mHealth for midwives: a call to action

ICT and Women's Health: An Examination of the Impact of ICT on Maternal Health in SADC States

Attainment of sexual and reproductive health is regarded as a human rights matter. Notwithstanding this, maternal mortality continues to be a major public health concern in low-income countries, especially those in sub-Saharan Africa. Maternal mortality remains high in Africa, yet there are information communication technologies (ICTs) (such as the internet, mobile communication, social media, and community radios) that have the potential to make a difference. Making effective use of all of these ICTs can considerably decrease preventable maternal deaths. ICTs, particularly mobile devices, offer a platform for access to health information and services that can bring change in areas where health infrastructure and resources are often limited. However, for Southern Africa, maternal mortality remains high despite the presence of ICT tools that have transformative potential to improve maternal health. In light of this, this study sought to examine the impact of ICT on maternal health. The study was quantitative in nature, and it used panel data that covered the period from 2000-2018. The Mean Group and Pooled Mean Group cointegration techniques and a generalised method of moments panel technique were used for estimation purposes. Results showed that ICT has a negative effect on maternal health. This shows that ICT tools contribute positively to maternal health. The study gave a number of recommendations. The mobile gender gap should be closed (digital inclusion), mobile network connectivity boosted, and digital platforms must be created in order to enhance the transformative potential of ICT in improving health outcomes.

Clinical decision making in basic emergency obstetric and newborn care among nurses and midwives: the role of the safe delivery mhealth application_pre-post-intervention study (research protocol)

Most maternal and newborn deaths in low-income countries, including Rwanda, are attributable to preventable causes. Timely access to Basic Emergency Obstetric and Newborn Care (BEmONC) guidelines to support clinical decisions could lead to better obstetric care thus reduction of maternal and newborn deaths. Besides, innovative methods such as the usage and reference to healthcare guidelines using mobile devices (mhealth) may support clinical decision making. However, there is little evidence about mhealth that focuses on the clinical decision support process. This proposal aims to investigate the effect of the Safe Delivery mhealth Application(SDA) on nurses' and midwives' clinical decision making, so as to inform mhealth interventions for work in specific contexts. The study adopts a quasi-experimental design. Convergent parallel mixed - methods will be used to collect, analyze and interpret data. A pre-intervention assessment of the BEmONC outcomes: Apgar score and PPH progressions, and related knowledge, skills, and perceptions of nurses and midwives will be conducted. The intervention will take place in two district hospitals in Rwanda and entails the implementation of the SDA for six months. Six months' post-intervention, the effect of the SDA on BEmONC outcomes and the nurses' and midwives' knowledge and skills will be evaluated.

A cross-sectional study of partograph utilization as a decision making tool for referral of abnormal labour in primary health care facilities of Bangladesh

BACKGROUND

In Bangladesh, female paramedics known as Family Welfare Visitors (FWVs), conduct normal deliveries in first-level primary care facilities, or Union Health and Family Welfare Centres (UH&FWC). Utilization of partographs allow for early identification of abnormal labour and referral for advanced care to Emergency Obstetric Care (EmOC) facilities. A systematic assessment of the quality of partograph utilization in clinical-decision making will contribute to understanding the use of the tool by health workers.

METHODS

In 2013, the USAID supported MaMoni HSS project, led in country by Save the Children, trained FWVs on the use of partographs in five UH&FWCs in Habiganj district. As part of the follow-up after training, intrapartum case record forms, accompanying partographs, and referral registers for all obstetric cases managed in these five facilities from July 2013 to June 2014 were reviewed. Partographs were reviewed to identify abnormal labour cases based on pre-defined indications. All referred cases were ascertained from the case records in the referral registers. Five health workers were interviewed to assess their knowledge, attitude and experience in partograph use and to explore the challenges for referral decision making associated with the tool.

RESULTS

A total of 1,198 deliveries were managed at the study sites, of which 663 presented with cervical dilatation of 8 cm or less. Partographs were initiated in 98% of these cases. Indication of abnormal labour was found in 71 partographs (11%) and among them, only 1 was referred to a higher-level facility. Foetal heart rate and cervical dilatation were appropriately recorded in 61% and 70% of the partographs, respectively. Interviews with health workers revealed poor interpretation of referral indications from the partographs. Limited accessibility to the nearest EmOC facility, inadequate time for referral, and non-compliance to referral by clients were identified by the interviewed health workers as the key barriers for referral decision making.

CONCLUSIONS

Supporting the health workers at first-level primary care facilities to better interpret and act on partograph data in a timely manner, and strengthening the referral systems are needed to ensure that women in labour receive the prompt quality care they and their babies require to survive.

Improving Global Health With Smartphone Technology

The widespread use of smartphones makes them a popular platform for healthcare applications. This article reveals the global trends and overarching goals of mHealth initiatives that seek to enhance healthcare quality, increase access to health services, and improve global health communication. Three main themes emerged from this study: a) the impact of mHealth on international public health, b) overcoming mhealth barriers, and c) emerging mHealth technologies. The costs of developing mHealth apps and handling related data security concerns are the key barriers which need to be addressed to successfully implement global mHealth campaigns. Future directions of mHealth research are discussed, including the integration of new technologies, development of innovative healthcare systems, and overall improvement of global healthcare.

mHealth Application Areas and Technology Combinations*. A Comparison of Literature from High and Low/Middle Income Countries

BACKGROUND

With the continuous and enormous spread of mobile technologies, mHealth has evolved as a new subfield of eHealth. While eHealth is broadly focused on information and communication technologies, mHealth seeks to explore more into mobile devices and wireless communication. Since mobile phone penetration has exceeded other infrastructure in low and middle-income countries (LMICs), mHealth is seen as a promising component to provide pervasive and patient-centered care.

OBJECTIVES

The aim of our research work for this paper is to examine the mHealth literature to identify application areas, target diseases, and mHealth service and technology types that are most appropriate for LMICs.

METHODS

Based on the 2011 WHO mHealth report, a combination of search terms, all including the word "mHealth", was identified. A literature review was conducted by searching the PubMed and IEEE Xplore databases. Articles were included if they were published in English, covered an mHealth solution/ intervention, involved the use of a mobile communication device, and included a pilot evaluation study. Articles were excluded if they did not provide sufficient detail on the solution covered or did not focus on clinical efficacy/effectiveness. Cross-referencing was also performed on included articles.

RESULTS

842 articles were retrieved and analyzed, 255 of which met the inclusion criteria. North America had the highest number of applications (n=74) followed by Europe (n=50), Asia (n=44), Africa (n=25), and Australia (n=9). The Middle East (n=5) and South America (n=3) had the least number of studies. The majority of solutions addressed diabetes (n=51), obesity (n=25), CVDs (n=24), HIV (n=18), mental health (n=16), health behaviors (n=16), and maternal and child's health (MCH) (n=11). Fewer solutions addressed asthma (n=7), cancer (n=5), family health planning (n=5), TB (n=3), malaria (n=2), chronic obtrusive pulmonary disease (COPD) (n=2), vision care (n=2), and dermatology (n=2). Other solutions targeted stroke, dental health, hepatitis vaccination, cold and flu, ED prescribed antibiotics, iodine deficiency, and liver transplantation (n=1 each). The remainder of solutions (n=14) did not focus on a certain disease. Most applications fell in the areas of health monitoring and surveillance (n=93) and health promotion and raising awareness (n=88). Fewer solutions addressed the areas of communication and reporting (n=11), data collection (n=6), telemedicine (n=5), emergency medical care (n=3), point of care support (n=2), and decision support (n=2). The majority of solutions used SMS messaging (n=94) or mobile apps (n=71). Fewer used IVR/phone calls (n=8), mobile website/email (n=5), videoconferencing (n=2), MMS (n=2), or video (n=1) or voice messages (n=1). Studies were mostly RCTs, with the majority suffering from small sample sizes and short study durations. Problems addressed by solutions included travel distance for reporting, self-management and disease monitoring, and treatment/medication adherence.

CONCLUSIONS

SMS and app solutions are the most common forms of mHealth applications. SMS solutions are prevalent in both high and LMICs while app solutions are mostly used in high income countries. Common application areas include health promotion and raising awareness using SMS and health monitoring and surveillance using mobile apps. Remaining application areas are rarely addressed. Diabetes is the most commonly targeted medical condition, yet remains deficient in LMICs.

An ontology of and roadmap for mHealth research

PURPOSE

Mobile health or mHealth research has been growing exponentially in recent years. However, the research on mHealth has been ad-hoc and selective without a clear definition of the mHealth domain. Without a roadmap for research we may not realize the full potential of mHealth. In this paper, we present an ontological framework to define the mHealth domain and illuminate a roadmap.

METHODS

We present an ontology of mHealth. The ontology is developed by systematically deconstructing the domain into its primary dimensions and elements. We map the extent research on mHealth in 2014 onto the ontology and highlight the bright, light, and blind/blank spots which represent the emphasis of mHealth research.

FINDINGS

The emphases of mHealth research in 2014 are very uneven. There are a few bright spots and many light spots. The research predominantly focuses on individuals' use of mobile devices and applications to capture or obtain health-related data mostly to improve quality of care through mobile intervention.

CONCLUSIONS

We argue that the emphases can be balanced in the roadmap for mHealth research. The ontological mapping plays an integral role in developing and maintaining the roadmap which can be updated periodically to continuously assess and guide mHealth research.

Exploring the ambivalent evidence base of mobile health (mHealth): A systematic literature review on the use of mobile phones for the improvement of community health in Africa

BACKGROUND

Africa is labelled the world's fastest-growing 'mobile region'. Considering such growth and the fragility of the continent's healthcare, mHealth has flourished. This review explores mHealth for community health in Africa in order to assess its still ambivalent evidence base.

METHODS

Using PubMed, Web of Science, OvidSP and Google Scholar, a systematic review was conducted of one decade (2005-2015) of peer-reviewed literature on mHealth in Africa. Data analysis focused on qualifications of success and failure. Impact evaluations of project assessments (n = 65) were complemented with general analyses/overviews of mHealth's effectiveness (n = 35).

RESULTS

Review of these texts reveals ambivalence in the appraisal of mHealth; essentially, the critical stance in general analyses/overviews is absent from project assessments. Especially weak evidence concerning sustainability and scalability is stressed in overviews. Project assessments are more optimistic. Their analysis suggests a causal connection between simplicity and success. Effective interventions are thus characterized by straightforward design and modest objectives. Greatest impediments of impact are general technology-related issues and intervention inappropriateness due to insufficient understanding of beneficiaries and specific context of use (circumstantial complications).

CONCLUSION

Distinguishing between these two categories of complications helps to break the deadlock that marks the mHealth debate and add nuance to claims that mHealth's evidence base is weak. Constructive realism - rather than unfounded optimism or pessimism without nuance - should guide the design of interventions. Besides anticipative of technology-related complications, such realism must lead to either basic interventions or to smart mHealth shaped by deep understanding of the context of implementation.

Barriers to and incentives for achieving partograph use in obstetric practice in low- and middle-income countries: a systematic review

Background

The partograph is a graphic display of the progress of labour, recommended by the World Health Organization, but often underused in practice in low- and middle-income countries. We were interested in going beyond demonstration of potential efficacy – on which the existing literature concentrates - through a systematic review to identify barriers to and incentives for achieving partograph use.

Methods

We searched Ovid MEDLINE, Ovid Maternity and Infant Care, POPLINE, Web of Science, and Scopus, from 1^st January 1994 to 30^th September 2013, using the term ‘partogra*’ to include ‘partograph’, ‘partogram’, or ‘partogramme’. The selection criteria were for primary or secondary research describing barriers to and incentives for partograph use in low- and middle-income countries, in English, reported in peer-reviewed publications since 1994. Thematic analysis of text on partograph use was applied to a commonly used framework for change in clinical practice, with levels describing the innovation, the individual professional, the woman, and social, organisational, economic and political contexts.

Results

Reported barriers to and incentives for partograph use related to the partograph itself, professional skills and practice, clinical leadership and quality assurance, and the organisational environment within the wider provision of obstetric care. Neither the evidence base for its effectiveness, nor its credibility, was reported as a barrier to use.

Conclusion

Identifying and addressing local barriers and incentives in low- and middle-income countries, based on those in published research, could inform strategies to improve partograph use. Emerging technologies could be used to address some barriers. The thresholds for essential maternity care at which the partograph adds value should be further evaluated.

Using the lives saved tool (LiST) to model mHealth impact on neonatal survival in resource-limited settings

While the importance of mHealth scale-up has been broadly emphasized in the mHealth community, it is necessary to guide scale up efforts and investment in ways to help achieve the mortality reduction targets set by global calls to action such as the Millennium Development Goals, not merely to expand programs. We used the Lives Saved Tool (LiST)–an evidence-based modeling software–to identify priority areas for maternal and neonatal health services, by formulating six individual and combined interventions scenarios for two countries, Bangladesh and Uganda. Our findings show that skilled birth attendance and increased facility delivery as targets for mHealth strategies are likely to provide the biggest mortality impact relative to other intervention scenarios. Although further validation of this model is desirable, tools such as LiST can help us leverage the benefit of mHealth by articulating the most appropriate delivery points in the continuum of care to save lives.

Knowledge and skill retention of a mobile phone data collection protocol in rural Liberia

INTRODUCTION

With a large number of births occurring outside the formal health system, it is difficult to determine the number of pregnant women in rural regions of Liberia. The exponential growth of mobile phone use in developing countries provides a potential avenue for data collection on maternal and child health in such rural, remote regions.

METHODS

A pre-, post-, and one-year posttest design was used to collect data on knowledge and skill retention for 7 essential items required for mobile phone use among traditional birth attendants (TBAs) trained in a short message service (SMS) texting data collection protocol (N = 99) in rural Liberia.

RESULTS

Sixty-three participants (63.6% retention) completed the one-year posttest and displayed evidence of statistically significant knowledge and skill retention in 6 of the 7 tasks (P < .005), including the ability to: 1) turn on the phone, 2) use the mobile phone to make a call, 3) recognize that they have coverage, 4) recognize that the mobile phone is charged, 5) create a SMS text message without help, and 6) send a SMS text message without help. The TBAs continued to have difficulty with more complex tasks such as adding minutes to a phone.

DISCUSSION

The mobile phone data-collection protocol proved feasible with TBAs demonstrating knowledge retention in a one-year posttest; however, clinical significance needs further investigation. The protocol increased communication and collaboration among TBAs, certified midwives, and clinic staff.