Maternal, child and reproductive health (51)

Africa’s average child mortality’s about 70 per 1,000, and sits in a very wide range of about 35 to 160 per 1,000. It’s a high priority of healthcare interventions. Helping Babies Breath (HBB) teaches neonatal resuscitation techniques for health workers in low resource locations in over 80 countries. It includes skills needed to follow the The Golden Minute steps. The first minute after birth poses a significant risk of death to newborns. Within this minute, babies should either be breathing well or should be ventilated with a bag and mask. The Golden Minute identifies the steps that birth attendants must take immediately after births to evaluate babies and stimulate their breathing.

HBB’s a global initiative of many organisations. They include the American Academy of Pediatrics (AAP), WHO, USAID, Saving Newborn Lives, the National Institute of Child Health and Development.

Its paper data collection methods aren’t efficient enough to monitor, evaluate and report key indicators. Finance from the Laerdal Foundation for Acute Medicine2  enabled a team from the USA’s Indiana and Kenya’s Mo i University Schools of Medicine to develop mHBB, an mHealth solution.

mHBB captures proposed key indicators and metrics of the Every Newborn Action Plan, and initiative of the Partnership for Maternal, Newborn & Child Health (PMNCH).  Four parts of the current initiative are:

  1. Desk review, stakeholder survey, and contextual analysis to identify partners and scale-up opportunities
  2. Iterative developments and improvements of data collection forms and processes to enhance integration of additional data fields that support links with the Every Newborn Action Plan
  3. Expanding mHBB’s platform to include integrated support for more essential functions such as links to video content and links to data collection for Survive and Thrive programmes, including Essential Care for Every Baby, Essential Care for Small Babiesand Helping Mothers Survive
  4. Usability and feasibility assessments at selected East African sites. 

mHBB was included as a linked ASH USAID mHealth case study for the Kenya Digital Health

Dashboard developed by HealthEnabled. HBB’s developing collaborative opportunities with a wide range of potential partners, including iHRIS, the open source health workforce information solution, DHIS2 from HISPComm Care and Open HIE.

Female sex workers (FSW) in Mombasa, Kenya have HIV prevalence of 30%, a 26% annual pregnancy incidence and 10% use two contraceptives, one of which‘s a condom. Formative research by an international team set out to describes the process and results of developing, optimising and testing the content and delivery of WHISPER, an mHealth intervention for Mombasa’s FSWs.

A literature review of sexual and reproductive health (SRH) domains, barriers and motivators for FSWs adopting healthier behaviours provided data for SMS content. These mapped to cognition strategies from behaviour change communication theory, and were expanded using role model stories about FSWs overcoming challenges and adopting safer sex behaviours.

Workshops firmed up the content in four steps. They were, content, delivery, potential harms and behaviour change strategies. The response to the intervention was positive, especially the value of the role model stories, with the result that almost all FSWs wanted to enrol.

Findings from the workshops were used by the team to improve the content, such as adding more Kiswahili words and expressions. Emergency help was a significant issue too. Some FSWs thought they could call or text WHISPER if they needed help, resulting in two changes. First, risks were minimised risk by adding a message to the informed consent form saying what they should do in an emergency. Second, an automated response SMS was included to reply to texts.

Next steps are to establish the online system, conduct more interviews for more testing and start a cluster-randomised controlled trial. A parallel nutrition intervention’s planned addition too.

Reliance on a strong theory and evidence base with FSWs playing a core role has helped to create relevant, engaging messages that are more likely to impact on pregnancy and HIV rates.


mHealth offers good opportunities to support Community Health Workers (CHW) to be more effective and efficient. A software toolkit developed by Medic Mobile can contribute. It’s Linux-based toolkit runs on the VMware Workstation Player. VMware provides cloud and business mobility services.

An article in ITWebAFRICA says the toolkit works with or without Internet connectivity, both locally or in the cloud. It enables CHWs to collect and send patient data to a central clinic.

VMware and, Medic Mobile developed a modified SIM card that can insert into their mobile phones if they were made after 1992. It’s a microcontroller that allows it to run Medic Mobile’s software tool kit apps. They can then use their mobiles to register pregnancies, track disease outbreaks, keep stock of medicines, communicate in real-time about emergencies and connect with their patients.

Medic Mobile says more than 9,000 healthcare workers, serving over 5 million people in 23 developing countries, are using its tools. Their average patient workload’s more than 550 patients each. Results for maternal and infant health have been very positive. In Uganda, infant mortality rates have been falling since the toolkit was introduced. In Medic Mobile’s view, “This is largely due to the ability of community health workers to now register pregnancies via a simple text message to the Medic Mobile system, containing the patient's name, estimated due date, and risk factors. The system automatically creates a patient ID and sends automated reminders to patient and health worker regarding scheduled antenatal appointments. If a patient misses an appointment the system will alert the health worker to follow up with the patient."

Dr Danny Devito Gotto of the Federation of NGOs Development Cooperation (ACODEV), that has projects in Bwera, Uganda, explains why the country has one of the world's highest rates of infant mortality and women dying during childbirth. Women simply don't have the time to walk many miles to a clinic for prenatal care. And they frequently don't make a decision to do so until there's a problem, and then, it's often far too late.

Medic Mobile’s toolkit’s having an impact on healthcare access in Africa. It’s saving lives. Josh Nesbit, CEO at Medic Mobiles says "There are a billion people who lack access to healthcare. There are 300,000 women who will die in childbirth this year. And there are at least ten countries where one in four children will not live to age five. Those are all linked, and they are all unacceptable. Being poor should not mean that you have poor healthcare.” It’s scale-up across Africa could have considerable benefits.

Diabetes is considered to be the biggest global health crisis faced today. Around 422 million adults live with the condition, resulting in 1.5 million deaths per year, and these numbers are expected to double in the next 20 years.

One type of diabetes often goes unrecognised; gestational diabetes. It develops in pregnancy and affects an estimated 3.7 million births each year.

Medical Aid Films (MAF) has launched Diabetes in pregnancy: Stories from Saint Lucia, new films that tell the stories of women affected by diabetes during pregnancy. They were shot in Saint Lucia with the help of the Saint Lucia Ministry of Health, Wellness, Human Services and Gender Relations and the Saint Lucia Diabetes and Hypertension Association and support from W Science. The films aim to raise awareness of diabetes in pregnancy, how to manage the risks through healthy diet and exercise, and how to reduce chances of developing type 2 diabetes later in life.

Permanent Secretary in the Ministry of Health, Cointha Thomas said, “Diabetes is one of the greatest health challenges facing our country, and little is known about gestational diabetes. This film will enable the Ministry to share lifesaving knowledge and strengthen our efforts to reduce the impact of this condition, helping to ensure more mothers and their babies are healthy in pregnancy and throughout their life course.

These new films are available in English and Saint Lucian Creole and part of a major drive to raise diabetes awareness in Saint Lucia and the Caribbean. They’ll be screened in hospital waiting rooms, antenatal clinics and in the wider community as part of a campaign to transform understanding of gestational diabetes, complementing a nationwide diabetes screening programme and training for diabetes specialists.

You can watch the full-length film here or view this short trailer – both available for free, in English and Saint Lucian Creole.

Feedback’s important to MAF. Please take five minutes to complete this a short survey. And films like these are dependent on donations so please support MAF’s work.

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Positive Action for Girls and Women, in partnership with Every Woman Every Child, has announced the launch of the Empowering Girls in Emergency Settings (EmGEmS) Challenge Prize. It addresses the Sexual and Reproductive Health (SRH) needs of adolescent girls in emergencies where girls are particularly vulnerable to violence, rape, lack of privacy, often forego education and how they access to health services.

An article in allAfrica says the EmGEmS Challenge Prize will award $100,000 to a programme that supports young girls and empowers them to improve their education about their sexual and reproductive health needs and rights. The Global Strategy for Women's, Children's and Adolescents' Health 2016-2030 hopes the prize will highlight the specific needs of adolescent girls who suffer physical, mental and emotional risks. It’s partnering with Positive Action on this Community Challenges.

The grant will support implementation of ideas and programmes focused on SRH services for adolescent girls in emergency settings as key intervention to address HIV epidemic.

Maternal health challenges won’t fade away in developing countries. mHealth can help, but what type of mHealth? Pedro Pagalday Olivares master thesis has set out one version, reported in Chalmers.

It’s based on different geographic service levels. Rural communities have the lowest number of deliveries attended by a Skilled Birth Attendant (SBA). In response, Olivares looked for the potential and requirements of eHealth solutions to improve maternal health. From these, a prototype cloud based mHealth solution can be developed to meet local needs. His location was Lake Volta’s remote peninsulas and islands. Lake Volta is a large reservoir contained by Ghana’s Akosombo Dam. Kpando Municipality was part of the study.

Olivares developed use cases of different pregnancies, then used the Three Delay Model  for healthcare utilisation and Drury’s eHealth model to analyse the data and identify eHealth challenges and potential. It led on to using Android Studio for a prototype of a cloud-based mHealth solution. Each feature was tested through simulations to identify trouble shooting and re-design needs.

The prototype provides:

  1. Protocol driven guidance
  2. Decision support system to identify high risk pregnancies
  3. Monitoring system to visualise patient vitals and detect danger patterns
  4. Adaptations to local practices
  5. Facilitate data collection and exchange between facilities
  6. Using the cloud to provide access where there are no network conditions.

An important benefit‘s reduced delays in receiving care. Providing caution’s exercised, it should transfer to other remote communities in Ghana and other African countries.

Text messaging could help identify postpartum women at risk for developing potentially life-threatening complications from preeclampsia, says a new study from researchers at the Perelman School of Medicine at the University of Pennsylvania. Results show that text messages are effective in identifying preeclampsia among postpartum women and can lead to treatments for patients earlier than traditional approaches, says the news release in Penn Medicine.

Preeclampsia, the onset of high blood pressure resulting from pregnancy, is a leading cause of death and complications for women in following childbirth and discharge from the hospital. It’s especially true for women in developing countries who don’t have access to healthcare, or live many miles away from clinics or hospitals. The sooner the doctors can detect the condition after delivery, the greater the chance of successful treatment with medication. Since there’s currently no effective way of predicting who’s at risk, by the time worsening conditions are identified, patients often require more intensive care. 

Healthcare guidelines recommend blood pressure monitoring at routine follow-up office visits within 72 hours of discharge and again at seven to ten days after childbirth to monitor mothers and ensure there are no complications. However, as many as 70% of patients don’t attend first follow-up appointments, so they’re vulnerable.

The Pennsylvania team hoped to determine whether implementing a remote blood pressure monitoring system for patients diagnosed with preeclampsia would allow them to identify advanced cases and intervene before hospital readmission is necessary. “Platforms that take advantage of telemedicine technology allow clinical care teams to evaluate, diagnose and treat patients remotely, and have been well established as an effective means of delivering care across a variety of specialties,” said lead author Adi Hirshberg, a fellow in the department of Obstetricics and Gynecology at the Hospital of the University of Pennsylvania. “By monitoring blood pressure levels for our postpartum patients who are at home with new babies and can’t always get to office visits, we can provide a convenient and effective way of identifying those who are at risk for complications and may require follow-up care before the situation becomes critical.”

The study monitored 32 patients who had previously been diagnosed with preeclampsia. Each patient was given blood pressure cuffs when discharged from the hospital after childbirth. For seven days following discharge, text messages were sent reminding patients to take a daily blood pressure reading and send the results to their care provider. Patients whose blood pressure was high were then asked to take additional readings. 84% of participants reported a blood pressure reading within 24 or 48 hours of discharge, and 65% continued reporting test results for at least five of the seven days. As a result of the reports, two patients were identified as having elevated blood pressure and were put on oral medications, but none of the participants required readmission to the hospital. 

“Our results show that remote blood pressure monitoring via text messaging is an effective, convenient and patient-centered way of identifying patients who could be at risk of developing potentially life-threatening complications related to the condition,” said senior author Sindhu Srinivas, Director of Obstetrical Services at the Hospital of the University of Pennsylvania and an associate professor of Obstetrics and Gynecology at the Perelman School of Medicine at the University of Pennsylvania. “Further studies are necessary to determine the widespread efficacy of adopting telemedicine platforms for obstetrics care, but by all indications, it could become a cost-conscious way to improve care for patients, allowing them the convenience of staying home and lowering their risks of readmissions or complications.”

Similar systems could be put in place in African countries to monitor mothers after childbirth. Text messages could also be used as a platform to share other vital healthcare and nutritional information, supporting the health of moms and babies across the continent.

Underprivileged pregnant and post-pregnant women are a global health priority. A report in Business Wire says in Bangalore, capital city of the southern Karnataka state, the health department, Baxter, the Baxter International Foundation and World Vision India have launched an mHealth app for Community Health Workers (CHW) to use to improve their monitoring of the health status of impoverished women during and after their pregnancy and for immunisation programmes for their children under two. It’s used in 17 poor areas in Bangalore.

Baxter’s a company widely recognised for its initiatives for inclusion and social responsibility. This one’s called Sisu Janani Seva, which is mHealth. It has video and audio features, and CHWs can use it to provide essential and continuing healthcare information and counselling to women. The planned outcomes are reduced health risks to mothers and babies. Mothers also have counselling messages that use the apps multimedia features. 

CHWs can use the app to access information remotely. The first phase was for twelve Junior Health Assistant Female staff and 24 accredited social health activist workers. The final project is planned to support 3,000 pregnant women and 2,800 children in the 17 areas.

This role for mHealth is already working in many parts of Africa. It seems to be a norm, and a core part of achieving Sustainable Development Goals.

Big bars of soap might offer good value for money, but for many Africans, they’re not affordable. ColaLife’s created a solution for Zambia. It’s working with Trade Kings, a wholly owned Zambian company, to produce 22g soap bars. The new, small, low-cost pack will transform access to soap for Zambia’s poor. It meets their shopping habits of people in developing countries with the lowest incomes who prefer to buy products in small sizes as they need them. 

The initiative replaces imported soap used in ColaLife’s Kit Yamoyo, used to avoid and treat diarrhoea. The new soap bars mean that Kit Yamoyo’s components are 100% Zambian, reducing costs.

When ColaLife set up its ColaLife Trial four years ago, the only local Kit Yamoyo component was Oral Rehydration Salts (ORS) in one litre sachets. Since then, minimisation and affordability’s taken hold. Local 200 ml ORS sachets using local Zinc in the right format’s in the Kit Yamoyo, and it’s now matched with local soap in the right size.

Two benefits are a boost to the local economy and Kit Yamoyo’s more resilient. Imported components can have time lags, uncertainty and risks. They increase prices and market response times and reduce the shelf life of finished products. Importing large volumes, long lead times, importers exchange rate hedging, slow delivery fulfilment, transport bottlenecks and import procedures all increase the risk of medicines nearing their expiry date before they can be sold and used.

ColaLife’s grasp of an African solution for African problems is considerable. Is it’s next step expanding further across Africa?

A new emergency taxi service in Tanzania could save thousands of pregnant mothers and their babies each year. The UK’s Daily Telegraph, estimate up to 2,700 lives could be saved by the new service. The taxi service, similar to the car service, Uber, established by the Vodafone Foundation, is the organizations’ latest initiative focused on maternal health. Instead of driving someone home from a late night out on the town, Vodafone’s service was specifically designed to provide emergency vehicles for expectant mothers. Using a smart or feature phone, a pregnant mother can call an emergency line, linking her to a network of local emergency taxi drivers says an article in Global Citizen

WHO estimates that every day, about 830 women die from pregnancy or childbirth-related complications around the world. More than half of these deaths occur in sub-Saharan Africa and many can be prevented. In most cases, lack of quality health care and lack of transportation to health facilities creates complications.

Tanzania, like many other African countries, struggles with maternal health. Roughly 70% of the population lives in rural areas where there are few ambulances. The initiative is novel, and was launched in districts in Tanzania where maternal and infant mortality rates are believed to be among highest in the world. The districts of Sengerema and Shinyanga have a combined population of two million, yet share a total of ten ambulances. There is a substantial shortage, leaving many pregnant women vulnerable.

The new program directly addresses this problem by providing essential transportation at the most crucial time. The new service will be a life saver for many girls and women in Tanzania. It’ll allow pregnant women with serious complications to be admitted to hospitals in time to deliver their babies safely.

The Tanzanian emergency line is a quick response service. The emergency taxi drivers arrive promptly and, upon arrival, they’re ready to drive to the nearest hospital, a journey that could take up to three hours by foot.  Similar to Uber, the local taxi driver is paid a pre-determined fee using M-Pensa, the mobile payment system. 

The combination of the M-Pesa phone app and the local taxi service makes the service rapid and responsive. First introduced as a trial last year to a small part of Tanzania, Vodafone has estimated that trial has saved lives of over 300 mothers and babies.

Bringing together mobile technology, management, and transportation has saved lives in Tanzania. Other African countries could certainly benefit from this initiative too.

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Image from AFK Insider