Maternal, child and reproductive health (51)

Women in developing countries are arguably one of the groups most affected by inequality in access to healthcare. It’s especially true for pregnant women and mothers who often struggle with healthcare accessibility, affordability and practicality, says an article in Mashable.

WHO reports that more than 800 women globally die each day from preventable causes related to childbirth and pregnancy. Almost all of those women, a staggering 99%, live in developing countries.

Major complications account for most of these maternal deaths. They include severe bleeding, infections, high blood pressure during pregnancy, complications during birth and unsafe abortions. Most of these complications are preventable with more access and education for both expectant mothers and healthcare providers.

In developing countries where mobile phones are often accessible, mHealth is proving to be part of the solution to the maternal health crisis. From SMSs educating mothers on what to expect when they’re pregnant to apps helping medical professionals in their quest to provide comprehensive care, mHealth is increasing access in life-saving ways. 

Eight apps and mHealth services helping to improve maternal health in developing countries are:

  1. GiftedMom, providing pregnant women and new mothers with free SMSs to educate them on prenatal care, vaccines and reproductive health and reminders of important pregnancy milestones and health services their newborns should be receiving, and has more than 6,700 users in Cameroon and Nigeria.
  2. Zero Mothers Die, provides small mobile phones to women in Africa, specifically Ghana, Gabon, Mali, Nigeria, and Zambia, at no cost to them, with the goal to curb e maternal healthcare inaccessibility by using SMSs to provide women living in isolated areas with essential information for having a healthy pregnancy and birth.
  3. maymay, a free app, sends three tailored health alerts every week to pregnant women, providing tips on having a successful, healthy pregnancy, nutritional advice, explanations of early signs and symptoms of pregnancy, recommendations for safe baby items, catered to a user’s stage in pregnancy and allowing pregnant women to find doctors in their area, sorting by specialty and medical institution.
  4. Safe Delivery was launched in Ethiopia and Ghana and provides simple instructions to health workers in remote areas on assisting with non-routine births and uses animated videos to provide instruction to health workers, and flashcards, so an attendant can self-assess their knowledge outside of emergency situations.
  5. MAMA, is for new and expectant mothers in Bangladesh, South Africa, India and Nigeria, where women receive stage-based, culturally sensitive messages two to three times per week addressing three main areas: warning signs, reminders and encouragement.
  6. Mobile Midwife SMSs and pre-recorded voice messages to help spread information to pregnant women, new mothers and their families in Ghana, with all messages time-specific, providing information relevant to women that hinges on their stage in motherhood.
  7. Suyojana is a mHealth clinical-decision support system that provides guidance on care throughout all stages of motherhood and houses medical records to helps Auxiliary nurse midwives (ANM) responsible for tasks like immunisations, referrals and emergency assessment, and who serve as point people for maternal healthcare, can use it to transfer information to databases, helping medical professionals identify regional trends and improve how they serve specific communities.
  8. Safe Pregnancy and Birth is for expectant mothers in developing countries and provides maternal health knowledge to expectant mothers and healthcare providers, relays information to pregnant women on how to stay healthy during pregnancy, how to recognise pre-natal health concerns, what to do in emergency situations, and has step-by-step instructions for community health workers explaining how to perform procedures such as taking blood pressure, treating someone in shock and stopping bleeding post-birth.

These are likely to become more prevalent across Africa as sustainable, affordable solutions to high priority health goals. New mHealth initiatives will follow them and offer even more solutions.

Good films can have a big impact on our emotions and memory. They’re an effective way to communicate. Medical Aid Films is a charity based in London. It uses film aiming to save the lives of vulnerable women and children in developing countries. 

Its latest film’s Obstructed Labour: An Introduction for Midwives. It explains the main causes of obstructed labour, what happens during obstructed labour, how signs of obstructed labour can be identified, and steps to be taken for effective management. The film follows Kandie, a midwife at the clinic, as she monitors a mother in early labour, and a mother with suspected obstructed labour. 

The film provides valuable support for midwife training across sub-Saharan Africa. The Gynocare Fistula Center in Eldoret, Kenya’s the location for the film, and it provided considerable support to the production. It was reviewed by Medical Aid Films’ medical advisor and midwife Zoe Vowles from the Liverpool School of Tropical Medicine’s Centre for Maternal and Newborn Health, and midwifery advisor Terri Coates, who was advisor for the BBC’s Call the Midwife series. The Vitol Foundation financed it.

Medical Aid Films can only keep making its films free to access if it can demonstrate their use and value. One way it does this is to find out what users think about them. It takes about five minutes to complete a questionnaire. It provides essential information and feedback, so please help. Africa’s vulnerable women and children need it.

mHealth apps and initiatives are expanding across Africa to improve health and healthcare. Kenya’s implementing a new solutiontargeting maternal and child health. Experts will now be sending mothers SMSs to remind them to take their children for immunisation says an article in All Africa.

Vaccines are effective for reducing childhood illnesses and deaths. Immunisation is estimated to save over 2.5 million lives per year in the world. Despite their life-saving potential, research indicates that between 1995 and 2006, about 24 million infants in low-and middle-income countries did not receive all the scheduled vaccines and if they were vaccinated, they often were vaccinated late.

A new study carried out in Western region explored the viability of using mobile phones to improve immunisation in counties. According to a study published in Science Direct, The Feasibility of mHealth Interventions to Improve Immunization Timeliness and Coverage, most mothers in rural areas have access to mobile phones. This confirmed the potential for the mobile-based intervention to improve immunisation coverage. The researchers found that by sending simple SMS reminders, the number of women taking their children for vaccination has significantly increased.

The initiative was launched among mothers in rural Western Kenya. At least 55% of them owned mobile phones, 76% received SMSs and 54% had sent SMSs in the past week, just before survey. 

Despite the massive benefits, certain challenges remain. Unequal access to mobile phones and lack of proper framing of SMS reminders, as well as language barriers and inappropriate content were identified as challenges that need addressing in order for the initiative to reach its full potential.

The RapidSMS system was initiated in 2009 by the Ministry of Health of Rwanda in collaboration with UNICEF. It’s expanded rapidly since then. RapidSMS monitors the activity of Community Health Workers (CHWs) to help them to improve maternal, newborn and child survival, says an article in AllAfrica.

Marie Gorethe Nyirabambari is one of the CHWs using RapidSMS every day. Her task is to keep tabs on pregnant mothers from the time their pregnancies are announced until delivery. She also follows up on children after their births. Nyirabambari says it was difficult until she started using RapidSMS to convey all the messages related to the state of pregnant mothers to the appropriate institutions, mainly those under the Ministry of Health.

She’s been a CHW since before RapidSMS was available, and has found that it’s eased her work compared to the past when all information and data had to be recorded manually. The process was painstakingly slow and often led to inaccuracies, missed communications and delays between healthcare institutions. 

"RapidSMS has changed our way of communication and helped us speed up communication while following up with pregnant mothers," Nyirabambari says. "With RapidSMS, everything is easy, when we know a mother is pregnant, we immediately send the short message which is received by the ministry of health and we receive a feedback on how to proceed," she added.

RapidSMS is credited for reducing child and maternal mortality rates. “Before the RapidSMS was introduced, we recorded many deaths, most pregnant women were helped to deliver by traditional birth attendants who were unable to handle attendant infections or complications," she adds.

Jeaninne Uwimanimpaye, a mother of four from Cyuve Sector, Musanze District, commends CHWs for helping her in various ways when she was pregnant. They’ve worked closely with her to raise her babies through counseling. "Community health workers have helped me since I conceived my second born. One of them visited me so often and whatever we talked was sent via SMS, she could also tell me what to do next and in some cases accompany me for consultations," says Uwimanimpaye.

More than 45,000 CHWs use RapidSMS in 15,000 villages across Rwanda, and have saved lives of thousands of new expectant mothers and their new born babies, according to Dr Emmanuel Manzi, a UNICEF health specialist. The programme has seen some improvement since its launch in 2009 with new functionality and services. It now includes supporting pregnant mothers during pregnancy, the births and up to 1,000 days after birth with important aspects such as their hygiene and sanitation. 

Findings from Rwanda Demographic and Health Survey 2014-2015 show that infant mortality has fallen from 50/1,000 births in 2010 to 35/1,000 births in 2014-2015. Under- five mortality rates have dropped From 76/1,000 births in 2010 to 50/1,000 births in 2014-2015. RapidSMS seems to have helped make these possible.

Kesandu Nwokolo, a young Nigerian woman, has developed CradleCount, a mobile app to help reduce infant and maternal mortality in her country. CradleCount helps pregnant women and healthcare workers to calculate reliable expected delivery dates. Pregnant woman can then plan ahead to make sure their births are either in a hospital or at home with a skilled birth attendant, says an article in AllAfrica.  

It’s estimated that roughly six out of ten women have their babies at home without supervision by a skilled birth attendant. Errors in estimating expected delivery dates often leads to babies being delivered somewhat unexpectedly. "This is the problem faced by pregnant women in Nigeria and Africa, if this is not addressed, there will be increased pregnancy related complications resulting in more maternal and infant mortality,” says Nwokolo.

The app informs pregnant women how many days to their deliveries and has alerts that remind them to register and follow up with their antenatal care. It sends regular pregnancy and health tips to expectant mothers too. A statement obtained by the News Agency of Nigeria (NAN) says, the app is well designed with good aesthetic values and doesn’t require an Internet connection to work.

According to UNICEF, Nigeria is the second largest contributor to the under-five and maternal mortality rate in the world. Organisations like WHO, and National Demographic and Health Survey (NDHS) confirm that statistics show that everyday, about 90 women in Nigeria die of pregnancy related conditions. 

CradleCount is available to download free through Google Play store. It can offer benefits for many pregnant women in Africa.

Airtel has officially handed over its mobile clinic to Embu County. The mobile clinic was donated by the company on in late October 2015 in support of the First Lady’s Beyond Zero campaign which aims to reduce high rates of maternal and child mortality in Kenya, says an article in BIZTECH Africa.

Airtel Kenya CEO Adil El Youssefi, says that Airtel is committed to promoting socio-economic development in the community through different programmes such as Airtel Internet for Schools program which continues to provide hundreds of thousands of students across the country to have free 24 hours Internet connection. They benefit from the unlimited amount of educational information available online to broaden their learning.

In support of the government’s effort to improve health service provision in Kenya, Airtel has in the past launched health initiatives which include:

It’s encouraging to see a vibrant, developing contribution by big corporates to Africa’s health systems. Transferring and expanding the model is an important part of countries’ eHealth strategies.

Ten winners of the Innovation Awards 2015 were announced and honoured at a Cape Town celebration of African mobile and tech ecosystem innovation. Entries were received from very diverse sectors such as entertainment, agriculture, transport and market research. Health, education and fintech were also very popular categories, all illustrating the explosive growth of Africa’s mobile first markets and tech ecosystem. The 2015 entries came from over 21 countries and the winners on the night came from South Africa, Nigeria, Kenya, Cameroon, Tanzania and Togo.

The Health Innovation winner was GiftedMom. It’s a low-technology mHealth platform to help mothers and pregnant women access medical advice in remote rural communities. There’s a one-off subscription fee of less than one dollar for the android app. All subsequent messages, including alerts for vaccinations due for newborns, are free. In order to include about 17% of Cameroonian women who aren’t literate, the Gifted Mom team’s developing voice technology in four widely-spoken traditional languages.

The organisation behind the mobile app, also called GiftedMom, is based in Cameroon. Its mission is to create a world free of maternal and infant deaths using the latest mobile technologies. They use SMS notification platforms for maternal engagement to NGOs and provide simple mobile data collection and analysis solutions to enterprises. Some of the other services the orgnaisation provides include:

  • Follow-up care of pregnant women
  • Antenatal care SMS notification
  • Tracking children’s vaccination programmes
  • Teen health and sex education
  • Family planning and contraception education
  • Outreach education campaigns
  • Real-time monitoring using google fusion tables
  • Mobilising community and health workers.

GiftedMom’s another excellent example of the mHealth’s role in health and health for mothers and young children in Africa. It’s an expanding set of initiatives.

La Tanzanie a lancé une campagne nationale visant à aider les parents à enregistrer la naissance de leurs enfants par téléphone mobile. L'initiative espère améliorer le processus d'enregistrement des naissances de sorte que le gouvernement puisse utiliser des données plus complètes afin de mieux planifier la santé, l'éducation et autres services publics.
Le nouveau système qui sera déployé au cours des cinq prochaines années, permet aux travailleurs de la santé d'envoyer les noms des bébés, le sexe, la date de naissance et les détails de la famille par téléphone à une base de données centrale. Le certificat de naissance est délivré dans les jours suivants sans frais aux parents, d’après un article dans allAfrica.

L'initiative est dirigée par l'Agence d’enregistrement de l'insolvabilité fiduciaire Agence (RITA) l'UNICEF et la société de télécommunications Tigo. Le chef par intérim de RITA, Emmy Hudson, a déclaré que le projet a déjà accéléré l'enregistrement des naissances, après des années de stagnation.

Le pays a l'un des taux les plus bas de l'enregistrement des naissances en Afrique orientale et australe. Quelques 80% des Tanzaniens ne possèdent pas de certificat de naissance, selon le recensement de 2012.

Cela était en partie dû au coût élevé de l'acte de naissance. Les parents ont dû payer 3.500 shillings tanzaniens, environ 1,60 $ pour le certificat si la demande est faite dans les 90 jours de la naissance d'un enfant, ou 4.000 shillings si la demande est faite après les 90 jours. Le coût du certificat était raide et le coût de Voyage ajouté à la charge. C’est un prix élevé dans un pays où de nombreuses populations rurales vivent avec moins de 1 $ par jour.

Le gouvernement prévoit d'enregistrer environ un million d'enfants de moins de cinq ans avant la fin de cette année et 90% de tous les nouveau-nés dans les cinq prochaines années. Anna Mbelwa, qui a accouché un petit garçon à l'hôpital Mbalizi dans la région sud de Mbeya ce mois-ci, a déclaré que l'initiative a fait une énorme différence. "Je suis très impressionnée parce que cela prend généralement beaucoup de temps pour obtenir un certificat de naissance. Il était très gênant avant puisque les parents parcouraient une longue distance pour le service d’enregistrement du district pour se faire dire que les fichiers pour leurs enfants sont portés disparus."

La plupart des parents en zones rurales de la Tanzanie ne déclaraient pas leurs enfants à cause du coût excessif, de longues distances pour atteindre les bureaux d'enregistrement, processus lourd et le manque de prise de conscience des avantages. Cette simple initiative pourrait contribuer à changer cette situation. Il pourrait aider à résoudre les problèmes similaires dans d'autres pays africains également.


See article in english

Starting in mid-2014, Dimagi implemented mHealth tools for malnutrition screening in four countries in partnership with World Vision International. The first malnutrition screening app for Community Management of Acute Malnutrition (CMAM) was launched in Nigeria, says an article in Dimagi.

The World Vision CMAM app provides decision-support, multimedia and checklists to help nurses and health workers diagnose cases of malnutrition among children aged 6 to 59 months and among pregnant and lactating women. The app then tracks users throughout their continuum of care, recommending dosages of supplemental food or medicine each person should have, providing audio-supported counseling, or referring them to a health center when appropriate.

In December 2014, Dimagi deployed the first CMAM app in eight clinics with 16 users after training trainers and users. In the past ten months, these clinics have screened over 6,000 women and babies. The grant that facilitated World Vision’s first launch also funded deployments in Mali, Chad and Kenya. Mali launched in April 2015, northern Kenya in June, and Chad in July 2015. By the end of all deployments, 49 clinics will be using the app.

Initial results are positive. Some early evidence shows that the app’s making a big difference for decision support, so improving the continuum of care. Which countries will be next?

Samsung Electronics East Africa is partnering with VSO Jitolee to launch an eHealth solution that will improve maternal and child health in Kenya says an article BIZTECH Africa. The solution will help health workers shift from manual data entry to real time digital data entry, registration, tracking and maintaining follow ups with mothers at various stages of their pregnancy on an ePlatform. It’ll enable health workers to monitor patients’ health histories and inform registered parents of their children’s immunisation records. Additionally, the solution will provide information on how to prevent HIV and AIDS transmission from mother to child and the value of nutritional supplements.

Initially, health workers in urban locations of Dagoretti will be able to enter data into the system which will then be sent to a central database. The Ministry of Health will be able to generate accurate reports to inform rapid decision making and support resource allocation across the medical sector. 

Samsung Electronics East Africa is also donating TVs and DVD players which will be used to disseminate information on maternal and child health care to women of child-bearing age in the county. “This initiative is an important step towards embracing the real needs of healthcare providers and patients. We aim to leverage our technology to help individuals lead healthier lives, while delivering healthcare providers the tools they need to improve clinical outcomes," said Robert Ngeru, Vice President and COO, Samsung Electronics East Africa.

VSO has a similar healthcare vision. “Our vision as VSO is to empower local communities to achieve sustainable change and build resilience against future challenges. In partnership with other stakeholders, we are contributing to the achievement of Sustainable Development Goal 3 (Health and Well-being), to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030,” said George Awalla, VSO Jitolee’s Head of programmes.