Mobile-health tool to improve maternal and neonatal health care in Bangladesh: a cluster randomized controlled trial

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.

Guidelines for maternal and neonatal "point of care": needs of and attitudes towards a computerized clinical decision support system in rural Burkina Faso

BACKGROUND

In 2010, 245,000 women died due to pregnancy-related causes in sub-Saharan Africa and southern Asia. Our study is nested into the QUALMAT project and seeks to improve the quality of maternal care services through the introduction of a computerized clinical decision support system (CDSS) to help healthcare workers in rural areas. Healthcare information technology applications in low-income countries may improve healthcare provision but recent studies demonstrate unintended consequences with underuse or resistance to CDSS and that the fit between the system and the clinical needs does present challenges.

AIMS

To explore and describe perceived needs and attitudes among healthcare workers to access WHO guidelines using CDSS in maternal and neonatal care in rural Burkina Faso.

METHODS

Data were collected with semi-structured interviews in two rural districts in Burkina Faso with 45 informants. Descriptive statistics were used for the analysis of the quantitative part of the interview corresponding to informants' background. Qualitative data were analyzed using manifest content analysis.

RESULTS

Four main findings emerged: (a) an appreciable willingness among healthcare workers for and a great interest to adapt and use modern technologies like computers to learn more in the workplace, (b) a positive attitude to easy access of guidelines and implementation of decision-support using computers in the workplace, (c) a fear that the CDSS would require more working time and lead to double-work, and (d) that the CDSS is complicated and requires substantial computer training and extensive instructions to fully implement.

CONCLUSIONS

The findings can be divided into aspects of motivators and barriers in relation to how the CDSS is perceived and to be used. These aspects are closely connected to each other as the motivating aspects can easily be turned into barriers if not taken care of properly in the final design, during implementation and maintenance of the CDSS at point of care.

[Reduction Of Maternal And Neonatal Mortality Due To Free Caesarean In Segou's Nianankoro Fomba Hospital In Mali]

INTRODUCTION

Emergency obstetrical treatment influences maternal and neonatal mortality and so the government of the republic of Mali decided on June 23, 2005 to establish a free caesarean policy in public health establishments. After 3 years and half, we evaluated the impact of the policy on maternal and neonatal mortality.

METHOD

A comparative transversal study was conducted. The data of women who had a caesarean performed in the Segou regional hospital covering the span of 5 years (18 months before the policy and 42 following the new law) was collected. The data was analyzed using the Info 6.4 software. We employed a Pearson's Chi-2 with significance set at p<0.05.

RESULTS

Frequency of the caesarean increased following the policy to 25.48 % in 2008 versus 9.33 % in 2004 (p=0.0067). Maternal mortality rate was improved: 3.85 % in 2004 versus 0.23 % in 2008. The rate of neonatal mortality in the same period dropped from 25.39 % to 9.36 % (p=0.021).

CONCLUSION

It is noted that the free caesarean policy enabled an increase in the number of caesareans performed and a significant reduction in maternal and neonatal mortality rates.