Maternal, child and reproductive health (51)

The mHealth Tanzania Partnership’s Healthy Pregnancy, Healthy Baby Text Messaging Service (HPHB) has reached an exciting millstone. It’s celebrating a million registrations to its service since its launch in November 2012. According to the mHealth Tanzania Partnership’s press release, the service has sent 55 million free SMSs with safe antenatal, motherhood and infant healthcare information to Tanzanian pregnant women, mothers with newborns, male supporters and general information seekers across all national mobile networks.

A key contributor to the progamme’s success is the collaboration of a diverse group of partners that share the common goal to improve maternal health and reduce infant mortality. The partners support the message content development and updates, on-the-ground roll-out, service promotion, end user mobilisation and registration supprt and the service’s technical application. The mHealth Tanzania Public Private Partnership manages the text messaging service in collaboration with the Ministry of Health and Social Welfare (MoHSW). The United States President’s Emergency Plan for AIDS Relief (PEPFAR), through CDC funded the development of the service and continues to provide financial and technical support for its development and operation.

End users register through instructions received through the Wazazi Nipendeni, Parents Love Me in Kiswahili, national multimedia campaign. Others receive registration assistance from the thousands of trained healthcare professionals and hundreds of community healthcare workers. All major national mobile operators, Airtel Tanzania, Tigo Tanzania, Vodacom Foundation and Zantel, facilitate SMS dissemination through zero-rating the messages.

The numbers for maternal and infant mortality in Tanzania have improved dramatically over the years. With Wazazi Nipendeni, it seems they’re set to improve even more.

Tanzania has launched a nationwide drive to help parents register their childrens births by mobile phone. The initiative hopes to improve the birth registration process so the government can use more complete data to plan health, education and other public services better.

The new system, which’ll be rolled out over the next five years, allows health workers to send babies’ names, sex, dates of birth and family details by phone to a central data base. The birth certificate is issued within days at no cost to the parents, says an article in allAfrica.

The initiative is run by the Registration Insolvency, Trustee Agency (RITA) UNICEF and telecommunications company Tigo. RITAs acting head, Emmy Hudson, said the project has already accelerated birth registration after years of stagnation.

The country has one of the lowest rates of birth registration in eastern and southern Africa. Some 80% of Tanzanians do not have birth certificates, according to the 2012 census.

This was partly due to the high cost of the birth certificate. Parents had to pay 3,500 Tanzanian shillings, about $1.60 for the certificate if requested within 90 days of a childs birth, or 4,000 shillings if requested after the 90 days. The cost of the certificate was steep, and the cost of travel added to the burden. It’s a high price in a country where many rural people live on less than $1 a day.

The government expects to register about a million children under the age of five before the end of this year, and 90% of all newborns within the next five years. Anna Mbelwa, who gave birth to a baby boy at Mbalizi Hospital in the southern Mbeya region this month, said the initiative has made a massive difference. "I was very impressed because it usually takes a long time to get a birth certificate. It was very inconvenient before since parents had to travel a long distance to the district registrar only to be told their childrens files were missing."

Most parents in rural areas of Tanzania do not register their children because of the steep cost, long distances to registry offices, cumbersome process and lack of awareness of the benefits. This simple initiative could help change this. It could help address similar problems in other African countries too.

A big health challenge for children under five and their parents is dealing with diarrhoea. It’s a killer, and shouldn’t be. A WHO study says:

  • Diarrhoeal disease is the second leading cause of death in the under-fives, and is preventable and treatable
  • Diarrhoea kills about 760,000 under-fives every year
  • It’s a leading cause of malnutrition in under-fives
  • There are nearly 1.7b cases of diarrhoeal disease every year
  • A significant proportion of cases can be prevented through safe drinking-water, adequate sanitation and hygiene.

In remote parts of Africa, where resources are scarce, CocaCola seems to be able reach them. This triggered Colalife, a charity, which has used this ubiquity to do something about the diarrhoea challenge. It works with CocaCola to piggyback on Coke’s distribution network to deliver zinc supplementation plus oral rehydration salts (ORS) in kits Colalife calls Kit Yamoyo, to families living in these margins. A trial’s been underway in Zambia for four years. Simon Berry, a Colalife founder, described the initiative at Royal Society of Medicine (RSM) Innovation Summit in September.

Over that time, the initiative’s undergone a considerable transformation from ColaLife’s project office in Lusaka. The original sachets were too big, leading to waste, so they were redesigned into smaller containers. Pricing was an issue, so it’s been reviewed and reduced. Its branding as Kit Yamoyo, the Kit of Life, is now a preferred brand for sale in local shops, with some 26,000 kits sold in 2013. From there, a scale-up was planned in 2014 for implementation this year.

Perhaps the most astonishing success is that Coke’s supply chain’s only used to distribute about 4% of the kits. The other 96% are bought directly by shopkeepers as part of their normal product range to sell over their counters. This success in the private sector’s now accompanied by a Government initiative for the public sector which will use the kits, but not the brander version.

This imaginative use of existing supply chains to solve a long-standing and big scale health problem. As Colalife expands its activities across a longer and more complex value chain, sharing supply chain management with existing networks still offers a smart part of the solution. If it works in Zambia, it’ll work in every other African country.

Pregnant women with shock and high Blood Pressure (BP) are at increased risk of dying. A new hand-held device, Microlife’s Vital Signs Alert (VSA) is being tested in some African countries with an aim to reduce maternal deaths by 25%. The initiative was presented at Royal Society of Medicine (RSM) Innovation Summit in September.

The development team from London’s Guy’s and St Thomas’ Hospital in London, King’s College London and Jhpiego, a global organisation specialising in gynaecology and obstetrics and affiliated to Johns Hopkins University have had a $1m grant from the Bill and Melinda Gates Foundation for the project. Microlife, a company specialising in BP measurement is also involved. It’s producing VSA, subsidising its pricing for low and middle income countries.

VSA measures BP and pulse rate, and contains algorithms that use the data to identify shock. This’s a state where a body can’t cope with blood loss or infection, and there’s insufficient blood to supply the brain and organs adequately. High BP in pregnancy can indicate pre-eclampsia, a potentially deadly condition for both mothers and babies. With more accurate readings than conventional BP devices, VSA has a better chance of identifying problems earlier.

It’s more accurate than conventional BP devices, and doesn’t need calibrating. It’s also cheaper, by about a third. Its traffic light reporting using hypertension thresholds helps to make clinical decision taking easier. Stepped wedge random control trials are underway in several African countries. It’s in use in parts of Zambia, where it was mainly developed, Egypt, Nigeria and South Africa.

VSA uses batteries that are recharged using a USB connector. These are used for smartphones, which are in increasingly plentiful supply in Africa.

It’s already recognised by the Community blood pressure monitoring in Rural Africa: Detection of underLying pre-Eclampsia  (CRADLE) and has won a PATH award.  It’s also the first device of its type to achieve WHO’s standards for use in under-resourced settings.

With VSA products now available, the challenge is to expand their use in Africa. With price gains for health systems, and direct benefits for pregnant women, the business case for VSA is appealing. Africa’s health ministries need rolling programmes to introduce VSA.

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Image from The Independent 

mHealth in Tanzania is reaching the most remote populations, and SMS is at the core. The Tanzania Communications Regulatory Authority says there are some 25 million subscribers and the country has the highest monthly SMS rate in East Africa. SMS for better health offers a sustainable way forward.

A post by Thomson Reuters Foundation says Tanzania has made progress in preventing deaths from complications related to childbirth, but has failed to meet a Millennium Development Goal (MDG) of reducing maternal deaths to 193 per 100,000 live births from 454 per 100,000 by the end of 2015. The government blames the lack of skilled health workers, insufficient well-equipped clinics, the impact of HIV/AIDS, a lack of funding and women’s poor awareness of reproductive health issues.

Despite this disappointment, women are signing up for information from SMSs on staying healthy during pregnancy and after giving birth. The initiative’s part of a government campaign to improve maternal and new born health. It already has some 125,000 pregnant women registered for the free SMS’s. More than 5 million SMSs have been sent to subscribers to remind them about their appointments with their doctors and refer them to health guidance.

Melinda Gates has been tweeting about the initiative, saying it can help maternal health. It shows that headline MDG performance may mask good initiatives that need scaling up.

South Africa has many healthcare challenges and lots of innovative community health solutions. One of these is Mentor Mothers, and they're now using tablets to become better informed and step up their efforts.

study published last October showed that repeated home visits by trained community health workers to neighbourhood mothers led to significant health improvements both for mothers and children, including prevention of mother-to-child HIV transmission. It ws a collaboration between the Philani Maternal, Child Health and Nutrition Trust, USA's University of California and South Africa's Stellenbosch University.

Mentor mothers caught the attention of professors at USA's Stanford University who agreed to provide the health workers with tablets pre-loaded with educational videos. The videos explain basic health and nutrition facts in a simple and intuitive way, with the aim of helping mentor mothers to improving health in their communities.

Nomfusi Nquru, one of the twelve mentor mothers testing the project, says her interaction with the videos have been overwhelming positive. Mothers pay careful attention to what is being said in the videos and often ask healthcare questions after watching.

The tablet project is the brainchild of Dr Maya Adam, a lecturer at Stanford School of Medicine with years of experience in developing digital educational content. According to Adam, who volunteered at Philani during her medical school and undergraduate studies, recruiting successful mothers and training them to become community health workers “is a powerful model for passing on good health practices in a way that is sustainable because women are counseling within their own communities.”

Community health workers can help bridge the gap, in the short term, between what we need in access to healthcare providers and what we have,” says Adam. “If we wait for access to education and healthcare in South Africa to catch up with the need for it in these under-resourced communities, we are going to wait for a long time. By using technology like the tablets we can accelerate that process in communities otherwise cut off from main infrastructures.”

The project will soon be expanding to other regions. The videos are all picture-based, so can easily be translated and used in other countries in Africa. 

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Image: Mentor Mother Nomfusi Nkubu, from the justcookforkids blog

Preventing illness using immunisations seems to be under new pressures. A report from Canada in the Journal of the American Medical Informatics Association (JAMIA) says that current information systems are challenged by fragmented vaccine administration, people’s increasing mobility, new vaccine development, numerous products, and increasingly frequent changes in recommendations.

mHealth’s proposed as part of the solution. Enabling people to use their mobile devices to have more control of their immunisation information could:

  • Improve the timeliness and accuracy of data in Immunisation Information Systems (IIS)
  • Offer mobile reporting of adverse events after immunisation
  • Scan two-dimensional (2D) barcodes
  • Enable bidirectional communication between individuals and public health officials
  • Transfer immunisation information across local, regional, and national borders
  • Develop surveillance functions, including better adverse event reporting.

Improving the unidirectional information flow needs links from a mobile app to IIS. It could adopt HL7 and SNOMED CT standards to ensure effective data exchange between different systems. Better bidirectional flow needs a facility for people to access immunization information from public health officials. Authenticated data in the IIS will have to flow, and be downloaded, through people’s mobile devices.

Recall and SMS reminders already improve immunisation practice. The proposed IIS changes overcome SMS character limitations. With the extra changes, the goal is for people to have the same immunisation information that their healthcare providers and public health officials have. As Africa’s healthcare adopts more IIS services, the report sets a valuable development path for immunisation information and services. 

In 2013, GSK and Save the Children launched the first Healthcare Innovation Award to identify and reward innovations that have proven successful in reducing child deaths in developing countries. In 2014, four initiatives from across Africa won their share of the global US$1 million Award, according to the GSK press release.

ColaLife Zambia and UKZN’s FoneAstra toolkit were two of four African initiatives, chosen from a list of over 100 applications from countries across the developing world. The University of Kwazulu-Natal (UKZN) and ColaLife Zambia was awarded joint first prize and received $370,000 for their innovations.

The ‘FoneAstra’ human milk pasteurisation toolkit, originally developed by the University of KwaZulu-Natal in collaboration with PATH and the University of Washington, uses an app to provide a step-by-step guide through the pasteurisation process. The app makes it easier to track and trace donor milk for increased quality control and assurance and can be adapted for use in settings with no electricity. Up to 25% of premature or low birth-weight babies cannot get sufficient breast milk from their mothers, which leaves them more vulnerable to life threatening conditions such as diarrhoea, pneumonia and neonatal sepsis.

The FoneAstra system is currently used in four milk banks at district-level hospitals in South Africa, and will soon be rolling out to an additional five district hospitals across KwaZulu-Natal. The team aims to set up a network of HMB’s across the country, which will act as local focal points for breast-feeding promotion and support beyond the district hospital level, reaching the needs of newborns and vulnerable infants in the community.

Joint first prize- winner, ColaLife Zambia, won its award for its innovative Kit Yamoyo, meaning Kit of Life, which brings affordable diarrhoea treatment to families in remote rural areas. Diarrhoea is one of the world’s biggest killers of children under five. It can be easily treated using oral rehydration salts (ORS) and zinc, yet less than 1% of children in sub-Saharan Africa receive the treatment.

ColaLife worked with mothers to design the tailored, low-cost treatment kit. Each kit contains 200ml sachets of ORS, 10 zinc tablets and soap, all packaged in a container that serves as a measure for the correct amount of water, a mixing and storage device, and cup for administering the ORS. It is promoted by community health workers and delivered by trained local village-based micro-retailers. At the end of a 12-month trial in Zambia, 45% of children with diarrhoea received the correct treatment. A Lives Saved Tool (LiST) estimate suggests that one life is saved for every 330 kits sold. To date, 50,000 kits have been distributed.

Two other organisations awarded grants from the $1 million fund were the University of Nairobo Kenya and Living Goods Uganda. The University of Nairobi, Kenya was awarded $120,000 for its bar-coded Vaccination/Mother-Child Wellness Card that tracks vaccinations and rewards mothers with discounts on farm products. The vaccination card automatically updates when a newborn is registered and each time the child and/or mother receives a vaccine.  It then allows the mother discounts on farm products, such as seeds and fertilizer, from Agrovets shops run by the University’s partner agency.                 

Living Goods, Uganda, was also awarded $120,000 to support the expansion of its innovative approach to tackling child deaths in remote areas by bringing life-saving health services directly to people’s doorsteps. The health promoters travel door-to-door teaching families how to improve their health, and diagnosing and treating patients. They also sell health products such as bed nets, de-worming pills, anti-malaria and diarrhoea treatments, fortified foods, and water filters.

These innovations are reminders of the dramatic impact simple innovations can have in helping to save children’s lives. They also show the innovative spirit of the African people, coming up with simple solutions to address real African healthcare problems.

This year, after 15 years, the UN’s Millennium Development Goals (MDG) reach the end of their life. The top priority for the UN’s new Sustainable Development Goals (SDG) is eradicating poverty. Better health is goal 3 of the 17 SDGs. It’s described as “Ensure healthy lives and promote well-being for all at all ages.” The components are:

  • Reduce the global maternal mortality ratio to less than 70 per 100,000 live births
  • End preventable deaths of new born children and under fives
  • End the epidemics of AIDS, tuberculosis, malaria, neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases
  • Reduce by a third premature mortality from non-communicable diseases by prevention and treatment and promote mental health and well being
  • Strengthen prevention and treatment of substance abuse
  • Halve global deaths and injuries from road traffi­c accidents
  • Ensure universal access to sexual and reproductive healthcare, including family planning, information and education, and integrating reproductive health into national strategies and programmes
  • Achieve universal health coverage, including financial risk protection, access to quality essential healthcare and safe, elective, quality and affordable essential medicines and vaccines for all
  • Substantially reduce deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination
  • Strengthen WHO’s Framework Convention on Tobacco Control
  • Support research and development of vaccines and medicines for the communicable and non-communicable diseases
  • Substantially increase health financing and the recruitment, development, training and retaining health workers
  • Strengthen the capacity for early warning, risk reduction and management of national and global health risks.

These are wide-ranging. As a strategic framework for African countries’ eHealth plans, they reveal a need for an equivalent wide-ranging and integrated investment, and avoiding a set of independent initiatives. This requires moves towards interoperability, analytics and a socio-technical architecture that extends from healthcare to people and communities. Each of these needs an expansion to current endeavours and a sustainable investment.

Les taux de mortalité infantiles et maternels du Mali comptent parmi les plus élevés du monde. Ils s’élèvent à 196 pour mille personnes et 464 pour cent mille naissances vivantes. En moyenne, huit femmes meurent chaque jour de complications de la grossesse. La réponse du Ministère de la Santé consiste notamment en l’utilisation de la téléphonie mobile pour renforcer le système de santé en faveur de l’unité dédiée au couple mère-enfant et pour améliorer le système de santé national en général.

Le développement du secteur des communications du Mali a contribué à la fourniture d’une plateforme de soutien. Le parc mobile a été multiplié par 14 entre 2005 et 2011, atteignant plus de 10 millions fin 2011. Le Mali est passé de la 12e place sur 14 pays au sein de l’UEMOA (Union économique et monétaire ouest-africaine) à la 8e place, et de la 41e place en Afrique sub-saharienne à la 28e.

Aujourd’hui, nous tweetons, nous envoyons des SMS et nous sommes sur Facebook. Nous vivons l’avènement incontestable des médias sociaux dans nos vies quotidiennes et l’expérience internationale montre que les TIC, particulièrement la mSanté, peuvent contribuer au développement harmonieux de nos pays.

C’est pour cette raison que le Ministère de la Santé du Mali, via l’Agence nationale de télésanté et d’informatique médicale, a déployé des infrastructures de flotte mobile de plus de 600 téléphones mobiles, mis à disposition des agents de santé au niveau périphérique pour soutenir les services de santé. Les projets incluent Pesinet pour le paludisme, Médimobile et d’autres projets pilotes.

Les projets prévoient notamment le suivi de la santé d’enfants de moins de 5 ans et un meilleur partage d’information sur les décès maternels et infantiles. Entre janvier 2012 et mars 2013, 11 décès maternels et 162 décès infantiles ont été signalés, 73 % d’entre eux à domicile et 27 % dans des structures de santé. Plus de 24 000 cas de paludisme chez les femmes enceintes ont été rapportés, dont 670 décès : 522 enfants de moins de 5 ans, 145 enfants de plus de 5 ans et 3 femmes enceintes.

Une amélioration significative d’environ 91 % a été observée en termes de précision et d’intégralité des données, en comparaison avec les données issues du Système national d’information sanitaire dont le taux équivalent est d’environ 40 % et qui n’utilise pas encore la mSanté.

Le ministère de la Santé du Mali cherche à étendre ces résultats positifs et est un partenaire clé du projet conjoint OMS-UIT concernant l’utilisation de la mSanté pour les maladies non-transmissibles. Des maladies comme le diabète, les cancers du sein ou du col de l’utérus, le contrôle de l’hypertension artérielle en lien avec d’autres maladies cardiovasculaires, la prévention des crises aiguës de drépanocytose et d’asthme pourraient toutes bénéficier de la mSanté pour améliorer la prise en charge des patients, renforcer les capacités des professionnels de la santé et mettre les bonnes informations à la disposition des autorités sanitaires pour assurer des décisions prises sur des bases factuelles. Ceci constitue la marche à suivre pour tous les pays en développement.

En dépit de résultats positifs, des défis persistent. Les ressources financières sont limitées, la gestion du changement est difficile et des problèmes importants d’interopérabilité entre les divers plateformes technologiques existent. Le Mali n’est pas le seul pays confronté à ces difficultés et valorise la collaboration visant à enseigner et à partager ses expériences pour saisir les opportunités croissantes en télésanté et mSanté en Afrique.