Africa
WHO World Health Organization

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Table 1. The PCC framework to be employed in the scoping review.
Table 1. The PCC framework to be employed in the scoping review.
PCC element Description
Population Women aged ≥18 years residing in SSA. Studies including women only or reporting sex-disaggregated data for women will be eligible. Where reported, life-course stages (e.g., reproductive-age, pregnant, postpartum, midlife, menopausal, and older women) will be captured.
Concept Stress (psychosocial, biological, physiological, environmental, and reproductive) measured using digital approaches, biomarkers, and/or multi-omics methods, and examined in relation to cardiometabolic health outcomes, trajectories, or resilience indicators.
Context Studies conducted in SSA in any healthcare, community, academic, occupational, or population-based setting.
Studies will be included or excluded based on the following criteria:
Table 2. Planned data charting framework for the scoping review.
Table 2. Planned data charting framework for the scoping review.
Domain Variables to be charted (as applicable)
Study identification Author(s); Year of publication; Country; Region of SSA
Study characteristics Study design; Sample size
Population characteristics Age group; Life-course stage; Pregnancy status; Urban/rural setting
Context / setting Study setting (community, primary healthcare, hospital, mixed)
Stress exposure Stress domain (psychosocial, occupational, environmental); measurement approach; acute/chronic classification
Digital health component Technology type (wearable, mobile app, EHR); type of data captured
Biomarker component Biomarker type; specific biomarkers assessed
Multi-omics component Omics category (genomics, proteomics, metabolomics); platform/technology used
Data integration Presence of integration (digital + biomarker/omics) (Yes/No); integration approach (if reported)
Cardiometabolic outcomes Hypertension; glycemic outcomes; obesity/adiposity; lipid profile; metabolic syndrome; cardiovascular disease; pregnancy-related outcomes
Resilience indicators Presence of resilience measure (Yes/No); type (validated scale or proxy)
Methodology Study design type; follow-up duration; statistical/analytical methods
Ffindings Narrative summary of findings relevant to objectives; reported evidence gaps
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Copyright: This open access article is published under a Creative Commons CC BY 4.0 license, which permit the free download, distribution, and reuse, provided that the author and preprint are cited in any reuse.
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