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De P, Pradhan MR. Effectiveness of mobile technology and utilization of maternal and neonatal healthcare in low and middle-income countries (LMICs): a systematic review. BMC Womens Health 2023; 23:664. [PMID: 38082424 PMCID: PMC10714653 DOI: 10.1186/s12905-023-02825-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 12/01/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Maternal and neonatal mortality are important indicators of the development of a nation and pose a severe health concern, especially in developing and Low and Middle-Income Countries (LMICs). Healthcare providers use various mobile technologies as tools to provide antenatal, delivery, and postnatal care and thereby promote maternal and child health. We conducted a systematic review to critically assess the existing literature on the effectiveness of mobile phone technology in maternal and neonatal healthcare (MNH) utilization, especially in LMICs in Asia and Africa. METHODS A systematic search strategy was developed, and Boolean combinations of relevant keywords were utilized to search relevant literature on three electronic databases (PubMed/Medline, Scopus, and Google Scholar) from 2012 to 2022. After assessing the inclusion and exclusion criteria, 25 articles were selected for systematic review. A narrative synthesis strategy was applied to summarise the information from the included literature. RESULTS This review reveals that research and evaluation studies on mobile phone or Mobile Health (mHealth) and MNH service utilization substantially varied by research designs and methodology. Most studies found that mobile phone technology is highly appreciable in improving several MNH indicators, especially in LMICs. Despite the identified benefits of mobile technology in MNH utilization, some studies also mentioned challenges related to technology use and misuse, rich-poor discrimination, and disparity in phone ownership need to be addressed. CONCLUSION There is constantly increasing evidence of mobile counseling and the use of digital technology in the MNH care system. Public health practitioners and policymakers need to make efforts to smooth the functioning of technology-based healthcare services, considering all the issues related to the confidentiality and safety of health-related data on the Internet.
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Affiliation(s)
- Prasenjit De
- Department of Fertility and Social Demography, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India.
| | - Manas Ranjan Pradhan
- Department of Fertility and Social Demography, International Institute for Population Sciences (IIPS), Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India
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Carvalho LLD, Teixeira JMDS, Unger RJG, Motti VG, Lovisi GM, Grincenkov FRDS. Technologies Applied to the Mental Health Care of Pregnant Women: A Systematic Literature Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:149-158. [PMID: 37105199 PMCID: PMC10139771 DOI: 10.1055/s-0043-1768458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE This article aims to review the literature regarding the use of technologies to promote mental health for pregnant women. We seek to: understand the strategies that pregnant women use for mental health care. Also, we investigate the existence of scientific evidence that validates such practices. METHODS This study follows the PRISMA guidelines for systematic reviews. We analyze 27 studies published between 2012 and 2019. We include publications in Portuguese, English, and Spanish. RESULTS The results revealed several different possibilities to use technology, including the use of text messages and mobile applications on smartphones. Mobile applications are the most commonly used approaches (22.5%). Regarding the strategies used, cognitive-behavioral approaches, including mood checks, relaxation exercises, and psychoeducation comprised 44.12% of the content. CONCLUSION There is a need for further investigation and research and development efforts in this field to better understand the possibilities of intervention in mental health in the digital age.
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Affiliation(s)
| | | | | | - Vivian Genaro Motti
- George Mason University, Information Sciences and Technology, Fairfax, VA, United States
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Chaudhary K, Nepal J, Shrestha K, Karmacharya M, Khadka D, Shrestha A, Shakya PR, Rawal S, Shrestha A. Effect of a social media-based health education program on postnatal care (PNC) knowledge among pregnant women using smartphones in Dhulikhel hospital: A randomized controlled trial. PLoS One 2023; 18:e0280622. [PMID: 36662821 PMCID: PMC9858435 DOI: 10.1371/journal.pone.0280622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 12/09/2022] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Postnatal care services helps in detecting and subsequently managing life threatening complications. With the ubiquitous use of the mobile phone in Nepal, social media based postpartum education has the potential to increase PNC knowledge among pregnant women. This study aimed to assess the effect of social media-based health education program on PNC knowledge among pregnant women attending Dhulikhel hospital, Nepal. MATERIALS AND METHODS We conducted a two-arm open-label randomized controlled trial among literate pregnant women visiting Dhulikhel hospital for ANC check-up from May to August, 2021. A computer-based program allocated 229 pregnant women owning smartphones with internet connectivity in a 1:1 ratio to either intervention (n = 109) or usual care (n = 120). We assessed PNC knowledge in the participants by interviewing in-person or via phone. The intervention group received a 16 minutes video on PNC and the participants were reminded to view the video every week via telephone for a month. Control group received usual care. The primary outcome of the study was change in PNC knowledge score. We utilized intent-to-treat analysis and measured the effect of the intervention on PNC knowledge score using simple linear regression analysis. RESULTS AND DISCUSSION The mean PNC knowledge score increased by additional 8.07 points among pregnant women in the intervention group compared to the control group (95% CI: 2.35: 13.80; p-value = 0.006). The maternal care attribute knowledge increased by 4.31 points (95% CI: 1.51-7.10, p-value = 0.03) and newborn care attribute knowledge increased by 3.39 points (95% CI: 0.41-6.37, p-value = 0.02) among pregnant women in the intervention compared to the control group. CONCLUSION A social media-based health education is effective in improving PNC knowledge score among pregnant women. Further research is needed to evaluate if this increased knowledge is translated into the increased utilization of PNC care. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05132608.
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Affiliation(s)
- Kalpana Chaudhary
- Department of Public Health, Kathmandu University School of Medical Sciences, Panauti, Nepal
| | - Jyoti Nepal
- Department of Community Program, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Kusum Shrestha
- Department of Community Program, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Manita Karmacharya
- Department of Community Program, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Dipesh Khadka
- Department of Community Program, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Abha Shrestha
- Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
| | - Prabin Raj Shakya
- Biomedical Knowledge Engineering Lab, Seoul National University, Seoul, Korea
| | - Shristi Rawal
- Department of Clinical and Preventive Nutrition Sciences, School of Health Professions, Rutgers University, New Brunswick, NJ, United States of America
| | - Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Panauti, Nepal
- Institute for Implementation Science and Health, Kathmandu, Nepal
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, United States of America
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Korsah KA, Abdulai E, Dzansi G, Gamor N. Perception of nurses on the use of mobile phone text messaging for the management of diabetes mellitus in rural Ghana. Nurs Open 2023; 10:3415-3423. [PMID: 36611225 PMCID: PMC10077418 DOI: 10.1002/nop2.1596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/12/2022] [Accepted: 12/23/2022] [Indexed: 01/09/2023] Open
Abstract
AIM This study aims to explore the perception of nurses on the use of mobile phone SMS for managing diabetes in rural Ghana. DESIGN Exploratory Descriptive Qualitative Design. METHODS Purposive sampling was used to recruit (13) participants relative to data saturation after ethical clearance (REDACTED); using a semi-structured interview guide. All interviews were transcribed verbatim and analysed using thematic content analysis. RESULTS Participants believe SMS was useful in facilitating interaction between nurses, clients, family and statistically significant others; improving medication adherence and supporting blood glucose monitoring. The use of infographics was preferred to traditional SMS among digitally literate patients and voice calls for those who were illiterate. Participants had limited knowledge of downloadable diabetic applications. Participants were willing to accept and use SMS for the management of diabetes mellitus. PATIENT OR PUBLIC CONTRIBUTION Thirteen nurses actively participated in the study.
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Affiliation(s)
| | - Eliasu Abdulai
- School of Nursing and Midwifery, College of Health SciencesUniversity of GhanaLegonGhana
| | - Gladys Dzansi
- School of Nursing and MidwiferyUniversity of GhanaLegonGhana
| | - Nathan Gamor
- Catholic Hospital BattorUniversity of GhanaLegonGhana
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Bossman E, Johansen MA, Zanaboni P. mHealth interventions to reduce maternal and child mortality in Sub-Saharan Africa and Southern Asia: A systematic literature review. Front Glob Womens Health 2022; 3:942146. [PMID: 36090599 PMCID: PMC9453039 DOI: 10.3389/fgwh.2022.942146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Reducing maternal mortality, neonatal mortality and under 5-year mortality are important targets addressed by the United Nations' Sustainable Development Goals. Despite studies reported an improvement in maternal and child health indicators, the progress achieved is not uniform across regions. Due to the increasing availability of mobile phones in low and middle-income countries, mHealth could impact considerably on reducing maternal and child mortality and maximizing women's access to quality care, from the antenatal stage to the post-natal period. Methods A systematic literature review of mHealth interventions aimed at reducing maternal and child mortality in Sub-Saharan Africa and Southern Asia. Primary outcomes were maternal mortality, neonatal mortality, and under-five mortality. Secondary outcomes were skilled birth attendance, antenatal care (ANC) and post-natal care (PNC) attendance, and vaccination/immunization coverage. We searched for articles published from January 2010 to December 2020 in Embase, Medline and Web of Science. Quantitative comparative studies were included. The protocol was developed according to the PRISMA Checklist and published in PROSPERO [CRD42019109434]. The Quality Assessment Tool for Quantitative Studies was used to assess the quality of the eligible studies. Results 23 studies were included in the review, 16 undertaken in Sub-Saharan Africa and 7 in Southern Asia. Most studies used SMS or voice message reminders for education purposes. Only two studies reported outcomes on neonatal mortality, with positive results. None of the studies reported results on maternal mortality or under-five mortality. Outcomes on skilled birth attendance, ANC attendance, PNC attendance, and vaccination coverage were reported in six, six, five, and eleven studies, respectively. Most of these studies showed a positive impact of mHealth interventions on the secondary outcomes. Conclusion Simple mHealth educational interventions based on SMS and voice message reminders are effective at supporting behavior change of pregnant women and training of health workers, thus improving ANC and PNC attendance, vaccination coverage and skilled birth attendance. Higher quality studies addressing the role of mHealth in reducing maternal and child mortality in resource-limited settings are needed, especially in Southern Asia. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019109434, identifier CRD42019109434.
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Affiliation(s)
- Elvis Bossman
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Monika A. Johansen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Paolo Zanaboni
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
- *Correspondence: Paolo Zanaboni
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Maresca G, Formica C, De Cola MC, Lo Buono V, Latella D, Cimino V, Carnazza L, Giambò FM, Parasporo N, Bramanti A, Corallo F. Care models for mental health in a population of patients affected by COVID-19. J Int Med Res 2022; 50:3000605221097478. [PMID: 35531918 PMCID: PMC9092593 DOI: 10.1177/03000605221097478] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Emergency psychological interventions are needed in patients with COVID-19. During the pandemic, psychological counseling services have been provided using online platforms to address adverse psychological impacts and symptoms in patients and the general population. We investigated the effects of telepsychotherapy on emotional well-being and psychological distress in patients affected by COVID-19. Methods Forty-five Sicilian patients who had contracted COVID-19 joined “Telecovid Sicilia” from March to June 2020. Participants completed self-assessment questionnaires and psychological testing to measure levels of anxiety, presence of depressive symptoms, and altered circadian rhythm with consequent sleep disorders and psychological distress. Individual telepsychotherapy services were provided for 1 hour, twice a week, for 16 sessions in total. Results We enrolled 45 patients (42.2% women). We found significant changes between baseline and the end of follow-up in all outcome measures, especially depression (χ2 (1) = 30.1; effect size [ES] = 0.82), anxiety (χ2 (1) = 37.4; ES = 0.91), and paranoid ideation (χ2 (1) = 5.6; ES = 0.35). The proportion of participants with sleep disorders decreased to 84.1% after intervention (χ2 (1) = 58.6; ES = 1.14). Conclusion A telepsychotherapeutic approach showed promising effects on psychological symptoms, with significantly reduced patient anxiety and depression.
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Affiliation(s)
| | | | | | | | | | | | - Lara Carnazza
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | | | - Alessia Bramanti
- Department of Medicine Surgery and Dentistry ‘Salerno Medical School', University of Salerno, Fisciano, Italy
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How do traditional media access and mobile phone use affect maternal healthcare service use in Bangladesh? Moderated mediation effects of socioeconomic factors. PLoS One 2022; 17:e0266631. [PMID: 35476825 PMCID: PMC9045672 DOI: 10.1371/journal.pone.0266631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background Exposure to traditional media (TV, radio, and newspapers) and the use of mobile as an interpersonal communication tool allow for a variety of information provision. The purpose of this study is to investigate how women’s media and mobile access affect maternal health service (MHS) utilization. The study also aims to look into the moderated mediation effects of socioeconomic variables on the association mentioned above. Methods The study analyzed reproductive and media data of 5,011 ever-married women extracted from the latest nationally representative Bangladesh Demographic and Health Survey. Hierarchical logistic regression and moderated mediation analysis are performed to determine the association. Results Only 26.9% of women used mobile for health service use, while more than 55% had media access. Media access is significantly associated with all three types of MHS use; mobile usage also has a significant association with antenatal and delivery care. When women have both access to media and mobile, the likelihood of delivering in a health facility increased by 1.82 times (AOR: 1.82, 95%CI: 1.51, 2.20) which is slightly better than having access to only one type of media channel. Women’s education, household wealth, place of residence, religion, and current working status are among the socioeconomic factors associated with access to media and mobile. Women’s education mediates the relationship of media and MHS; however, the mediation effect of women (β: .45; LLCI: .21, ULCI: .68) on the association of media and place of delivery is seen to be moderated by household wealth. Women who belong to well-off families moderates positively (Effect: .33, 95%CI: .27, .40) the education effect of media and where to deliver. Place of residence, another moderator, significantly moderates (Effect: .09, BootLLCI: .02, BootULCI: .16) the mediation effect of women’s education on the association of media and antenatal care visits; women living in urban areas seems to have positively moderated the education effects on the mentioned association. Conclusions Provision of media access and mobile use indicate better utilization of MHS in Bangladesh, and women’s education mediates these relationships via the influence of household wealth and area of residence. Therefore, while planning interventions to increase MHS use, its relationships with the media and mobile use should be extrapolated. The collective use of these channels could be a catalyst for the success of health promotion initiatives to improve women’s health behaviors, build community capacity, and create mass awareness that supports the optimal use of MHS in Bangladesh.
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Biau S, Bonnet E, Dagenais C, De Allegri M, Traoré Z, Ouedraogo AW, Sow A, Dubois-Nguyen K, Ridde V. Using Information and Communication Technologies to Engage Citizens in Health System Governance in Burkina Faso: Protocol for Action Research. JMIR Res Protoc 2021; 10:e28780. [PMID: 34783671 PMCID: PMC8663653 DOI: 10.2196/28780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/10/2021] [Accepted: 09/10/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Health systems are complex systems involving a vast range of actors. In West Africa, they are often not accessible or responsive. Burkina Faso has widely expressed, in its public health policy, the need to improve both access to quality care and health system responsiveness. There is also a strong wish to give more voice to citizens. To support Burkinabè institutions in achieving these goals, we have developed an action research (AR) protocol. OBJECTIVE This paper presents the protocol that will address citizens' participation in health policies and their empowerment through the expression of opinions, for accountability, as well as the strengthening of the health system using information and communication technologies (ICTs). METHODS Our approach will consist of (1) enabling people to express their opinions on the health system by means of a toll-free (TF) service coupled with an interactive voice server (IVS); (2) building an information base with anonymous and reliable data; and (3) conducting information awareness-raising activities, including knowledge transfer (KT) and advocacy, social integration activities, development of OpenData platforms, and the capitalization and media coverage of governance issues. For this purpose, the AR project will be implemented in Burkina Faso. The design uses a concurrent mixed-methods approach. This AR project will evaluate the acceptability, process, effectiveness, and economic costs of the device's implementation. We will also analyze the potential for the data collected by the device to be used to improve practices. RESULTS Data collection is in progress; the TF number was officially launched on July 1, 2020, and data collection is planned to continue throughout 2021. By using mixed methods, our AR will be approached from a variety of perspectives. Mixed methods will support us in combining the partial insights into sophisticated realities from qualitative inquiries with the data analyses produced by quantitative research. CONCLUSIONS This AR is expected to add knowledge on how to increase the empowerment of the population, especially the most vulnerable, to participate in democratic processes and enjoy and exercise their human rights. This protocol recommends implementing a low-cost, contextually adapted technology, associated with an evidence-based approach and carried out on a significant scale. The originality of this approach lies in the fact that it introduces a real AR dimension with local communities and nongovernmental organizations (NGOs), combined with an integrated strategy of KT and application throughout the project for all stakeholders. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/28780.
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Affiliation(s)
- Sandrine Biau
- Unité de santé internationale, Université de Montréal, Montreal, QC, Canada
- AfricaSys Company, Ouagadougou, Burkina Faso
| | - Emmanuel Bonnet
- UMR 215 PRODIG, Institut de recherche pour le développement, Aubervilliers, France
| | | | - Manuela De Allegri
- Heidelberg Institute of Global Health, Heidelberg University Hospital and Medical Faculty, Heidelberg University, Heidelberg, Germany
| | | | | | - Abdramane Sow
- Health and Development Working Group, Action-Governance-Integration-Strengthening, Ouagadougou, Burkina Faso
| | | | - Valéry Ridde
- Centre Population et Développement, Institut de recherche pour le développement, institut national de la santé et de la recherche médicale, Université de Paris, Paris, France
- Institut de Santé et Développement, Dakar, Senegal
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Kaunda W, Umali T, Chirwa ME, Nyondo-Mipando AL. Assessing Facilitators and Barriers to Referral of Children Under the Age of Five Years at Ndirande Health Centre in Blantyre, Malawi. Glob Pediatr Health 2021; 8:2333794X211051815. [PMID: 34734105 PMCID: PMC8559201 DOI: 10.1177/2333794x211051815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/14/2021] [Indexed: 11/17/2022] Open
Abstract
Patient referrals among health facilities are initiated to maximize receipt of quality care at a proper level within the health system. This study explored the processes, factors that influence, and strategies for referral of children from Ndirande Health Centre to Queen Elizabeth Central Hospital in Blantyre, Malawi. We drew a purposive sample comprising health care workers, mothers, fathers, ambulance drivers, and Health Center Advisory Committee (HCAC) members and held 19 in-depth interviews and 1 focus group discussion in August 2020. The referral process is influenced by the availability of motor and bicycle ambulances that are well equipped with medical equipment, delay in seeking health services, uptake of referral, and community support. Education and communication with the community and parents respectively optimize the process of referral. There is a need to improve the referral system of under-five children by instituting a policy that is functional while addressing the main barriers.
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Affiliation(s)
- Wezzie Kaunda
- Kamuzu College of Health Sciences, Chichiri, Blantyre, Malawi
| | - Thokozani Umali
- Kamuzu College of Health Sciences, Chichiri, Blantyre, Malawi
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Bucher SL, Cardellichio P, Muinga N, Patterson JK, Thukral A, Deorari AK, Data S, Umoren R, Purkayastha S. Digital Health Innovations, Tools, and Resources to Support Helping Babies Survive Programs. Pediatrics 2020; 146:S165-S182. [PMID: 33004639 DOI: 10.1542/peds.2020-016915i] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
The Helping Babies Survive (HBS) initiative features a suite of evidence-based curricula and simulation-based training programs designed to provide health workers in low- and middle-income countries (LMICs) with the knowledge, skills, and competencies to prevent, recognize, and manage leading causes of newborn morbidity and mortality. Global scale-up of HBS initiatives has been rapid. As HBS initiatives rolled out across LMIC settings, numerous bottlenecks, gaps, and barriers to the effective, consistent dissemination and implementation of the programs, across both the pre- and in-service continuums, emerged. Within the first decade of expansive scale-up of HBS programs, mobile phone ownership and access to cellular networks have also concomitantly surged in LMICs. In this article, we describe a number of HBS digital health innovations and resources that have been developed from 2010 to 2020 to support education and training, data collection for monitoring and evaluation, clinical decision support, and quality improvement. Helping Babies Survive partners and stakeholders can potentially integrate the described digital tools with HBS dissemination and implementation efforts in a myriad of ways to support low-dose high-frequency skills practice, in-person refresher courses, continuing medical and nursing education, on-the-job training, or peer-to-peer learning, and strengthen data collection for key newborn care and quality improvement indicators and outcomes. Thoughtful integration of purpose-built digital health tools, innovations, and resources may assist HBS practitioners to more effectively disseminate and implement newborn care programs in LMICs, and facilitate progress toward the achievement of Sustainable Development Goal health goals, targets, and objectives.
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Affiliation(s)
- Sherri L Bucher
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana; .,Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana
| | | | - Naomi Muinga
- Kenya Medical Research Institute Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jackie K Patterson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, School of Medicine, Seattle, Washington.,Department of Global Health, School of Medicine, University of Washington, Seattle, Washington; and
| | - Saptarshi Purkayastha
- Department of Data Science and Health Informatics, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
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Masoi TJ, Kibusi SM, Ibolinga AE, Lilungulu AG. The Pattern and Level of Knowledge on Obstetric and Newborn Danger Signs and Birth Preparedness among Pregnant Women in Dodoma Municipal: a Cross Sectional Study. East Afr Health Res J 2020; 4:73-80. [PMID: 34308223 PMCID: PMC8279159 DOI: 10.24248/eahrj.v4i1.624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 04/29/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Unacceptable high maternal mortality rates remain a major challenge in many low-income countries. Early detection and management of antenatal risk factors and good preparation for birth and emergencies are critical for improved maternal and infant outcomes. The aim of this study was to understand the pattern and level of knowledge on obstetric and newborn danger signs, Individual Birth Preparedness and Complication Readiness (IBPACR) among pregnant women in Dodoma Municipal. Methods: A quantitative cross sectional study was carried out between February and June 2018. A random selection of participants was employed to achieve a sample size of 450 pregnant women. A standard semi-structure questionnaire was used to collect data and descriptive analysis was carried out by using SPSS software to see the pattern and level of knowledge on obstetric danger signs and individual birth preparedness. Results: The mean age of participants was 25.6 years ranging from 16 to 48 years and majority 326 (72.4%) had 2 to 4 pregnancies. Only 203(45.1%) of the pregnant women were able to tell 8 and above danger signs with at least 1 from each of the 4 phases, with the most known obstetric danger signs being vagina bleeding during pregnancy 287(63.8), labour and delivery 234(52.0%), after delivery 278 (61.8) . 164 (36.4%) of the participants reported fever and difficult in feeding 182 (40.4%) as danger signs in newborn. Furthermore, only 75(16.7%) of the participants reported to be prepared for birth and complications. The most known component of birth preparedness was preparing important supply which are needed during birth 283 (62.9%). Conclusion: Results of this study showed a low level of knowledge on obstetric and newborn danger signs as well as poor individual birth preparedness and complication readiness. Important predictors of knowledge level and birth preparedness were found to be age, education level, gestation age at first visit and husband involvement in Antenatal visit and care.
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Special Issue on E-Health Services. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082885. [PMID: 32331273 PMCID: PMC7215852 DOI: 10.3390/ijerph17082885] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/16/2020] [Indexed: 12/15/2022]
Abstract
The importance of e-health to citizens, patients, health providers, governments, and other stakeholders is rapidly increasing. E-health services have a range of advantages. For instance, e-health may improve access to services, reduce costs, and improve self-management. E-health may allow previously underserved populations to gain access to services. Services utilizing apps, social media, or online video are rapidly gaining ground in most countries. In this special issue, we present a range of up-to-date studies from around the world, providing important insights into central topics relating to e-health services.
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Ayatollahi H, Ghalandar Abadi M, Hemmat M. Web and mobile-based technologies for monitoring high-risk pregnancies. BMJ Health Care Inform 2019; 26:bmjhci-2019-000025. [PMID: 31201201 PMCID: PMC7062320 DOI: 10.1136/bmjhci-2019-000025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 03/18/2019] [Accepted: 12/08/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction High-risk pregnancy is an illness in which there are severe complications and problems that may cause fetal loss and requires continuous care. It seems that using telemedicine technology is helpful to provide wider access to prenatal care. The aim of this study was to compare the feasibility of using web-based and mobile-based technologies in caring for high-risk pregnancy. Materials and methods This was a cross-sectional study and the participants included midwives and gynaecologists who worked at teaching hospitals. The data were collected by using two five-point Likert scale questionnaires which were designed based on the literature review. The questionnaires included two main sections: demographic questions and questions related to five aspects of a feasibility study. Face and content validity of the questionnaires were confirmed by the experts and the reliability was checked by using the test-retest method. The data were analysed using descriptive and inferential statistics. Results In this study, 79 questionnaires were completed by 50 midwives (63.29%) and 29 gynaecologists (36.71%). Overall, midwives (p=0.001) and gynaecologists (p=0.003) believed that using mobile-based technologies was more feasible than using web-based technologies in caring for high-risk pregnancies. Conclusion It seems that planning for the future technological direction and providing mobile-based applications should be taken into account and prioritised to improve the quality of prenatal care and to increase access to healthcare services for high-risk pregnancies.
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Affiliation(s)
- Haleh Ayatollahi
- Health Management and Economics Research center, Iran University of Medical Sciences, Tehran, Iran
| | - Malihe Ghalandar Abadi
- Health Information Technology, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Hemmat
- Health Information Management, Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
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Masoi TJ, Kibusi SM. Improving pregnant women's knowledge on danger signs and birth preparedness practices using an interactive mobile messaging alert system in Dodoma region, Tanzania: a controlled quasi experimental study. Reprod Health 2019; 16:177. [PMID: 31831076 PMCID: PMC6909441 DOI: 10.1186/s12978-019-0838-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 11/20/2019] [Indexed: 12/02/2022] Open
Abstract
Background Unacceptably high maternal and perinatal mortality remain a major challenge in many low income countries. Early detection and management of danger signs through improved access to maternal services is highly needed for better maternal and infant outcomes. The aim of this study was to test the effectiveness of an interactive mobile messaging alert system on improving knowledge on danger signs, birth preparedness and complication readiness practices among pregnant women in Dodoma region, Tanzania. Methods A controlled quasi experimental study of 450 randomly selected pregnant women attending antenatal care was carried in Dodoma municipal. Participants were recruited at less than 20 weeks of gestation during the first visit where 150 were assigned to the intervention and 300 to the control group. The intervention groups was enrolled in an interactive mobile messaging system and received health education messages and were also able to send and receive individualized responses on a need basis. The control group continued receiving usual antenatal care services offered at the ANC centers. Pregnant women were followed from their initial visit to the point of delivery. Level of knowledge on danger signs and birth preparedness were assessed at baseline and a post test was again given after delivery for both groups. Analyses of covariance, linear regression were employed to test the effectiveness of the intervention. Results The mean age of participants was 25.6 years ranging from 16 to 48 years. There was significant mean scores differences for both knowleadge and birth preparedness between the intervention and the control group after the intervention (p < .001). The mean knowleadge score was (M = 9.531,SD = 2.666 in the intervention compared to M = 6.518,SD = 4.304 in the control, equivalent to an effect size of 85% of the intervention. Meanwhile, the mean score for IBPACR was M = 4.165,SD = 1.365 for the intervention compared to M = 2.631,SD = 1.775 in the control group with an effect size of 90% A multivariate linear regression showed a positive association between the intervention (p < 0.001) and level of knowledge (B = 2.910,95%CI = 2.199–3.621) and birth preparediness (B = 1.463,95%CI = 1.185–1.740). Conclusion The Interactive mobile messaging alert system demonstrated to be effective in increasing women’s knowledge on danger signs and improving their birth preparedness practices.
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Affiliation(s)
- Theresia J Masoi
- Department of Nursing and midwifery, College of Health Sciences, the University of Dodoma, P.O. Box 259, Dodoma, Tanzania. .,Department of Public Health, College of Health Scinces, the University of Dodoma, Dodoma, Tanzania.
| | - Stephen M Kibusi
- Department of Nursing and midwifery, College of Health Sciences, the University of Dodoma, P.O. Box 259, Dodoma, Tanzania.,Department of Public Health, College of Health Scinces, the University of Dodoma, Dodoma, Tanzania
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Experiences of using the toll-free telephone line to access maternal and newborn health services in central Uganda: a qualitative study. Public Health 2019; 179:1-8. [PMID: 31698207 DOI: 10.1016/j.puhe.2019.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 09/14/2019] [Accepted: 09/20/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Save the Mothers (STM) operates the toll-free telephone line (TFL) service in nine health facilities in Uganda. The TFL is influential in addressing the first and second delays in seeking care as it connects vulnerable mothers to health facilities at no cost. This study aimed at exploring the experiences of health workers and community members in using the TFL to access maternal and newborn health services in four health facilities in central Uganda. STUDY DESIGN This phenomenological/qualitative study used focus group discussions (FGDs) to collect data in four health facilities. METHODS A total of 10 FGDs were conducted; two with health workers, four with women, and another four with both men and women. Each session lasted 45-60 min and had a moderator, observer, and note taker. All discussions were audio-recorded after obtaining consent from the participants. Interviews were transcribed verbatim and translated to English from audio recordings. Data analysis was performed using the thematic analysis using QDA DATA Miner software. RESULTS The TFL service was pivotal in improving health worker and community relations, relaying timely health advice, ensuring prompt response to obstetric emergencies and facilitated timely referrals. However, the service faced several obstacles: unanswered calls, language differences, poor connectivity/network, and misuse/abuse. CONCLUSION This study demonstrates the potential of the TFL service in addressing the first and second delay as it allows for timely linkage of vulnerable mothers to health facilities. The TFL enhanced health worker and community relations and facilitated timely referrals and relaying of health advice. Addressing maternal mortality in low-income settings necessitates increased investment and scale up of such high-impact mHealth interventions.
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16
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Schmitz MM, Serbanescu F, Arnott GE, Dynes M, Chaote P, Msuya AA, Chen YN. Referral transit time between sending and first-line receiving health facilities: a geographical analysis in Tanzania. BMJ Glob Health 2019; 4:e001568. [PMID: 31478017 PMCID: PMC6703299 DOI: 10.1136/bmjgh-2019-001568] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/21/2019] [Accepted: 06/08/2019] [Indexed: 12/04/2022] Open
Abstract
Background Timely, high-quality obstetric services are vital to reduce maternal and perinatal mortality. We spatially modelled referral pathways between sending and receiving health facilities in Kigoma Region, Tanzania, identifying communication and transportation delays to timely care and inefficient links within the referral system. Methods We linked sending and receiving facilities to form facility pairs, based on information from a 2016 Health Facility Assessment. We used an AccessMod cost-friction surface model, incorporating road classifications and speed limits, to estimate direct travel time between facilities in each pair. We adjusted for transportation and communications delays to create a total travel time, simulating the effects of documented barriers in this referral system. Results More than half of the facility pairs (57.8%) did not refer patients to facilities with higher levels of emergency obstetric care. The median direct travel time was 25.9 min (range: 4.4–356.6), while the median total time was 106.7 min (22.9–371.6) at the moderate adjustment level. Total travel times for 30.7% of facility pairs exceeded 2 hours. All facility pairs required some adjustments for transportation and communication delays, with 94.0% of facility pairs’ total times increasing. Conclusion Half of all referral pairs in Kigoma Region have travel time delays nearly exceeding 1 hour, and facility pairs referring to facilities providing higher levels of care also have large travel time delays. Combining cost-friction surface modelling estimates with documented transportation and communications barriers provides a more realistic assessment of the effects of inter-facility delays on referral networks, and can inform decision-making and potential solutions in referral systems within resource-constrained settings.
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Affiliation(s)
- Michelle M Schmitz
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Florina Serbanescu
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - George E Arnott
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Michelle Dynes
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Paul Chaote
- Kigoma Regional Medical Office, Kigoma, Tanzania, United Republic of
| | | | - Yi No Chen
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kabongo EM, Mukumbang FC, Delobelle P, Nicol E. Understanding the influence of the MomConnect programme on antenatal and postnatal care service utilisation in two South African provinces: a realist evaluation protocol. BMJ Open 2019; 9:e029745. [PMID: 31266842 PMCID: PMC6609052 DOI: 10.1136/bmjopen-2019-029745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Timely antenatal care (ANC) and postnatal care (PNC) attendance decrease maternal and child mortality by improving maternal and child health (MCH) outcomes. Mobile health or mHealth has been identified as an effective way of improving the uptake of MCH services. The MomConnect programme is an mHealth initiative launched by the National Department of Health of South Africa in August 2014 to support MCH. Although widely used, there is a limited understanding of how, why, for whom and under which health system conditions, the implementation of MomConnect improves the health-seeking behaviour of pregnant women and mothers of infants in ANC and PNC facilities. This paper describes the protocol for a realist evaluation of the MomConnect programme, to provide a theory-based understanding of how, why and under what healthcare conditions the MomConnect programme works or not. METHOD AND ANALYSIS We will use the realist evaluation approach through its research cycle conducted in three phases. In phase I, a multimethod elicitation study design will be used, including a document review, key informant interviews and a scoping review to formulate an initial programme theory of the MomConnect intervention. Content and thematic analytic approaches will be used to analyse the data that will be fitted into a realist framework to formulate the initial programme theory. In phase II, a multi-case study design will be applied using a multimethod approach in two South African provinces. In each case, a theory-testing approach underpinned by the hypothetico-deduction analytic model will be used to test the initial programme theory. Surveys, interviews and focus group discussions will be conducted with various programme actors and analysed using appropriate methods. Phase III will entail refining the tested/modified programme theory through cross-case analysis. EXPECTED OUTCOMES An improved understanding of how and why the MomConnect intervention improves the health-seeking behaviour of pregnant women and mothers of infants, and the health system conditions that influence its implementation. ETHICS AND DISSEMINATION Ethics approval was granted by the Stellenbosch University Ethics Committee (S18/09/189). The protocol has been designed and the study will be conducted in line with the principles of the Declaration of Helsinki (1964).
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Affiliation(s)
- Eveline M Kabongo
- Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa
| | | | - Peter Delobelle
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, Western Cape Province, South Africa
| | - Edward Nicol
- Division of Health Systems and Public Health, Stellenbosch University, Cape Town, South Africa
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
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18
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Lechat L, Bonnet E, Queuille L, Traoré Z, Somé PA, Ridde V. Relevance of a Toll-Free Call Service Using an Interactive Voice Server to Strengthen Health System Governance and Responsiveness in Burkina Faso. Int J Health Policy Manag 2019; 8:353-364. [PMID: 31256567 PMCID: PMC6600022 DOI: 10.15171/ijhpm.2019.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 02/25/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In Africa, health systems are poorly accessible, inequitable, and unresponsive. People rarely have either the confidence or the opportunity to express their opinions. In Burkina Faso, there is a political will to improve governance and responsiveness to create a more relevant and equitable health system. Given their development in Africa, information and communication technologies (ICTs) offer opportunities in this area. METHODS This article presents the results of an evaluation of a toll-free call service coupled with an interactive voice server (TF-IVS) tested in Ouagadougou, Burkina Faso, to assess its relevance for improving health systems governance. The approach consisted of a 2-phased action research project to test 2 technologies: recorded messages and touch keypad. Using a concurrent mixed approach, we assessed the technological, social, and instrumental relevance of the service. RESULTS The call service is available everywhere, 24 hours per day, seven days per week. The equipment and its physical location were not adequately protected against technological hazards. Of the 278 days of operation, 49 were non-functional. In 8 months, there were 13 877 calls, which demonstrated the popularity of ICTs and the ease of access to telephone networks and mobile technologies. The TF-IVS was free, anonymous, and multilingual, which fostered the expression of public opinion. However, cultural context (religion, ethnic culture) and fear of reprisals may have had a negative influence. In the end, questions remained regarding people's capacity to use this innovative service. In the first trial, 49% of callers recorded their message and in the second, 48%. Touch key technology appeared more relevant for automated and real-time data collection and analysis, but there was no comprehensive strategy for translating the information collected into a response from healthcare actors or the government. CONCLUSION This study showed the relevance and feasibility of implementing a TF-IVS to strengthen health system responsiveness in one of the world's poorest countries. Public opinion expressed through data collected in real-time is helpful for improving system responsiveness to meet care needs and enhance equity. However, the strategy for developing this tool must take into account the implementation context and the activities needed to influence the mechanisms of social responsibility (eg, information provision, citizen action, and state response).
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Affiliation(s)
- Lucie Lechat
- UMI Resiliences, IRD (French Institute For Research on sustainable Development), Bondy, France
| | - Emmanuel Bonnet
- UMI Resiliences, IRD (French Institute For Research on sustainable Development), Bondy, France
| | | | | | - Paul-André Somé
- NGO Action-GovernanceIntegration-Strengthening, Health and Development Working Group (AGIRSD), Ouagadougou, Burkina-Faso
| | - Valéry Ridde
- IRD (French Institute For Research on sustainable Development), CEPED (IRD-Université Paris Descartes), Universités Paris Sorbonne Cités, ERL INSERM SAGESUD, Paris, France
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Kanyesigye H, Muhwezi O, Kazungu C, Kemigisha E, Woolcott C. Will district health centres use preloaded cell phones for pre-referral phone calls for women in labour: a randomized pilot study at Mbarara Regional Referral Hospital in southwest Uganda. Canadian Journal of Public Health 2019; 110:520-522. [PMID: 31140141 DOI: 10.17269/s41997-019-00222-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 05/07/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Hamson Kanyesigye
- Department of Obstetrics Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda.
| | - Obed Muhwezi
- Mbarara Regional Referral Hospital, Mbarara, Uganda
| | | | - Elizabeth Kemigisha
- Department of Human Development and Relational Sciences, Faculty of Interdisciplinary Studies, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Christy Woolcott
- Department of Obstetrics and Gynecology and Department of Pediatrics, Dalhousie University, Halifax, Canada
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Amoakoh HB, Klipstein-Grobusch K, Grobbee DE, Amoakoh-Coleman M, Oduro-Mensah E, Sarpong C, Frimpong E, Kayode GA, Agyepong IA, Ansah EK. Using Mobile Health to Support Clinical Decision-Making to Improve Maternal and Neonatal Health Outcomes in Ghana: Insights of Frontline Health Worker Information Needs. JMIR Mhealth Uhealth 2019; 7:e12879. [PMID: 31127719 PMCID: PMC6555115 DOI: 10.2196/12879] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/04/2019] [Accepted: 04/04/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Developing and maintaining resilient health systems in low-resource settings like Ghana requires innovative approaches that adapt technology to context to improve health outcomes. One such innovation was a mobile health (mHealth) clinical decision-making support system (mCDMSS) that utilized text messaging (short message service, SMS) of standard emergency maternal and neonatal protocols via an unstructured supplementary service data (USSD) on request of the health care providers. This mCDMSS was implemented in a cluster randomized controlled trial (CRCT) in the Eastern Region of Ghana. OBJECTIVE This study aimed to analyze the pattern of requests made to the USSD by health workers (HWs). We assessed the relationship between requests made to the USSD and types of maternal and neonatal morbidities reported in health facilities (HFs). METHODS For clusters in the intervention arm of the CRCT, all requests to the USSD during the 18-month intervention period were extracted from a remote server, and maternal and neonatal health outcomes of interest were obtained from the District Health Information System of Ghana. Chi-square and Fisher exact tests were used to compare the proportion and type of requests made to the USSD by cluster, facility type, and location; whether phones accessing the intervention were shared facility phones or individual-use phones (type-of-phone); or whether protocols were accessed during the day or at night (time-of-day). Trends in requests made were analyzed over 3 6-month periods. The relationship between requests made and the number of cases reported in HFs was assessed using Spearman correlation. RESULTS In total, 5329 requests from 72 (97%) participating HFs were made to the intervention. The average number of requests made per cluster was 667. Requests declined from the first to the third 6-month period (44.96% [2396/5329], 39.82% [2122/5329], and 15.22% [811/5329], respectively). Maternal conditions accounted for the majority of requests made (66.35% [3536/5329]). The most frequently accessed maternal conditions were postpartum hemorrhage (25.23% [892/3536]), other conditions (17.82% [630/3536]), and hypertension (16.49% [583/3536]), whereas the most frequently accessed neonatal conditions were prematurity (20.08% [360/1793]), sepsis (15.45% [277/1793]), and resuscitation (13.78% [247/1793]). Requests made to the mCDMSS varied significantly by cluster, type of request (maternal or neonatal), facility type and its location, type-of-phone, and time-of-day at 6-month interval (P<.001 for each variable). Trends in maternal and neonatal requests showed varying significance over each 6-month interval. Only asphyxia and sepsis cases showed significant correlations with the number of requests made (r=0.44 and r=0.79; P<.001 and P=.03, respectively). CONCLUSIONS There were variations in the pattern of requests made to the mCDMSS over time. Detailed information regarding the use of the mCDMSS provides insight into the information needs of HWs for decision-making and an opportunity to focus support for HW training and ultimately improved maternal and neonatal health.
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Affiliation(s)
- Hannah Brown Amoakoh
- Department of Epidemiology, School of Public Health, University of Ghana, Accra, Ghana
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | - Mary Amoakoh-Coleman
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Charity Sarpong
- Regional Health Directorate, Ghana Health Services, Koforidua, Ghana
| | - Edith Frimpong
- Dodowa Research Centre, Ghana Health Service, Accra, Ghana
| | - Gbenga A Kayode
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, Netherlands
| | | | - Evelyn K Ansah
- Centre for Malaria Research, University of Health and Allied Sciences, Ho, Ghana
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Alam M, Banwell C, Olsen A, Lokuge K. Patients' and Doctors' Perceptions of a Mobile Phone-Based Consultation Service for Maternal, Neonatal, and Infant Health Care in Bangladesh: A Mixed-Methods Study. JMIR Mhealth Uhealth 2019; 7:e11842. [PMID: 31008716 PMCID: PMC6658262 DOI: 10.2196/11842] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 12/07/2018] [Accepted: 03/04/2019] [Indexed: 12/27/2022] Open
Abstract
Background A mobile-based consultation service, or telehealth, can be used for remote consultations with health care professionals for screening, self-care management, and referral. In rural Bangladesh, where there is high demand for scarce male and even scarcer female doctors, remote consultations may help women seeking maternal and child health care. Aponjon is a mHealth service in Bangladesh that provides weekly voice or text messages to pregnant women, new mothers, and family members on various aspects of maternal, neonatal, and infant health. Subscribers can also access a dedicated 24*7 call center to discuss maternal, neonatal, and infant health or emergencies with medically trained doctors. The service provides advice, primary diagnoses, prescriptions, and referrals to subscriber callers. Objective We investigated the Aponjon service to understand access, acceptability, usability, benefits, and challenges of a mobile phone-based consultation service. Methods We conducted call log data analysis for September to November 2015 to understand how many unique subscribers accessed the service, who accessed the service, the geographical distribution of callers, and the purpose of the calls. We also conducted a qualitative exploratory substudy of eight married women and eight married men who were subscribers to and accessed the service during this time to understand their experiences. We interviewed 11 doctors from the same service who provided phone consultations to subscribers. Results Approximately 3894 unique subscribers accessed the service for single or multiple consultations during the study period; 68.36% (2662/3894) of subscribers were from rural households, and 53.00% (2064/3894) of calls were made by pregnant women or new mothers. Approximately 96.08% (5081/5288) calls were nonurgent, 2.69% (142/5288) semiurgent, and 1.23% (65/5288) urgent. Almost 64.7% (134/207) semiurgent or urgent calls came between 8 PM and 8 AM. Callers found the consultation service trustworthy, cost-effective, and convenient. The doctors dispelled misconceptions and promoted good health care practices, regular health check-ups, and responsible use of medicine. They helped families understand the severity of sicknesses and advised them to seek care at health facilities for semiurgent or urgent conditions. The service lacked a pro-poor policy to support talk times of subscribers from poor households and a proper referral system to help patients find the right care at the right facilities. Conclusions Although a regular messaging service is constrained by a one-way communication system, this service using the same platform, gave subscribers access to an abbreviated “consultation” with medical doctors. The consultations provided subscribers with valued medical advice and support, although they were limited in their population reach and their integration into the wider medical system. Further research is required to understand the impact of advice and referral, cost-effectiveness, and willingness to pay for mHealth consultation services, but this research suggests that these services should be supported or even expanded.
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Affiliation(s)
- Mafruha Alam
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Cathy Banwell
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Anna Olsen
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Kamalini Lokuge
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australia
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Amoakoh HB, Klipstein-Grobusch K, Ansah EK, Grobbee DE, Yveoo L, Agyepong I. How and why front-line health workers (did not) use a multifaceted mHealth intervention to support maternal and neonatal healthcare decision-making in Ghana. BMJ Glob Health 2019; 4:e001153. [PMID: 30997162 PMCID: PMC6441261 DOI: 10.1136/bmjgh-2018-001153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 01/20/2023] Open
Abstract
Introduction Despite increasing use of mHealth interventions, there remains limited documentation of 'how and why' they are used and therefore the explanatory mechanisms behind observed effects on beneficiary health outcomes. We explored 'how and why' an mHealth intervention to support clinical decision-making by front-line providers of maternal and neonatal healthcare services in a low-resource setting was used. The intervention consisted of phone calls (voice calls), text messaging (short messaging service (SMS)), internet access (data) and access to emergency obstetric and neonatal protocols via an Unstructured Supplementary Service Data (USSD). It was delivered through individual-use and shared facility mobile phones with unique Subscriber Identification Module (SIM) cards networked in a Closed User Group. Methods A single case study with multiple embedded subunits of analysis within the context of a cluster randomised controlled trial of the impact of the intervention on neonatal health outcomes in the Eastern Region of Ghana was performed. We quantitatively analysed SIM card activity data for patterns of voice calls, SMS, data and USSD. We conducted key informant interviews and focus group discussions with intervention users and manually analysed the data for themes. Results Overall, the phones were predominantly used for voice calls (64%), followed by data (28%), SMS (5%) and USSD (2%), respectively. Over time, use of all intervention components declined. Qualitative analysis showed that individual health worker factors (demographics, personal and work-related needs, perceived timeliness of intervention, tacit knowledge), organisational factors (resource availability, information flow, availability, phone ownership), technological factors (attrition of phones, network quality) and client perception of health worker intervention usage explain the pattern of intervention use observed. Conclusion How and why the mHealth intervention was used (or not) went beyond the technology itself and was influenced by individual and context-specific factors. These must be taken into account in designing similar interventions to optimise effectiveness.
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Affiliation(s)
- Hannah Brown Amoakoh
- School of Public Health, University of Ghana, Accra, Ghana.,Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Linda Yveoo
- Ghana Health Service, Research and Development Division, Dodowa Research Centre, Accra, Ghana
| | - Irene Agyepong
- Ghana Health Service, Research and Development Division, Dodowa Research Centre, Accra, Ghana
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Saronga NJ, Burrows T, Collins CE, Ashman AM, Rollo ME. mHealth interventions targeting pregnancy intakes in low and lower-middle income countries: Systematic review. MATERNAL AND CHILD NUTRITION 2019; 15:e12777. [PMID: 30609297 DOI: 10.1111/mcn.12777] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 11/28/2018] [Accepted: 12/12/2018] [Indexed: 11/28/2022]
Abstract
Dietary intake during pregnancy plays a vital role in determining the health of both mother and baby. Maternal undernutrition affects a large proportion of women in low and lower middle income countries (LLMIC) likely influencing high maternal, infant, and child mortality in these countries. Mobile health (mHealth) interventions have been proposed as effective solutions to improve maternal and neonatal health. This paper reviews the literature to evaluate the effectiveness of mHealth interventions on improving dietary/nutrients intake of pregnant women in LLMIC. Eight electronic databases were searched from inception up to April 2018, including the MEDLINE, EMBASE, CINAHL, Cochrane, Web of Science, Scopus, Global Index Medicus, and Maternity and Infant Care. Using Covidence, two reviewers assessed articles for inclusion, assessed study quality and extracted data. Only studies published in English language were included. Data were summarised narratively. In total, 6,778 were identified of which four were included, with three randomised controlled trials and one prepost experimental study. Studies were conducted in India (n = 2), Indonesia (n = 1), and Kenya (n = 1). All articles evaluated the use of nutrient supplements; iron supplements (n = 1), vitamin supplements (composition not mentioned; n = 1), or calcium supplements (n = 1). This review suggests that mHealth interventions can be used to improve intake of micronutrient supplementation and nutritional status of pregnant women in LLMIC. Further studies are needed to address the limited evidence base related to mHealth nutrition interventions targeting dietary intakes of pregnant women in LLMIC.
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Affiliation(s)
- Naomi J Saronga
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, New Castle, Australia.,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, New Castle, Australia.,Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Tracy Burrows
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, New Castle, Australia.,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, New Castle, Australia
| | - Clare E Collins
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, New Castle, Australia.,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, New Castle, Australia
| | - Amy M Ashman
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, New Castle, Australia.,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, New Castle, Australia
| | - Megan E Rollo
- Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, New Castle, Australia.,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, New Castle, Australia
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Telemental Health in Low- and Middle-Income Countries: A Systematic Review. Int J Telemed Appl 2018; 2018:9602821. [PMID: 30519259 PMCID: PMC6241375 DOI: 10.1155/2018/9602821] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 10/03/2018] [Indexed: 12/21/2022] Open
Abstract
Introduction The rising incidence of mental illness and its impact on individuals, families, and societies is becoming a major public health concern, especially in resource-constrained countries. Consequently, there is an increasing demand for mental health services in many middle- and low-income countries (LMIC). Challenges such as inequality in access, lack of staff and hospital beds, and underfunding, often present in the LMIC, might in part be addressed by telemental health services. However, little is known about telemental health in the LMIC. Methods A systematic review was performed, drawing on several electronic databases, including PubMed, PsycINFO, Web of Science, Springer Link, and Google Scholar. Original English language studies on the practice of telemental health in LMIC, involving patients and published between 1 January 2000 and 16 February 2017, were included. Results Nineteen studies met the inclusion criteria. Most of the articles were recent, which may reflect an increasing focus on telemental health in the LMIC. Eight of these studies were from Asia. Eight of the studies were interventional/randomized controlled trials, and 11 examined general mental health issues. Videoconferencing was the most frequently (6) studied telemental modality. Other modalities studied were online decision support systems (3), text messaging and bibliotherapy (1), e-chatting combined with videoconferencing (1), online therapy (2), e-counseling (1), store-and-forward technology (1), telephone follow-up (1), online discussion groups (1), audiovisual therapy and bibliotherapy (1), and computerized occupational therapy (1). Although many of the studies showed that telemental services had positive outcomes, some studies reported no postintervention improvements. Conclusion The review shows a rising trend in telemental activity in the LMIC. There is a greater need for telemental health in the LMIC, but more research is needed on empirical and theoretical aspects of telemental activity in the LMIC and on direct comparisons between telemental activity in the LMIC and the non-LMIC.
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Tobe RG, Haque SE, Ikegami K, Mori R. Mobile-health tool to improve maternal and neonatal health care in Bangladesh: a cluster randomized controlled trial. BMC Pregnancy Childbirth 2018; 18:102. [PMID: 29661178 PMCID: PMC5902947 DOI: 10.1186/s12884-018-1714-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 03/22/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In Bangladesh, the targets on reduction of maternal mortality and utilization of related obstetric services provided by skilled health personnel in Millennium Development Goals 5 remains unmet, and the progress in reduction of neonatal mortality lag behind that in the reduction of infant and under-five mortalities, remaining as an essential issue towards the achievement of maternal and neonatal health targets in health related Sustainable Development Goals (SDGs). As access to appropriate perinatal care is crucial to reduce maternal and neonatal deaths, recently several mobile platform-based health programs sponsored by donor countries and Non-Governmental Organizations have targeted to reduce maternal and child mortality. On the other hand, good health-care is necessary for the development. Thus, we designed this implementation research to improve maternal and child health care for targeting SDGs. METHODS/DESIGN This cluster randomized trial will be conducted in Lohagora of Narail District and Dhamrai of Dhaka District. Participants are pregnant women in the respective areas. The total sample size is 3000 where 500 pregnant women will get Mother and Child Handbook (MCH) and messages using mobile phone on health care during pregnancy and antenatal care about one year in each area. The other 500 in each area will get health education using only MCH book. The rest 1000 participants will be controlled; it means 500 in each area. We randomly assigned the intervention and controlled area based on smallest administrative area (Unions) in Bangladesh. The data collection and health education will be provided through trained research officers starting from February 2017 to August 2018. Each health education session is conducting in their house. The study proposal was reviewed and approved by NCCD, Japan and Bangladesh Medical Research Council (BMRC), Bangladesh. The data will be analyzed using STATA and SPSS software. DISCUSSION For the improvement of maternal and neonatal care, this community-based intervention using mobile phone and handbook will do great contribution. Thus, a developing country where resources are limited received the highest benefit. Such intervention will guide to design for prevention of other diseases too. TRIAL REGISTRATION UMIN000025628 Registered June 13, 2016.
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Affiliation(s)
- Ruoyan Gai Tobe
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
| | | | - Kiyoko Ikegami
- School of Tropical Medicine and Global Health, Nagasaki University NCGM Satellite, Tokyo, Japan
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
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Amoakoh HB, Klipstein-Grobusch K, Amoakoh-Coleman M, Agyepong IA, Kayode GA, Sarpong C, Grobbee DE, Ansah EK. The effect of a clinical decision-making mHealth support system on maternal and neonatal mortality and morbidity in Ghana: study protocol for a cluster randomized controlled trial. Trials 2017; 18:157. [PMID: 28372580 PMCID: PMC5379695 DOI: 10.1186/s13063-017-1897-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 03/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) presents one of the potential solutions to maximize health worker impact and efficiency in an effort to reach the Sustainable Development Goals 3.1 and 3.2, particularly in sub-Saharan African countries. Poor-quality clinical decision-making is known to be associated with poor pregnancy and birth outcomes. This study aims to assess the effect of a clinical decision-making support system (CDMSS) directed at frontline health care providers on neonatal and maternal health outcomes. METHODS/DESIGN A cluster randomized controlled trial will be conducted in 16 eligible districts (clusters) in the Eastern Region of Ghana to assess the effect of an mHealth CDMSS for maternal and neonatal health care services on maternal and neonatal outcomes. The CDMSS intervention consists of an Unstructured Supplementary Service Data (USSD)-based text messaging of standard emergency obstetric and neonatal protocols to providers on their request. The primary outcome of the intervention is the incidence of institutional neonatal mortality. Outcomes will be assessed through an analysis of data on maternal and neonatal morbidity and mortality extracted from the District Health Information Management System-2 (DHIMS-2) and health facility-based records. The quality of maternal and neonatal health care will be assessed in two purposively selected clusters from each study arm. DISCUSSION In this trial the effect of a mobile CDMSS on institutional maternal and neonatal health outcomes will be evaluated to generate evidence-based recommendations for the use of mobile CDMSS in Ghana and other West African countries. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT02468310 . Registered on 7 September 2015; Pan African Clinical Trials Registry, identifier: PACTR20151200109073 . Registered on 9 December 2015 retrospectively from trial start date.
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Affiliation(s)
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, PO Box 85500, 3508 GA Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 27 St. Andrew’s Road, Parktown 2193, Johannesburg, South Africa
| | - Mary Amoakoh-Coleman
- School of Public Health, University of Ghana, Legon, PO Box LG13, Accra Ghana
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Irene Akua Agyepong
- School of Public Health, University of Ghana, Legon, PO Box LG13, Accra Ghana
- Research and Development Division, Ghana Health Service, PO Box MB 190, Accra, Ghana
| | - Gbenga A. Kayode
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Charity Sarpong
- Regional Health Directorate, Ghana Health Services, PO Box 175, Koforidua, Eastern Region Ghana
| | - Diederick E. Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Centre, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Evelyn K. Ansah
- School of Public Health, University of Ghana, Legon, PO Box LG13, Accra Ghana
- Research and Development Division, Ghana Health Service, PO Box MB 190, Accra, Ghana
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Lindquist B, Strehlow MC, Rao GVR, Newberry JA. Barriers to Real-Time Medical Direction via Cellular Communication for Prehospital Emergency Care Providers in Gujarat, India. Cureus 2016; 8:e676. [PMID: 27551654 PMCID: PMC4977222 DOI: 10.7759/cureus.676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice, nations leverage cellular phones and call centers for real-time online medical direction. However, there exist several barriers to adequate communication that impact the provision of emergency care. We sought to identify obstacles in the cellular communication process among GVK Emergency Management and Research Institute (GVK EMRI) EMTs in Gujarat, India. METHODS A convenience sample of practicing EMTs in Gujarat, India were surveyed regarding the barriers to call initiation and completion. RESULTS 108 EMTs completed the survey. Overall, ninety-seven (89.8%) EMTs responded that the most common reason they did not initiate a call with the call center physician was insufficient time. Forty-six (42%) EMTs reported that they were unable to call the physician one or more times during a typical workweek (approximately 5-6 twelve-hour shifts/week) due to their hands being occupied performing direct patient care. Fifty-eight (54%) EMTs reported that they were unable to reach the call center physician, despite attempts, at least once a week. CONCLUSION This study identified multiple barriers to communication, including insufficient time to call for advice and inability to reach call center physicians. Identification of simple interventions and best practices may improve communication and ensure timely and appropriate prehospital care.
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Affiliation(s)
- Benjamin Lindquist
- Department of Emergency Medicine, Stanford University School of Medicine
| | - Matthew C Strehlow
- Department of Emergency Medicine, Stanford University School of Medicine
| | - G V Ramana Rao
- Emergency Medicine Learning Centre (EMLC) & Research, GVK Emergency Management and Research Institute
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Balakrishnan R, Gopichandran V, Chaturvedi S, Chatterjee R, Mahapatra T, Chaudhuri I. Continuum of Care Services for Maternal and Child Health using mobile technology - a health system strengthening strategy in low and middle income countries. BMC Med Inform Decis Mak 2016; 16:84. [PMID: 27387548 PMCID: PMC4937606 DOI: 10.1186/s12911-016-0326-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 06/19/2016] [Indexed: 11/25/2022] Open
Abstract
Background Mobile phone technology is utilized for better delivery of health services worldwide. In low-and-middle income countries mobile phones are now ubiquitous. Thus leveraging mHealth applications in health sector is becoming popular rapidly in these countries. To assess the effectiveness of the Continuum of Care Services (CCS) mHealth platform in terms of strengthening the delivery of maternal and child health (MCH) services in a district in Bihar, a resource-poor state in India. Methods The CommCare mHealth platform was customized to CCS as one of the innovations under a project funded by the Bill and Melinda Gates Foundation to improve the maternal and newborn health services in Bihar. The intervention was rolled out in one project district in Bihar, during July 2012. More than 550 frontline workers out of a total of 3000 including Accredited Social Health Activists, Anganwadi Workers, Auxilliary Nurse Midwives and Lady Health Supervisors were trained to use the mHealth platform. The service delivery components namely early registration of pregnant women, three antenatal visits, tetanus toxoid immunization of the mother, iron and folic acid tablet supply, institutional delivery, postnatal home visits and early initiation of breastfeeding were used as indicators for good quality services. The resultant coverage of these services in the implementation area was compared with rest of Bihar and previous year statistics of the same area. The time lag between delivery of a service and its record capture in the maternal and child tracking system (MCTS) database was computed in a random sample of 16,000 beneficiaries. The coverage of services among marginalized and non-marginalized castes was compared to indicate equity of service delivery. Health system strengthening was viewed from the angle of coverage, quality, equity and efficiency of services. Results The implementation blocks had higher coverage of all the eight indicator services compared to rest of Bihar and the previous year. There was equity of services across castes for all the indicators. Timely capture of data was also ensured compared to paper-based reporting. Conclusion By virtue of its impact on quality, efficiency and equity of service delivery, health care manpower efficiency and governance, the mHealth inclusion at service provision level can be one of the potential strategy to strengthen the health system.
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Affiliation(s)
| | | | | | | | - Tanmay Mahapatra
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, 90095, USA
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